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Natriuretic Peptide System as Therapy in Human Preclinical Left Ventricle Dysfunction (PPG1)

Primary Purpose

Congestive Heart Failure

Status

Completed

Phase

Phase 1

Locations

United States

Study Type

Interventional

Intervention

Nesiritide

Placebo

Saline

About this trial

This is an interventional basic science trial for Congestive Heart Failure focused on measuring heart failure, diastolic dysfunction, systolic dysfunction, preclinical, natriuretic peptide, B-type natriuretic peptide, cyclic guanosine monophosphate

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion criteria for normal control group:

ejection fraction of greater 50%
normal Doppler diastolic function with no clinical signs or symptoms
history of cardiovascular and renal disease
no prior use of any cardiovascular medications.

Inclusion criteria for pre-systolic dysfunction group:

ejection fraction of less than 40% with no clinical signs or symptoms of congestive heart failure
ability to perform a 6-minute walk of > 450 meters
if subjects are not able to walk 450 meters due to pain in hips and knees and not fatigue or shortness of breath, then they will still qualify for the study
subjects will all be on stable doses of ACE inhibitor for two weeks prior to the active study date
previously prescribed cardiovascular medications are allowed, however, all medications must be at stable doses two weeks prior to the study date.

Inclusion criteria for pre-diastolic dysfunction group:

ejection fraction of greater than 50% with moderate or severe diastolic dysfunction as assessed by Doppler echocardiography
no signs or symptoms of congestive heart failure
ability to perform a 6-minute walk of > 450 meters
if subjects are not able to walk 450 meters due to pain in hips and knees and not fatigue or shortness of breath, then they will still qualify for the study
previously prescribed cardiovascular medications are allowed, however, all medications must be at stable doses two weeks prior to the study date.

Exclusion criteria for all groups:

myocardial infarction within 3 months of screening
unstable angina within 14 days of screening, or any evidence of myocardial ischemia
significant valvular stenosis, hypertrophic, restrictive or obstructive cardiomyopathy, constrictive pericarditis, primary pulmonary hypertension, or biopsy proven active myocarditis
severe congenital heart diseases
sustained ventricular tachycardia or ventricular fibrillation within 14 days of screening
second or third degree heart block without a permanent cardiac pacemaker
stroke within 3 months of screening, or other evidence of significantly compromised CNS perfusion
total bilirubin of > 1.5 mg/dL or other liver enzymes >1.5 times the upper limit of normal
serum creatinine of > 3.0 mg/dL
serum sodium of < 125 mEq/dL or > 160 mEq/dL
serum potassium of < 3.5 mEq/dL or > 5.0 mEq/dL
serum digoxin level of > 2.0 ng/ml
systolic pressure of < 85 mmHg
hemoglobin < 10 gm/dl
other acute or chronic medical conditions or laboratory abnormality which may increase the risks associated with study participation or may interfere with interpretation of the data
received an investigational drug within 1 month prior to dosing
patients with an allergy to iodine
in the opinion of the investigator, is unlikely to comply with the study protocol or is unsuitable for any reason.

Sites / Locations

Mayo Clinic

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Arm Label

Placebo First, then Nesiritide (Arm A)

Nesiritide First, then Placebo (Arm B)

Arm Description

In the first intervention period the subjects received subcutaneous placebo given in the abdomen. After a lead in period of 15 minutes, the acute saline load was administered. There was a 2 week washout period. In the second intervention period, the subjects received subcutaneous nesiritide given in the abdomen. After a lead in period of 15 minutes, the acute saline load was administered.

In the first intervention period the subjects received subcutaneous nesiritide given in the abdomen. After a lead in period of 15 minutes, the acute saline load was administered. There was a 2 week washout period. In the second intervention period, the subjects received subcutaneous placebo given in the abdomen. After a lead in period of 15 minutes, the acute saline load was administered.

Outcomes

Primary Outcome Measures

Change in Natriuresis (Urinary Sodium Excretion) in Control Subjects at 60 Minutes After Volume Expansion Compared to Baseline in Response to Placebo Treatment

Value at 60 minutes minus value at baseline.

Placebo Pre-Treatment Urinary Sodium Excretion After Volume Expansion (UnaV)

Subjects received subcutaneous placebo in the abdomen. After 15 minutes, the acute saline load (volume expansion, VE) was administered. Subjects were asked to empty bladder spontaneously every 30 min (if unable to void every 30 min, a urinary catheter was placed). Adequate bladder emptying was insured by ultrasonography. UNaV was collected at baseline (immediately before VE) and at 30 and 60 min after initiation of VE.

Placebo Pre-Treatment Urinary cGMP Excretion After Volume Expansion (UcGMPV)

Subjects received subcutaneous placebo in the abdomen. After 15 minutes, the acute saline load (volume expansion, VE) was administered. Subjects were asked to empty bladder spontaneously every 30 min (if unable to void every 30 min, a urinary catheter was placed). Adequate bladder emptying was insured by ultrasonography. UcGMPV was collected at baseline (immediately before VE) and at 30 and 60 min after initiation of VE.

Nesiritide Pre-Treatment Urinary Sodium Excretion After Volume Expansion (UNaV)

Subjects received subcutaneous Nesiritide in the abdomen. After 15 minutes, the acute saline load (volume expansion, VE) was administered. Subjects were asked to empty bladder spontaneously every 30 min (if unable to void every 30 min, a urinary catheter was placed). Adequate bladder emptying was insured by ultrasonography. UNaV was collected at baseline (immediately before VE) and at 30 and 60 min after initiation of VE.

Nesiritide Pre-Treatment Urinary cGMP Excretion After Volume Expansion (UcGMPV)

Subjects received subcutaneous Nesiritide in the abdomen. After 15 minutes, the acute saline load (volume expansion, VE) was administered. Subjects were asked to empty bladder spontaneously every 30 min (if unable to void every 30 min, a urinary catheter was placed). Adequate bladder emptying was insured by ultrasonography. UcGMPV was collected at baseline (immediately before VE) and at 30 and 60 min after initiation of VE.

Secondary Outcome Measures

Change in Urinary Cyclic Guanosine Monophosphate (cGMP) in Control Subjects at 60 Minutes After Volume Expansion Compared to Baseline in Response to Placebo Treatment

Value at 60 minutes minus value at baseline

Change in Natriuresis (Urinary Sodium Excretion) at 30 Minutes in Response to Nesiritide Treatment Compared to Placebo Treatment

Value of natriuresis at 30 min on nesiritide treatment minus value of natriuresis at 30 min on placebo treatment (per subject group). The baseline was not involved in this calculation.

Change in Natriuresis (Urinary Sodium Excretion) at 60 Minutes in Response to Nesiritide Treatment Compared to Placebo Treatment

Value of natriuresis at 60 min on nesiritide treatment minus value of natriuresis at 60 min on placebo treatment (per subject group). The baseline was not involved in this calculation.

Change in Urinary Cyclic Guanosine Monophosphate (cGMP) at 30 Minutes in Response to Nesiritide Treatment Compared to Placebo Treatment

Value of cGMP at 30 min on nesiritide treatment minus value of cGMP at 30 min on placebo treatment (per subject group). The baseline was not involved in this calculation.

Change in Urinary Cyclic Guanosine Monophosphate (cGMP) at 60 Minutes in Response to Nesiritide Treatment Compared to Placebo Treatment

Value of cGMP at 60 min on nesiritide treatment minus value of cGMP at 60 min on placebo treatment (per subject group). The baseline was not involved in this calculation.

Full Information

NCT ID

NCT00387621

First Posted

October 12, 2006

Last Updated

April 18, 2012

Sponsor

Horng Chen

Collaborators

National Heart, Lung, and Blood Institute (NHLBI), National Center for Research Resources (NCRR)

1. Study Identification

Unique Protocol Identification Number

NCT00387621

Brief Title

Natriuretic Peptide System as Therapy in Human Preclinical Left Ventricle Dysfunction

Acronym

PPG1

Official Title

To Define in Normal Controls, Human Preclinical Systolic Dysfunction (PSD) and Preclinical Diastolic Dysfunction (PDD) the Actions of Acute Subcutaneous Nesiritide (BNP) on the Cardiorenal and Humoral Function and the Integrated Response to Acute Sodium Loading

Study Type

Interventional

2. Study Status

Record Verification Date

April 2012

Overall Recruitment Status

Completed

Study Start Date

February 2006 (undefined)

Primary Completion Date

August 2008 (Actual)

Study Completion Date

August 2009 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title

Sponsor-Investigator

Name of the Sponsor

Horng Chen

Collaborators

National Heart, Lung, and Blood Institute (NHLBI), National Center for Research Resources (NCRR)

4. Oversight

Data Monitoring Committee

Yes

5. Study Description

Brief Summary

In congestive heart failure, cardiac output is low, blood pressure is high, and the body becomes congested with fluid. In normal people, when there is high blood pressure, the heart muscle cells secrete a hormone that excretes sodium and water in the urine, reducing blood pressure. The action of this hormone is called the natriuretic response. The purpose of this study is to determine if nesiritide can improve an impaired natriuretic response in subjects with asymptomatic systolic heart failure or asymptomatic diastolic heart failure.

Detailed Description

The American Heart Association and the American College of Cardiology define stage B heart failure (HF) as asymptomatic subjects with abnormal heart structure/function. With the advancement of cardiac imaging and biomarkers, abnormal heart structure and function can be detected before the development of symptoms. Stage B HF can represent either diastolic or systolic dysfunction and both are at increased risk of adverse cardiac events and development of symptomatic HF. The broad objective of this study is to define the integrated cardiorenal response to acute volume expansion (VE) in humans with presystolic dysfunction (PSD), prediastolic dysfunction (PDD), and normal cardiac function. We hypothesized that there is an impaired cardiorenal endocrine response to acute VE in PSD and PDD which is characterized by the lack of appropriate activation of urinary cGMP and urinary sodium excretion. Further, we hypothesized that PSD, PDD, and normal control subjects would respond similarly to exogenous administration B-type natriuretic peptide (BNP). The natriuretic peptides (NPs) are a family of structurally similar but genetically distinct peptides with vasodilating, natriuretic, renin inhibiting, and lusitropic properties. Acute peptide therapy with brain natriuretic peptide (BNP) infusion has recently been approved by the FDA as a therapeutic strategy for the treatment of acute human decompensated congestive HF. We will determine the effects of acute subcutaneous BNP or placebo administration on the integrated cardiorenal and humoral response to acute sodium load (sodium chloride 0.9% 0.25 ml/kg/min for 1 hour) in three groups of subjects: Group 1 normal controls, Group 2 with PSD, and Group 3 with PDD. Doppler echocardiography and tonometry will be used to measure cardiac and vascular function before and during the sodium load. Renal function studies will assess sodium excretion, renal plasma flow, and glomerular filtration rate at baseline, during, and after the sodium load. Blood will be drawn for humoral analysis including catecholamines, renin, aldosterone, angiotensin II, atrial natriuretic peptide (ANP), BNP, and cyclic guanosine monophosphate (cGMP) at baseline, during, and after the sodium load.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study

Congestive Heart Failure

Keywords

heart failure, diastolic dysfunction, systolic dysfunction, preclinical, natriuretic peptide, B-type natriuretic peptide, cyclic guanosine monophosphate

7. Study Design

Primary Purpose

Basic Science

Study Phase

Phase 1, Phase 2

Interventional Study Model

Crossover Assignment

Masking

ParticipantCare ProviderInvestigator

Allocation

Randomized

Enrollment

58 (Actual)

8. Arms, Groups, and Interventions

Arm Title

Placebo First, then Nesiritide (Arm A)

Arm Type

Experimental

Arm Description

Arm Title

Nesiritide First, then Placebo (Arm B)

Arm Type

Experimental

Arm Description

Intervention Type

Drug

Intervention Name(s)

Nesiritide

Other Intervention Name(s)

natrecor, human B-type natriuretic peptide (BNP)

Intervention Description

The first 10 subjects in each group will receive a dose of 5 ug/kg and the next ten subjects will receive 10 ug/kg.

Intervention Type

Drug

Intervention Name(s)

Placebo

Intervention Description

The pharmacy created a placebo subcutaneous injection volume to match the volume of the nesiritide dose.

Intervention Type

Drug

Intervention Name(s)

Saline

Intervention Description

Normal saline 0.9% 0.25 ml/kg/min for 60 minutes

Primary Outcome Measure Information:

Title

Change in Natriuresis (Urinary Sodium Excretion) in Control Subjects at 60 Minutes After Volume Expansion Compared to Baseline in Response to Placebo Treatment

Description

Value at 60 minutes minus value at baseline.

Time Frame

baseline and 60 minutes

Title

Placebo Pre-Treatment Urinary Sodium Excretion After Volume Expansion (UnaV)

Description

Time Frame

Baseline, 30 min, 60 min

Title

Placebo Pre-Treatment Urinary cGMP Excretion After Volume Expansion (UcGMPV)

Description

Subjects received subcutaneous placebo in the abdomen. After 15 minutes, the acute saline load (volume expansion, VE) was administered. Subjects were asked to empty bladder spontaneously every 30 min (if unable to void every 30 min, a urinary catheter was placed). Adequate bladder emptying was insured by ultrasonography. UcGMPV was collected at baseline (immediately before VE) and at 30 and 60 min after initiation of VE.

Time Frame

Baseline, 30 min, 60 min

Title

Nesiritide Pre-Treatment Urinary Sodium Excretion After Volume Expansion (UNaV)

Description

Time Frame

Baseline, 30 min, 60 min

Title

Nesiritide Pre-Treatment Urinary cGMP Excretion After Volume Expansion (UcGMPV)

Description

Subjects received subcutaneous Nesiritide in the abdomen. After 15 minutes, the acute saline load (volume expansion, VE) was administered. Subjects were asked to empty bladder spontaneously every 30 min (if unable to void every 30 min, a urinary catheter was placed). Adequate bladder emptying was insured by ultrasonography. UcGMPV was collected at baseline (immediately before VE) and at 30 and 60 min after initiation of VE.

Time Frame

Baseline, 30 min, 60 min

Secondary Outcome Measure Information:

Title

Change in Urinary Cyclic Guanosine Monophosphate (cGMP) in Control Subjects at 60 Minutes After Volume Expansion Compared to Baseline in Response to Placebo Treatment

Description

Value at 60 minutes minus value at baseline

Time Frame

baseline and 60 minutes

Title

Change in Natriuresis (Urinary Sodium Excretion) at 30 Minutes in Response to Nesiritide Treatment Compared to Placebo Treatment

Description

Value of natriuresis at 30 min on nesiritide treatment minus value of natriuresis at 30 min on placebo treatment (per subject group). The baseline was not involved in this calculation.

Time Frame

30 minutes

Title

Change in Natriuresis (Urinary Sodium Excretion) at 60 Minutes in Response to Nesiritide Treatment Compared to Placebo Treatment

Description

Value of natriuresis at 60 min on nesiritide treatment minus value of natriuresis at 60 min on placebo treatment (per subject group). The baseline was not involved in this calculation.

Time Frame

60 minutes

Title

Change in Urinary Cyclic Guanosine Monophosphate (cGMP) at 30 Minutes in Response to Nesiritide Treatment Compared to Placebo Treatment

Description

Value of cGMP at 30 min on nesiritide treatment minus value of cGMP at 30 min on placebo treatment (per subject group). The baseline was not involved in this calculation.

Time Frame

30 minutes

Title

Change in Urinary Cyclic Guanosine Monophosphate (cGMP) at 60 Minutes in Response to Nesiritide Treatment Compared to Placebo Treatment

Description

Value of cGMP at 60 min on nesiritide treatment minus value of cGMP at 60 min on placebo treatment (per subject group). The baseline was not involved in this calculation.

Time Frame

60 minutes

10. Eligibility

Sex

All

Minimum Age & Unit of Time

18 Years

Accepts Healthy Volunteers

Eligibility Criteria

Inclusion criteria for normal control group: ejection fraction of greater 50% normal Doppler diastolic function with no clinical signs or symptoms history of cardiovascular and renal disease no prior use of any cardiovascular medications. Inclusion criteria for pre-systolic dysfunction group: ejection fraction of less than 40% with no clinical signs or symptoms of congestive heart failure ability to perform a 6-minute walk of > 450 meters if subjects are not able to walk 450 meters due to pain in hips and knees and not fatigue or shortness of breath, then they will still qualify for the study subjects will all be on stable doses of ACE inhibitor for two weeks prior to the active study date previously prescribed cardiovascular medications are allowed, however, all medications must be at stable doses two weeks prior to the study date. Inclusion criteria for pre-diastolic dysfunction group: ejection fraction of greater than 50% with moderate or severe diastolic dysfunction as assessed by Doppler echocardiography no signs or symptoms of congestive heart failure ability to perform a 6-minute walk of > 450 meters if subjects are not able to walk 450 meters due to pain in hips and knees and not fatigue or shortness of breath, then they will still qualify for the study previously prescribed cardiovascular medications are allowed, however, all medications must be at stable doses two weeks prior to the study date. Exclusion criteria for all groups: myocardial infarction within 3 months of screening unstable angina within 14 days of screening, or any evidence of myocardial ischemia significant valvular stenosis, hypertrophic, restrictive or obstructive cardiomyopathy, constrictive pericarditis, primary pulmonary hypertension, or biopsy proven active myocarditis severe congenital heart diseases sustained ventricular tachycardia or ventricular fibrillation within 14 days of screening second or third degree heart block without a permanent cardiac pacemaker stroke within 3 months of screening, or other evidence of significantly compromised CNS perfusion total bilirubin of > 1.5 mg/dL or other liver enzymes >1.5 times the upper limit of normal serum creatinine of > 3.0 mg/dL serum sodium of < 125 mEq/dL or > 160 mEq/dL serum potassium of < 3.5 mEq/dL or > 5.0 mEq/dL serum digoxin level of > 2.0 ng/ml systolic pressure of < 85 mmHg hemoglobin < 10 gm/dl other acute or chronic medical conditions or laboratory abnormality which may increase the risks associated with study participation or may interfere with interpretation of the data received an investigational drug within 1 month prior to dosing patients with an allergy to iodine in the opinion of the investigator, is unlikely to comply with the study protocol or is unsuitable for any reason.

Overall Study Officials:

First Name & Middle Initial & Last Name & Degree

Horng H. Chen, M.D.

Organizational Affiliation

Mayo Clinic

Official's Role

Principal Investigator

Facility Information:

Facility Name

Mayo Clinic

City

Rochester

State/Province

Minnesota

ZIP/Postal Code

55905

Country

United States

12. IPD Sharing Statement

Citations:

PubMed Identifier

22051332

Citation

McKie PM, Schirger JA, Costello-Boerrigter LC, Benike SL, Harstad LK, Bailey KR, Hodge DO, Redfield MM, Simari RD, Burnett JC Jr, Chen HH. Impaired natriuretic and renal endocrine response to acute volume expansion in pre-clinical systolic and diastolic dysfunction. J Am Coll Cardiol. 2011 Nov 8;58(20):2095-103. doi: 10.1016/j.jacc.2011.07.042.

Results Reference

background

Links:

URL

http://clinicaltrials.mayo.edu

Description

Mayo Clinic Clinical Trials

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Natriuretic Peptide System as Therapy in Human Preclinical Left Ventricle Dysfunction

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