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Neural Cardiac Therapy for Heart Failure Study (NECTAR-HF) (NECTAR-HF)

Primary Purpose

Heart Failure, Congestive Heart Failure

Status
Active
Phase
Not Applicable
Locations
International
Study Type
Interventional
Intervention
Implant of investigational device system
Titration during the randomization phase
Titration after the randomization phase
Blood Draw
Sponsored by
Boston Scientific Corporation
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Heart Failure focused on measuring Heart failure, Congestive heart failure, New York Heart Association Class II-III, Vagal therapy, Vagal nerve stimulation

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Age 18 or above, and of legal age to give informed consent specific to national laws
  • Willing and capable of providing informed consent
  • Capable of participating in all testing associated with this clinical investigation
  • Stable symptomatic heart failure NYHA class II-III
  • Left ventricular (LV) ejection fraction equal or smaller than 35 %
  • Left ventricular end diastolic diameter (LVEDD) of 5.5 cm or greater
  • Prescribed to optimal pharmacologic therapy

Exclusion Criteria:

  • QRS larger than 130 ms
  • Patients who have been hospitalized for heart failure and who required the use of HF IV therapy within 30 days before enrollment
  • Patients unable to tolerate anesthesia required for implant
  • Patients with unstable angina, myocardial infarction, PTCA, coronary artery bypass graft, cerebral vascular accident, or transient ischemic attack within previous 90 days before enrollment
  • Patients whose primary cause of heart failure is mitral or aortic valve disease, with a severe classification
  • Patients with persistent or permanent atrial fibrillation within 90 days prior to enrollment
  • Pacemaker indicated patients
  • Patients whose heart failure is due to congenital heart disease
  • Patients who have started treatment for sleep apnea or sleep disordered breathing with therapies to maintain airway patency (e.g., CPAP, Bi-PAP,APAP) with or without oxygen supplementation within the previous 6 months prior to enrollment
  • Patients with hypertrophic obstructive cardiomyopathy or infiltrative cardiomyopathy (e.g. amyloidosis, sarcoidosis)
  • Patients with documented chronic obstructive lung disease
  • Patients on or indicated for renal dialysis
  • Type 1 diabetic patients
  • Type 2 diabetic patients that have been treated with insulin for more than 5 years prior to enrollment
  • Patients with a life expectancy of less than 12 months per physician judgment
  • Patients involved in any concurrent clinical investigation
  • Women of childbearing potential who are or might be pregnant at the time of the study or breastfeeding
  • Patients with a prior cardiac transplant or expecting a heart transplant operation within the next 12 months
  • Patients with a prior vagotomy
  • Patients with prior or existing vagal nerve stimulation treatment
  • Patients implanted with any active implantable medical device other than a left sided single or dual chamber implantable cardioverter defibrillator (ICD) with bipolar sensing, or a left sided CRT device with each sensing channel programmed to either bipolar sensing or no sensing. All CRT patients must have had CRT for at least 1 year prior to enrollment. The total number of CRT patients will not exceed 30
  • Patients with locally implanted semi-/permanent devices such as vascular catheters, etc. that would interfere with the NECTAR-HF study system
  • Patients with previously implanted devices on the right side that became infected before removal
  • Patients with previous neck surgery and resultant scar formation that interferes with the ability to implant the study system on the right side of the neck (Thyroid/parathyroid, carotid artery etc)
  • Patients with known recurrent nerve paralysis
  • Patients who have undergone radiotherapy for thyroid disease/cancer
  • Patients who have existing or prior tracheotomy
  • Patients with severe vertebral cervical disease and limited mobility in the neck; includes those that frequently wear a brace
  • Patients with carotid murmur/vascular bruit/carotid artery lesion
  • Patients with known/suspected vascular malformation in carotid/vertebral circulatory bed
  • Patients who are likely to need an MRI of the neck area because of previous medical conditions

Sites / Locations

  • UCL Bruxelles
  • Nemocnice Na Homolce
  • Centre d'Investigation Clinique Pierre Drouin, CHU de Nancy
  • CHRU de Lille - Hôpital Cardiologique
  • Immanuel Klinikum Bernau Herzzentrum Brandenburg
  • Universitätsmedizin Göttingen
  • Universitäres Herzzentrum GmbH, Universitätsklinikum Hamburg-Eppendorf
  • Universitätsklinikum Leipzig
  • Azienda Ospedaliera Niguarda Cà Granda
  • A. O. Dei Colli - Monaldi
  • Policlinico San Matteo
  • Catharina Ziekenhuis Eindhoven
  • UMC Utrecht
  • Clínica Universitaria de Navarra, Avenida Pio XII s/n
  • Hospital Clinic de Barcelona
  • Hospital Doce de Octubre
  • University Hospitals Bristol, NHS Foundation Trust
  • Liverpool Heart and Chest Hospital, NHS Foundation Trust
  • The Heart Hospital, University College London Hospitals, NHS Foundation Trust
  • Imperial College Healthcare NHS Trust, St. Mary's Hospital
  • King's College Hospital NHS Foundation Trust

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Sham Comparator

Arm Label

Therapy

Control

Arm Description

Implant of investigational device system for vagus nerve stimulation. Patients were randomized in a 2 : 1 ratio to receive therapy (VNS ON) or control (VNS OFF) for a 6-month period. The experimental arm was receiving vagus nerve stimulation during the first 6 months after implant. Titration during the randomization phase with delivery of highest tolerable by patient stimulation current. Blood Draw before implant and 6 months after implant. Titration after the randomization phase with adjustments of the chronically highest tolearble by patient current.

Implant of investigational device system for vagus nerve stimulation. Control group was implanted with study system like the experimental arm, but was not receiving experimental vagus nerve stimulation therapy during the first 6 months after implant. 6-month after implant a cross-over took place and the control arm also started to receive experimental vagus nerve stimulation. Blood Draw before implant and 6 months after implant. Titration after the randomization phase with adjustments of the chronically highest tolearble by patient current.

Outcomes

Primary Outcome Measures

Change in Left Ventricular End-systolic Dimension (LVESD)
Change in the Left ventricular end-systolic dimension (LVESD) between Baseline and the value at the end of the randomization phase (6 months after Baseline) i.e. 6 months after vagus nerve stimulation in the THERAPY Arm. No Vagus nerve stimulation during that time window in the CONTROL Arm. The sign (- ) indicates a reduction in the LVESD. Minus means a reduction in LVESD. The change was calculated from two time points as the value at the later time point minus the value at the earlier time point (e.g., value at 6 months minus value at baseline).
Percentage of Surviving Participants
As pre-specified in the study protocol, the All-cause Survival endpoint combined both groups into one analysis population. Subjects contributed data according to the follow-up period during they received VNS therapy (Implant through 18 months for Therapy subjects, 6 through 18 months for Control subjects). Control patients who exited the study in the first 6 months, or who did not have a 6 month visit, were excluded.

Secondary Outcome Measures

LVEF, Left Ventricular Ejection Fraction
LVEF, left ventricular ejection fraction.
Exercise Capacity, Peak VO2
Assessment of functional capacity (e.g., peak VO2) as measures related to patient heart failure status.
LVESV, Left Ventricular End Systolic Volume
Measurements of LVESV, left ventricular end systolic volume at Baseline and 6 months after Baseline in the Control Arm and in the Therapy Arm

Full Information

First Posted
June 28, 2011
Last Updated
August 9, 2023
Sponsor
Boston Scientific Corporation
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1. Study Identification

Unique Protocol Identification Number
NCT01385176
Brief Title
Neural Cardiac Therapy for Heart Failure Study (NECTAR-HF)
Acronym
NECTAR-HF
Official Title
Neural Cardiac Therapy for Heart Failure Study
Study Type
Interventional

2. Study Status

Record Verification Date
April 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
September 21, 2011 (Actual)
Primary Completion Date
May 2014 (Actual)
Study Completion Date
June 30, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Boston Scientific Corporation

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The NECTAR-HF feasibility trial is designed to evaluate the application of right vagal nerve stimulation in heart failure patients with a New York Heart Association Class III, an ejection fraction equal to or less than 35 %, and a narrow QRS duration equal to or less than 130 ms.
Detailed Description
The objectives of this study are to assess the impact of right vagal nerve stimulation on left ventricular remodeling, functional capacity, quality of life, and other measures in heart failure patients over a 6-month period. In addition, the study will assess the safety of the NECTAR-HF study system over an 18-month period.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Heart Failure, Congestive Heart Failure
Keywords
Heart failure, Congestive heart failure, New York Heart Association Class II-III, Vagal therapy, Vagal nerve stimulation

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Crossover Assignment
Model Description
Patients were randomized in a 2:1 ratio to receive therapy (VNS ON) or control (VNS OFF) for a 6-month period. The primary endpoint was the change in LVend systolic diameter (LVESD) at 6 months for control vs. therapy, with secondary endpoints of other echocardiography measurements, exercise capacity, quality-of-life assessments, 24-h Holter, and circulating biomarkers.
Masking
ParticipantOutcomes Assessor
Allocation
Randomized
Enrollment
118 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Therapy
Arm Type
Experimental
Arm Description
Implant of investigational device system for vagus nerve stimulation. Patients were randomized in a 2 : 1 ratio to receive therapy (VNS ON) or control (VNS OFF) for a 6-month period. The experimental arm was receiving vagus nerve stimulation during the first 6 months after implant. Titration during the randomization phase with delivery of highest tolerable by patient stimulation current. Blood Draw before implant and 6 months after implant. Titration after the randomization phase with adjustments of the chronically highest tolearble by patient current.
Arm Title
Control
Arm Type
Sham Comparator
Arm Description
Implant of investigational device system for vagus nerve stimulation. Control group was implanted with study system like the experimental arm, but was not receiving experimental vagus nerve stimulation therapy during the first 6 months after implant. 6-month after implant a cross-over took place and the control arm also started to receive experimental vagus nerve stimulation. Blood Draw before implant and 6 months after implant. Titration after the randomization phase with adjustments of the chronically highest tolearble by patient current.
Intervention Type
Device
Intervention Name(s)
Implant of investigational device system
Intervention Description
Vagus nerve stimulation lead was wrapped around the right cervical vagus nerve and then connected to a stimulator permanently implanted in the right pectoral region.
Intervention Type
Procedure
Intervention Name(s)
Titration during the randomization phase
Intervention Description
Amplitude of the chronically delivered vagus nerve stimulation in the experimental arm was adjusted to the highest tolerable by patient value. No chronically delivered vagus nerve stimulation in the control arm during the randomization phase.
Intervention Type
Procedure
Intervention Name(s)
Titration after the randomization phase
Intervention Description
Amplitude of the chronically delivered vagus nerve stimulation was adjusted to the highest tolerable by patient value in all patients in both arms of the study.
Intervention Type
Diagnostic Test
Intervention Name(s)
Blood Draw
Intervention Description
Blood draw before implant and 6 months after implant at the end of the randomization phase.
Primary Outcome Measure Information:
Title
Change in Left Ventricular End-systolic Dimension (LVESD)
Description
Change in the Left ventricular end-systolic dimension (LVESD) between Baseline and the value at the end of the randomization phase (6 months after Baseline) i.e. 6 months after vagus nerve stimulation in the THERAPY Arm. No Vagus nerve stimulation during that time window in the CONTROL Arm. The sign (- ) indicates a reduction in the LVESD. Minus means a reduction in LVESD. The change was calculated from two time points as the value at the later time point minus the value at the earlier time point (e.g., value at 6 months minus value at baseline).
Time Frame
LVESD at Baseline and at 6-months post Baseline
Title
Percentage of Surviving Participants
Description
As pre-specified in the study protocol, the All-cause Survival endpoint combined both groups into one analysis population. Subjects contributed data according to the follow-up period during they received VNS therapy (Implant through 18 months for Therapy subjects, 6 through 18 months for Control subjects). Control patients who exited the study in the first 6 months, or who did not have a 6 month visit, were excluded.
Time Frame
18-months
Secondary Outcome Measure Information:
Title
LVEF, Left Ventricular Ejection Fraction
Description
LVEF, left ventricular ejection fraction.
Time Frame
LVEF at Baseline and at 6-months after Baseline
Title
Exercise Capacity, Peak VO2
Description
Assessment of functional capacity (e.g., peak VO2) as measures related to patient heart failure status.
Time Frame
Measurements at Baseline and at 6-months after Baseline
Title
LVESV, Left Ventricular End Systolic Volume
Description
Measurements of LVESV, left ventricular end systolic volume at Baseline and 6 months after Baseline in the Control Arm and in the Therapy Arm
Time Frame
At Baseline and at 6-months after Baseline

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Age 18 or above, and of legal age to give informed consent specific to national laws Willing and capable of providing informed consent Capable of participating in all testing associated with this clinical investigation Stable symptomatic heart failure NYHA class II-III Left ventricular (LV) ejection fraction equal or smaller than 35 % Left ventricular end diastolic diameter (LVEDD) of 5.5 cm or greater Prescribed to optimal pharmacologic therapy Exclusion Criteria: QRS larger than 130 ms Patients who have been hospitalized for heart failure and who required the use of HF IV therapy within 30 days before enrollment Patients unable to tolerate anesthesia required for implant Patients with unstable angina, myocardial infarction, PTCA, coronary artery bypass graft, cerebral vascular accident, or transient ischemic attack within previous 90 days before enrollment Patients whose primary cause of heart failure is mitral or aortic valve disease, with a severe classification Patients with persistent or permanent atrial fibrillation within 90 days prior to enrollment Pacemaker indicated patients Patients whose heart failure is due to congenital heart disease Patients who have started treatment for sleep apnea or sleep disordered breathing with therapies to maintain airway patency (e.g., CPAP, Bi-PAP,APAP) with or without oxygen supplementation within the previous 6 months prior to enrollment Patients with hypertrophic obstructive cardiomyopathy or infiltrative cardiomyopathy (e.g. amyloidosis, sarcoidosis) Patients with documented chronic obstructive lung disease Patients on or indicated for renal dialysis Type 1 diabetic patients Type 2 diabetic patients that have been treated with insulin for more than 5 years prior to enrollment Patients with a life expectancy of less than 12 months per physician judgment Patients involved in any concurrent clinical investigation Women of childbearing potential who are or might be pregnant at the time of the study or breastfeeding Patients with a prior cardiac transplant or expecting a heart transplant operation within the next 12 months Patients with a prior vagotomy Patients with prior or existing vagal nerve stimulation treatment Patients implanted with any active implantable medical device other than a left sided single or dual chamber implantable cardioverter defibrillator (ICD) with bipolar sensing, or a left sided CRT device with each sensing channel programmed to either bipolar sensing or no sensing. All CRT patients must have had CRT for at least 1 year prior to enrollment. The total number of CRT patients will not exceed 30 Patients with locally implanted semi-/permanent devices such as vascular catheters, etc. that would interfere with the NECTAR-HF study system Patients with previously implanted devices on the right side that became infected before removal Patients with previous neck surgery and resultant scar formation that interferes with the ability to implant the study system on the right side of the neck (Thyroid/parathyroid, carotid artery etc) Patients with known recurrent nerve paralysis Patients who have undergone radiotherapy for thyroid disease/cancer Patients who have existing or prior tracheotomy Patients with severe vertebral cervical disease and limited mobility in the neck; includes those that frequently wear a brace Patients with carotid murmur/vascular bruit/carotid artery lesion Patients with known/suspected vascular malformation in carotid/vertebral circulatory bed Patients who are likely to need an MRI of the neck area because of previous medical conditions
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Faiez Zannad, M.D.
Organizational Affiliation
Centre d'Investigation Clinique (CIC), Batiment Louis Mathieu, CHU de Nancy
Official's Role
Principal Investigator
Facility Information:
Facility Name
UCL Bruxelles
City
Brussels
ZIP/Postal Code
1200
Country
Belgium
Facility Name
Nemocnice Na Homolce
City
Prague
ZIP/Postal Code
15030
Country
Czechia
Facility Name
Centre d'Investigation Clinique Pierre Drouin, CHU de Nancy
City
Vandoeuvre les Nancy
State/Province
Nancy
ZIP/Postal Code
54500
Country
France
Facility Name
CHRU de Lille - Hôpital Cardiologique
City
Lille
ZIP/Postal Code
59037
Country
France
Facility Name
Immanuel Klinikum Bernau Herzzentrum Brandenburg
City
Bernau
State/Province
Brandenburg
ZIP/Postal Code
16321
Country
Germany
Facility Name
Universitätsmedizin Göttingen
City
Göttingen
ZIP/Postal Code
37075
Country
Germany
Facility Name
Universitäres Herzzentrum GmbH, Universitätsklinikum Hamburg-Eppendorf
City
Hamburg
ZIP/Postal Code
20246
Country
Germany
Facility Name
Universitätsklinikum Leipzig
City
Leipzig
ZIP/Postal Code
04103
Country
Germany
Facility Name
Azienda Ospedaliera Niguarda Cà Granda
City
Milano
ZIP/Postal Code
20162
Country
Italy
Facility Name
A. O. Dei Colli - Monaldi
City
Napoli
ZIP/Postal Code
80131
Country
Italy
Facility Name
Policlinico San Matteo
City
Pavia
ZIP/Postal Code
27100
Country
Italy
Facility Name
Catharina Ziekenhuis Eindhoven
City
Eindhoven
ZIP/Postal Code
5623EJ
Country
Netherlands
Facility Name
UMC Utrecht
City
Utrecht
ZIP/Postal Code
3584CX
Country
Netherlands
Facility Name
Clínica Universitaria de Navarra, Avenida Pio XII s/n
City
Pamplona
State/Province
Navarra
ZIP/Postal Code
31008
Country
Spain
Facility Name
Hospital Clinic de Barcelona
City
Barcelona
ZIP/Postal Code
08036
Country
Spain
Facility Name
Hospital Doce de Octubre
City
Madrid
ZIP/Postal Code
28041
Country
Spain
Facility Name
University Hospitals Bristol, NHS Foundation Trust
City
Bristol
State/Province
England
ZIP/Postal Code
BS2 8HW
Country
United Kingdom
Facility Name
Liverpool Heart and Chest Hospital, NHS Foundation Trust
City
Liverpool
State/Province
England
ZIP/Postal Code
L14 3PD
Country
United Kingdom
Facility Name
The Heart Hospital, University College London Hospitals, NHS Foundation Trust
City
London
State/Province
England
ZIP/Postal Code
W1G 8PH
Country
United Kingdom
Facility Name
Imperial College Healthcare NHS Trust, St. Mary's Hospital
City
London
State/Province
England
ZIP/Postal Code
W2 1NY
Country
United Kingdom
Facility Name
King's College Hospital NHS Foundation Trust
City
London
ZIP/Postal Code
SE5 9RS
Country
United Kingdom

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
24846173
Citation
De Ferrari GM, Tuinenburg AE, Ruble S, Brugada J, Klein H, Butter C, Wright DJ, Schubert B, Solomon S, Meyer S, Stein K, Ramuzat A, Zannad F. Rationale and study design of the NEuroCardiac TherApy foR Heart Failure Study: NECTAR-HF. Eur J Heart Fail. 2014 Jun;16(6):692-9. doi: 10.1002/ejhf.80. Epub 2014 May 20.
Results Reference
background
PubMed Identifier
25176942
Citation
Zannad F, De Ferrari GM, Tuinenburg AE, Wright D, Brugada J, Butter C, Klein H, Stolen C, Meyer S, Stein KM, Ramuzat A, Schubert B, Daum D, Neuzil P, Botman C, Castel MA, D'Onofrio A, Solomon SD, Wold N, Ruble SB. Chronic vagal stimulation for the treatment of low ejection fraction heart failure: results of the NEural Cardiac TherApy foR Heart Failure (NECTAR-HF) randomized controlled trial. Eur Heart J. 2015 Feb 14;36(7):425-33. doi: 10.1093/eurheartj/ehu345. Epub 2014 Aug 31.
Results Reference
result
PubMed Identifier
28663046
Citation
De Ferrari GM, Stolen C, Tuinenburg AE, Wright DJ, Brugada J, Butter C, Klein H, Neuzil P, Botman C, Castel MA, D'Onofrio A, de Borst GJ, Solomon S, Stein KM, Schubert B, Stalsberg K, Wold N, Ruble S, Zannad F. Long-term vagal stimulation for heart failure: Eighteen month results from the NEural Cardiac TherApy foR Heart Failure (NECTAR-HF) trial. Int J Cardiol. 2017 Oct 1;244:229-234. doi: 10.1016/j.ijcard.2017.06.036. Epub 2017 Jun 10.
Results Reference
result

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Neural Cardiac Therapy for Heart Failure Study (NECTAR-HF)

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