Exogenous Ketones for Acutely Decompensated HEart Failure (KADHEF)
Primary Purpose
Acute Heart Failure, Low Cardiac Output Syndrome, Hemodynamic Instability
Status
Unknown status
Phase
Phase 3
Locations
Czechia
Study Type
Interventional
Intervention
25g Ketone monoester without added salts
Placebo
Sponsored by
About this trial
This is an interventional treatment trial for Acute Heart Failure
Eligibility Criteria
Inclusion Criteria:
- Chronic heart failure due ischemic or nonischemic cardiomyopathy
- Acute decompensation of heart failure with the need of inotropes
- Achievement of relative stabilization on inotropes (INTERMACS class >2)
- Left ventricular ejection fraction <= 35%
- Age >18 years
Exclusion Criteria:
- Deteriorating cardiogenic shock with likely need of mechanical circulatory support in the subsequent 48 hours
- Chronic kidney disease grade 4 or 5
- Diabetic ketoacidosis (3-OHB >2mmol/l at baseline)
- Hemodynamic severe arrhythmias
- Acute heart failure due to transient triggers (acute coronary syndrome, atrial fibrillation, infection etc..)
- Contraindications to invasive hemodynamic monitoring
Sites / Locations
- Institute for Clinical and Experimental Medicine (IKEM)Recruiting
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Placebo Comparator
Arm Label
Supplementation of exogenous ketones
Control group
Arm Description
Exogeneous ketones will be administered orally using monoester 3-OHB concentrate without added salts (25g 3-OHB in 65ml H.V.M.N Ketone Ester, H.V.M.N, USA or equivalent). The drink will be administered over 10 mins every 3 hours, 3 times in a row.
The patients will receive a placebo drink (drinking water) of equivalent volume (3x 65ml)
Outcomes
Primary Outcome Measures
Maximum change of stroke volume index
Maximum change of stroke volume index (ml/m2) between baseline and hour 1 - 3
Maximum change of cardiac index
Maximum change of cardiac index (L/m2) between baseline and hour 1 - 3
Change of mean stroke volume index
Difference between baseline stroke volume index and mean stroke volume index (ml/m2) during the study protocol
Change of mean cardiac index
Difference between baseline cardiac index (L/m2) and mean cardiac index during the study protocol
Secondary Outcome Measures
Change in patient/symptoms
Change in patient-referred symptoms by visual-analog scale (1=unbearable dyspnea, 10=no symptoms)
Full Information
NCT ID
NCT04698005
First Posted
December 2, 2020
Last Updated
January 5, 2021
Sponsor
Institute for Clinical and Experimental Medicine
1. Study Identification
Unique Protocol Identification Number
NCT04698005
Brief Title
Exogenous Ketones for Acutely Decompensated HEart Failure
Acronym
KADHEF
Official Title
Exogenous Ketones for Acutely Decompensated Heart Failure
Study Type
Interventional
2. Study Status
Record Verification Date
January 2021
Overall Recruitment Status
Unknown status
Study Start Date
December 2, 2020 (Actual)
Primary Completion Date
December 31, 2021 (Anticipated)
Study Completion Date
December 31, 2021 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Institute for Clinical and Experimental Medicine
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
Yes
Data Monitoring Committee
No
5. Study Description
Brief Summary
This study will evaluate whether supplementation of exogenous ketones in patients with severe left ventricular dysfunction and acutely decompensated heart failure requiring inotropic therapy would improve the patient's hemodynamics and symptoms.
Detailed Description
The study will include patients with acutely decompensated chronic heart failure requiring inotropic therapy for the syndrome of low cardiac output. While being on the inotropic therapy, the patients will be randomized to oral supplementation of exogenous ketones vs. placebo, which will be repeatedly administered over 9 hours. The patients will undergo continuous invasive hemodynamic monitoring by pulmonary artery catheter, repeated laboratory assessment, and repeated assessment of the severity of symptoms for 24 hours.
Exogenous ketones will be administered orally using monoester 3-OHB concentrate without added salts (25g 3-OHB in 65ml H.V.M.N Ketone Ester, H.V.M.N, USA or equivalent). The drink will be administered over 10 mins every 3 hours, 3 times in a row (hour 0, 3, 6).
All patients with K<3.7 mmol/l will receive a continuous infusion of 7.5% potassium until reach target K levels of 4.0-4.9 mmol /l. Glycemia will be controlled as needed by insulin and dextrose to maintain glucose concentration of 4 - 12 mmol/l
All patients will receive standard treatment of acute heart failure, including intravenous diuretics and inotropic therapy. The recommended inotropic therapy will include milrinone 0.5 ug/kg/min, levosimendan 0.1 ug/kg/min up to 25mg without initial bolus, or dobutamine 0.5 ug/kg/min in patients without chronic therapy with beta-blockers.
The severity of symptoms will be self-reported by the patient using 1-10 visual analog scale.
Workflow:
Hemodynamic assessment, assessment of ketones concentration: 1-3h before randomization, 0-9h hourly, 16-24h (next morning)
Biochemical assessment (renal function, liver enzymes, BNP, hs-TnT) 0h, 9h, 16-24h
Assessment of symptoms and Scv02: 0h, 1h, 3h, 9h, 16-24h
Statistical methods:
Each study arm will include 12 patients. The study size was estimated to have power of (1 - beta) of 0.8 and alpha of 5% for between-group comparison of changes in cardiac index and stroke volume index by ANOVA and for comparison of the changes in cardiac index and stroke volume index by paired t-tests.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Acute Heart Failure, Low Cardiac Output Syndrome, Hemodynamic Instability, Ketosis
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Model Description
randomisation 1:1 to active treatment (exogenous ketones) vs. placebo (drinking water of equivalent volume)
Masking
ParticipantCare ProviderInvestigator
Masking Description
The participant and the physician in charge of the participant will be blinded to the given treatment (ketone drink vs. placebo)
Allocation
Randomized
Enrollment
24 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
Supplementation of exogenous ketones
Arm Type
Experimental
Arm Description
Exogeneous ketones will be administered orally using monoester 3-OHB concentrate without added salts (25g 3-OHB in 65ml H.V.M.N Ketone Ester, H.V.M.N, USA or equivalent). The drink will be administered over 10 mins every 3 hours, 3 times in a row.
Arm Title
Control group
Arm Type
Placebo Comparator
Arm Description
The patients will receive a placebo drink (drinking water) of equivalent volume (3x 65ml)
Intervention Type
Dietary Supplement
Intervention Name(s)
25g Ketone monoester without added salts
Other Intervention Name(s)
25g 3-OHB in 65ml, H.V.M.N Ketone Ester, H.V.M.N, USA or equivalent
Intervention Description
oral supplementation of ketone monoester
Intervention Type
Other
Intervention Name(s)
Placebo
Intervention Description
The patients will receive a placebo drink (drinking water) of equivalent volume (3x 65ml)
Primary Outcome Measure Information:
Title
Maximum change of stroke volume index
Description
Maximum change of stroke volume index (ml/m2) between baseline and hour 1 - 3
Time Frame
Maximum value of stroke volume index measured between hour 1 - 3 of the study protocol at 15-minute intervals
Title
Maximum change of cardiac index
Description
Maximum change of cardiac index (L/m2) between baseline and hour 1 - 3
Time Frame
Maximum value of cardiac index measured between hour 1 - 3 of the study protocol at 15-minute intervals
Title
Change of mean stroke volume index
Description
Difference between baseline stroke volume index and mean stroke volume index (ml/m2) during the study protocol
Time Frame
Mean value of stroke volume index measured every 15 minutes during 9 hours of the study protocol
Title
Change of mean cardiac index
Description
Difference between baseline cardiac index (L/m2) and mean cardiac index during the study protocol
Time Frame
Mean value of cardiac index measured every 15 minutes during 9 hours of the study protocol
Secondary Outcome Measure Information:
Title
Change in patient/symptoms
Description
Change in patient-referred symptoms by visual-analog scale (1=unbearable dyspnea, 10=no symptoms)
Time Frame
Symptoms scored at hours 0, 1, 10, 24 and expressed as an area under the curve
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Chronic heart failure due ischemic or nonischemic cardiomyopathy
Acute decompensation of heart failure with the need of inotropes
Achievement of relative stabilization on inotropes (INTERMACS class >2)
Left ventricular ejection fraction <= 35%
Age >18 years
Exclusion Criteria:
Deteriorating cardiogenic shock with likely need of mechanical circulatory support in the subsequent 48 hours
Chronic kidney disease grade 4 or 5
Diabetic ketoacidosis (3-OHB >2mmol/l at baseline)
Hemodynamic severe arrhythmias
Acute heart failure due to transient triggers (acute coronary syndrome, atrial fibrillation, infection etc..)
Contraindications to invasive hemodynamic monitoring
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Marek Sramko, MD, PhD
Phone
+420776246127
Email
marek.sramko@ikem.cz
Facility Information:
Facility Name
Institute for Clinical and Experimental Medicine (IKEM)
City
Prague
ZIP/Postal Code
14059
Country
Czechia
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Marek Sramko, MD, PhD
Phone
+420731682681
Email
marek.sramko@ikem.cz
12. IPD Sharing Statement
Plan to Share IPD
Undecided
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Exogenous Ketones for Acutely Decompensated HEart Failure
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