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Dapagliflozin on Volume Vascular Outcomes. (DAPA-VOLVO)

Primary Purpose

Heart Failure,Congestive

Status
Recruiting
Phase
Phase 4
Locations
Switzerland
Study Type
Interventional
Intervention
Dapagliflozin
Placebo
Sponsored by
Frank Ruschitzka
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Heart Failure,Congestive focused on measuring heart failure, congestive, hospitalization, blood volume, vascular function

Eligibility Criteria

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

Inclusion criteria:

  1. Male or female, age of 18 or older;
  2. Patients with documented diagnosis of chronic or de novo heart failure (NYHA II-IV) and clinically stabilized (considered for hospital discharge) after hospitalization/ ambulatory care because of an acute decompensated (congestive) heart failure (ADHF) event;
  3. eGFR ≥ 30 mL/min/1.73 m2 (CKD-EPI formula) at enrolment;
  4. Provision of signed informed consent prior to any study specific procedure;

Exclusion criteria:

  1. Contraindications to the class of drugs under study, e.g. known hypersensitivity or allergy to class of drugs or the investigational product;
  2. Receiving therapy with an SGLT2 inhibitor within 8 weeks prior to enrolment or previous intolerance of an SGLT2 inhibitor;
  3. Participation in another study with investigational drug within the 30 days preceding and during the present study;
  4. Type 1 diabetes mellitus;
  5. Symptomatic hypotension or systolic blood pressure <90 mmHg at 2 out of 3 measurements either at visit 1 or visit 2;
  6. Coronary revascularization (percutaneous coronary intervention because of STEMI or coronary artery bypass grafting) or valvular repair/replacement within 12 weeks prior to enrolment or planned to undergo any of these operations after randomization;
  7. Implantation of a CRT device within 12 weeks prior to enrolment or intent to implant a CRT device during 12 weeks of study observation period if indicated according to the actual guidelines [11];
  8. Previous cardiac transplantation or implantation of a ventricular assistance device or similar device, or implantation expected after randomization;
  9. HF due to restrictive cardiomyopathy, active myocarditis, constrictive pericarditis, hypertrophic obstructive cardiomyopathy or uncorrected primary valvular disease;
  10. Symptomatic bradycardia or second or third degree heart block without a pacemaker;
  11. Severe (eGFR <20 mL/min/1.73 m2 by CKD-EPI), unstable or rapidly progressing renal disease;
  12. Women who are pregnant or breast feeding;
  13. Intention to become pregnant during the course of the study;
  14. Known or suspected non-compliance, drug or alcohol abuse;
  15. Inability to follow the procedures of the study, e.g. due to language problems, psychological disorders, dementia, etc. of the participant;
  16. Patients with severely restricted liver function;
  17. Patients with recurrent mycotic genital infections;

Sites / Locations

  • University Heart Center ZurichRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Placebo Comparator

Arm Label

Dapagliflozin

Placebo

Arm Description

Dapagliflozin tablet (10mg/tablet), orally, once daily for 12 weeks.

Placebo tablet, matching Dapglilflozin, orally, once daily for 12 weeks.

Outcomes

Primary Outcome Measures

Change in relative plasma volume status (PVS).
Change in relative plasma volume status (PVS) from baseline to 12 weeks of dapagliflozin treatment in comparison to placebo will be assessed. The plasma volume (PV) will be measured via optimized CO-rebreathing technique.

Secondary Outcome Measures

Change in blood volume (BV).
Change in BV from baseline to 12 weeks of dapagliflozin treatment in comparison to placebo will be assessed. The BV will be measured via optimized CO-rebreathing technique.
Change in red blood cell volume (RBCV).
Change in RBCV from baseline to 12 weeks of dapagliflozin treatment in comparison to placebo will be assessed. The RBCV will be measured via optimized CO-rebreathing technique.
Change in total hemoglobin mass (Hbmass).
Change in Hbmass from baseline to 12 weeks of dapagliflozin treatment in comparison to placebo will be assessed. The Hbmass will be measured via optimized CO-rebreathing technique.
Change in extracellular to total body water ratio (ECW/TBW).
Change in ECW/TBW ratio from baseline to 12 weeks of dapagliflozin treatment in comparison to placebo will be assessed. The ECW/TBW ratio will be measured via direct segmental multi-frequency bioelectrical impedance analaysis (DSM-BIA).
Change in intracellular to total body water ratio (ICW/TBW).
Change in ICW/TBW ratio from baseline to 12 weeks of dapagliflozin treatment in comparison to placebo will be assessed. The ICW/TBW ratio will be measured via direct segmental multi-frequency bioelectrical impedance analaysis (DSM-BIA).
Change in flicker-light induced retinal arteriolar dilatation (FIDa).
Change in FIDa from baseline to 12 weeks of dapagliflozin treatment in comparison to placebo will be assessed. The FIDa will be measured via dynamic retinal vessel analysis (DVA).
Change in flicker-light induced retinal venular dilatation (FIDv).
Change in FIDv from baseline to 12 weeks of dapagliflozin treatment in comparison to placebo will be assessed. The FIDv will be measured via dynamic retinal vessel analysis (DVA).
Change in retinal arterial to venous ratio (AVR).
Change in AVR from baseline to 12 weeks of dapagliflozin treatment in comparison to placebo will be assessed. The AVR will be measured via static retinal vessel analysis (SVA).
Change in pulse wave velocity (PWV).
Change in PWV from baseline to 12 weeks of dapagliflozin treatment in comparison to placebo will be assessed. The PWV as measure of arterial stiffness (AS) will be assessed via planar tonometry pulse wave analysis (PWA).
Change in flow-mediated dilatation (FMD) of the brachial artery.
Change in FMD from baseline to 12 weeks of dapagliflozin treatment in comparison to placebo will be assessed. The FMD as measure of endothelial function will be assessed via arm sonography and short-term cuff-mediated arm ischemia.
Change in glyceryl-trinitrate-(GTN) induced dilatation of the brachial artery.
Change in GTN-induced dilatation of the brachial artery from baseline to 12 weeks of dapagliflozin treatment in comparison to placebo will be assessed. The GTN-induced dilatation of the brachial artery will be measured via arm sonography and sublingual GTN-puff.

Full Information

First Posted
January 4, 2021
Last Updated
August 19, 2022
Sponsor
Frank Ruschitzka
Collaborators
AstraZeneca
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1. Study Identification

Unique Protocol Identification Number
NCT04869124
Brief Title
Dapagliflozin on Volume Vascular Outcomes.
Acronym
DAPA-VOLVO
Official Title
Effects of Dapagliflozin on Blood Volume Status and Vascular Function in Clinically Compensated Heart Failure Patients After an Acute Heart Failure Event.
Study Type
Interventional

2. Study Status

Record Verification Date
August 2022
Overall Recruitment Status
Recruiting
Study Start Date
February 15, 2021 (Actual)
Primary Completion Date
October 1, 2023 (Anticipated)
Study Completion Date
December 31, 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Frank Ruschitzka
Collaborators
AstraZeneca

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of the DAPA-VOLVO trial is to investigate the effects of Dapagliflozin on top of recommended standard therapy on volume status and vascular function in clinically stable de novo or chronic heart failure patients after hospitalization because of an acute decompensated heart failure event.
Detailed Description
Recent clinical trials found that Dapagliflozin can reduce the risk of cardiovascular events, hospitalization and death in heart failure (HF) patients with reduced left ventricular ejection fraction (HFrEF) in the presence of absence of diabetes. Additional trials are ongoing to investigate whether these results can be translated also to HF-patients with preserved ejection fraction (HFpEF). However, the underlying mechanisms leading to the improved clinical outcomes are not completely understood but the beneficial effects of Dapagliflozin on volume status and vascular function are discussed as potential key factors. This study is designed as a mechanistic study to investigate the impact of Dapagliflozin on volume status and vascular function in clinically stable de novo or chronic heart failure patients after hospitalization/ ambulatory care because of an acute decompensated heart failure (ADHF) event. After being informed about the study and potential risks all patients given written informed consent will be screened for the defined eligibility criteria and thereafter randomized in a double-blind manner (patients, investigators) 1:1 ratio to either receive the sodium-glucose co-transporter 2 inhibitor (SGLT2i) Dapagliflozin (10mg/day) or Placebo on top of recommended standard therapy for in total 12 weeks. The results of this study may provide new mechanistic insight into the beneficial effects of Dapagliflozin on volume regulation and vascular function and have great potential to contribute to change current clinical guidelines in the management of patients with heart failure.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Heart Failure,Congestive
Keywords
heart failure, congestive, hospitalization, blood volume, vascular function

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Model Description
A double-blind randomized placebo-controlled phase IV clinical trial.
Masking
ParticipantInvestigator
Masking Description
Double-blind
Allocation
Randomized
Enrollment
80 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Dapagliflozin
Arm Type
Active Comparator
Arm Description
Dapagliflozin tablet (10mg/tablet), orally, once daily for 12 weeks.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Placebo tablet, matching Dapglilflozin, orally, once daily for 12 weeks.
Intervention Type
Drug
Intervention Name(s)
Dapagliflozin
Other Intervention Name(s)
Forxiga
Intervention Description
Dapagliflozin propanediol (FORXIGA) tablet: 10 mg once daily p.o. on top of recommended standard therapy, duration of administration: 12 weeks.
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Placebo tablet, matching Dapagliflozin, once daily p.o. on top of recommended standard therapy, duration of administration: 12 weeks.
Primary Outcome Measure Information:
Title
Change in relative plasma volume status (PVS).
Description
Change in relative plasma volume status (PVS) from baseline to 12 weeks of dapagliflozin treatment in comparison to placebo will be assessed. The plasma volume (PV) will be measured via optimized CO-rebreathing technique.
Time Frame
Change between baseline (0 weeks) and after 2, 6 and 12 weeks of treatment.
Secondary Outcome Measure Information:
Title
Change in blood volume (BV).
Description
Change in BV from baseline to 12 weeks of dapagliflozin treatment in comparison to placebo will be assessed. The BV will be measured via optimized CO-rebreathing technique.
Time Frame
Change between baseline (0 weeks) and after 2, 6 and 12 weeks of treatment.
Title
Change in red blood cell volume (RBCV).
Description
Change in RBCV from baseline to 12 weeks of dapagliflozin treatment in comparison to placebo will be assessed. The RBCV will be measured via optimized CO-rebreathing technique.
Time Frame
Change between baseline (0 weeks) and after 2, 6 and 12 weeks of treatment.
Title
Change in total hemoglobin mass (Hbmass).
Description
Change in Hbmass from baseline to 12 weeks of dapagliflozin treatment in comparison to placebo will be assessed. The Hbmass will be measured via optimized CO-rebreathing technique.
Time Frame
Change between baseline (0 weeks) and after 2, 6 and 12 weeks of treatment.
Title
Change in extracellular to total body water ratio (ECW/TBW).
Description
Change in ECW/TBW ratio from baseline to 12 weeks of dapagliflozin treatment in comparison to placebo will be assessed. The ECW/TBW ratio will be measured via direct segmental multi-frequency bioelectrical impedance analaysis (DSM-BIA).
Time Frame
Change between baseline (0 weeks) and after 2, 6 and 12 weeks of treatment.
Title
Change in intracellular to total body water ratio (ICW/TBW).
Description
Change in ICW/TBW ratio from baseline to 12 weeks of dapagliflozin treatment in comparison to placebo will be assessed. The ICW/TBW ratio will be measured via direct segmental multi-frequency bioelectrical impedance analaysis (DSM-BIA).
Time Frame
Change between baseline (0 weeks) and after 2, 6 and 12 weeks of treatment.
Title
Change in flicker-light induced retinal arteriolar dilatation (FIDa).
Description
Change in FIDa from baseline to 12 weeks of dapagliflozin treatment in comparison to placebo will be assessed. The FIDa will be measured via dynamic retinal vessel analysis (DVA).
Time Frame
Change between baseline (0 weeks) and after 12 weeks of treatment.
Title
Change in flicker-light induced retinal venular dilatation (FIDv).
Description
Change in FIDv from baseline to 12 weeks of dapagliflozin treatment in comparison to placebo will be assessed. The FIDv will be measured via dynamic retinal vessel analysis (DVA).
Time Frame
Change between baseline (0 weeks) and after 12 weeks of treatment.
Title
Change in retinal arterial to venous ratio (AVR).
Description
Change in AVR from baseline to 12 weeks of dapagliflozin treatment in comparison to placebo will be assessed. The AVR will be measured via static retinal vessel analysis (SVA).
Time Frame
Change between baseline (0 weeks) and after 12 weeks of treatment.
Title
Change in pulse wave velocity (PWV).
Description
Change in PWV from baseline to 12 weeks of dapagliflozin treatment in comparison to placebo will be assessed. The PWV as measure of arterial stiffness (AS) will be assessed via planar tonometry pulse wave analysis (PWA).
Time Frame
Change between baseline (0 weeks) and after 12 weeks of treatment.
Title
Change in flow-mediated dilatation (FMD) of the brachial artery.
Description
Change in FMD from baseline to 12 weeks of dapagliflozin treatment in comparison to placebo will be assessed. The FMD as measure of endothelial function will be assessed via arm sonography and short-term cuff-mediated arm ischemia.
Time Frame
Change between baseline (0 weeks) and after 12 weeks of treatment.
Title
Change in glyceryl-trinitrate-(GTN) induced dilatation of the brachial artery.
Description
Change in GTN-induced dilatation of the brachial artery from baseline to 12 weeks of dapagliflozin treatment in comparison to placebo will be assessed. The GTN-induced dilatation of the brachial artery will be measured via arm sonography and sublingual GTN-puff.
Time Frame
Change between baseline (0 weeks) and after 12 weeks of treatment.
Other Pre-specified Outcome Measures:
Title
First episode of worsening of heart failure (WHF).
Description
The first episode of WHF from baseline to 12 weeks of dapagliflozin treatment in comparison to placebo will be assessed. WHF is defined as requiring intensification of therapy in the ambulatory or hospital setting including i.v. diuretics, i.v. nitrates, or other medications for HF, or institution of mechanical or ventilator support.
Time Frame
From baseline (0 weeks) to 12 weeks of treatment.
Title
Change in Kansas City cardiomyopathy questionnaire (KCCQ) score.
Description
Change in KCCQ overall score from baseline to 12 weeks of dapagliflozin treatment in comparison to placebo will be assessed. The KCCQ as a measure of HF-related quality of life will be assessed as self-administered 23-itmes questionnaire. The KCCQ-score range: from 0 (worst) to 100 (best).
Time Frame
Change between baseline (0 weeks) and after 12 weeks of treatment.
Title
Change in Pittsburgh sleep quality index (PSQI) score.
Description
Change in PSQI total score from baseline to 12 weeks of dapagliflozin treatment in comparison to placebo will be assessed.The PSQI as a measure of sleep quality will be assessed as self-administered 19-itmes questionnaire. The PSQI-score range: 0 (best) to 21 (worst).
Time Frame
Change between baseline (0 weeks) and after 12 weeks of treatment.
Title
Change in left ventricular ejection fraction (LVEF).
Description
Change LVEF from baseline to 12 weeks of dapagliflozin treatment in comparison to placebo will be assessed. The LVEF will be measured via transthoracic echocardiography (TTE).
Time Frame
Change between baseline (0 weeks) and after 12 weeks of treatment.
Title
Change in pulmonary artery systolic pressure (PASP).
Description
Change PASP from baseline to 12 weeks of dapagliflozin treatment in comparison to placebo will be assessed. The PASP will be measured via transthoracic echocardiography (TTE).
Time Frame
Change between baseline (0 weeks) and after 12 weeks of treatment.
Title
Change in peak oxygen uptake (VO2peak).
Description
Change in VO2peak from baseline to 12 weeks of dapagliflozin treatment in comparison to placebo will be assessed. The VO2peak as a measure of aerobic capacity will be assessed via cardio-pulmonary exercise test (CPET).
Time Frame
Change between baseline (0 weeks) and after 12 weeks of treatment.
Title
Change in ventilation to end-tidal carbon dioxide partial pressure (VE/ETCO2) slope.
Description
Change in VE/PETCO2 slope from baseline to 12 weeks of dapagliflozin treatment in comparison to placebo will be assessed. The VE/PETCO2 slope as a prognostic marker in HF will be assessed via cardio-pulmonary exercise test (CPET).
Time Frame
Change between baseline (0 weeks) and after 12 weeks of treatment.
Title
Change in stimulus response to cold pressor test (CPT) of muscle sympathetic nerve activity (MSNA) .
Description
Change in MSNA stimulus response from baseline to 12 weeks of dapagliflozin treatment in comparison to placebo will be assessed. The MSNA will be measured via transcutanous microneurography before and after cold pressor test (CPT).
Time Frame
Change between baseline (0 weeks) and after 12 weeks of treatment.
Title
Change in leg skin tissue sodium content (Skin-Na).
Description
Change in Skin-Na from baseline to 12 weeks of dapagliflozin treatment in comparison to placebo will be assessed. The Skin-Na will be measured via 23Na-magnetic resonance imaging (23Na-MRI) technique.
Time Frame
Change between baseline (0 weeks) and after 12 weeks of treatment.

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion criteria: Male or female, age of 18 or older; Patients with documented diagnosis of chronic or de novo heart failure (NYHA II-IV) and clinically stabilized (considered for hospital discharge) after hospitalization/ ambulatory care because of an acute decompensated (congestive) heart failure (ADHF) event; eGFR ≥ 30 mL/min/1.73 m2 (CKD-EPI formula) at enrolment; Provision of signed informed consent prior to any study specific procedure; Exclusion criteria: Contraindications to the class of drugs under study, e.g. known hypersensitivity or allergy to class of drugs or the investigational product; Receiving therapy with an SGLT2 inhibitor within 8 weeks prior to enrolment or previous intolerance of an SGLT2 inhibitor; Participation in another study with investigational drug within the 30 days preceding and during the present study; Type 1 diabetes mellitus; Symptomatic hypotension or systolic blood pressure <90 mmHg at 2 out of 3 measurements either at visit 1 or visit 2; Coronary revascularization (percutaneous coronary intervention because of STEMI or coronary artery bypass grafting) or valvular repair/replacement within 12 weeks prior to enrolment or planned to undergo any of these operations after randomization; Implantation of a CRT device within 12 weeks prior to enrolment or intent to implant a CRT device during 12 weeks of study observation period if indicated according to the actual guidelines [11]; Previous cardiac transplantation or implantation of a ventricular assistance device or similar device, or implantation expected after randomization; HF due to restrictive cardiomyopathy, active myocarditis, constrictive pericarditis, hypertrophic obstructive cardiomyopathy or uncorrected primary valvular disease; Symptomatic bradycardia or second or third degree heart block without a pacemaker; Severe (eGFR <20 mL/min/1.73 m2 by CKD-EPI), unstable or rapidly progressing renal disease; Women who are pregnant or breast feeding; Intention to become pregnant during the course of the study; Known or suspected non-compliance, drug or alcohol abuse; Inability to follow the procedures of the study, e.g. due to language problems, psychological disorders, dementia, etc. of the participant; Patients with severely restricted liver function; Patients with recurrent mycotic genital infections;
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Thomas Haider, M.D.
Phone
+41(0)442552280
Email
thomas.haider@usz.ch
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Frank Ruschitzka, M.D.
Organizational Affiliation
Cardiology, University Heart Center Zurich
Official's Role
Principal Investigator
Facility Information:
Facility Name
University Heart Center Zurich
City
Zurich
ZIP/Postal Code
8091
Country
Switzerland
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Frank Ruschitzka, MD
Phone
+41442553353
Email
frank.ruschitzka@usz.ch

12. IPD Sharing Statement

Plan to Share IPD
No

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Dapagliflozin on Volume Vascular Outcomes.

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