Evaluation of Sildenafil for the Treatment of Moderate Congestive Heart Failure
Primary Purpose
Heart Failure
Status
Withdrawn
Phase
Phase 4
Locations
United States
Study Type
Interventional
Intervention
Sildenafil
Sponsored by
About this trial
This is an interventional treatment trial for Heart Failure focused on measuring Heart failure, Sildenafil, Cardiopulmonary exercise test, quality of life, 6 minute walk test
Eligibility Criteria
Inclusion Criteria:
- Age greater than 18 years
- Diagnosis of chronic heart failure with an ejection fraction less than or equal to 45% per either an echocardiogram, nuclear cardiolyte stress test, or cardiac catheterization performed within the past 6 months.
- New York Heart Association Functional Class III
- Must be on optimal heart failure therapy according to AHA/ACC heart failure guidelines, including treatment with ACEI and beta-blocker therapy, or have documented rationale for variation, including intolerance, contraindication, patient preference, or personal physician's judgment
Exclusion Criteria:
- Comorbid disease or behavioral or other limitations that: 1) interfere with performing exercise test, or 2) prevent completion of 12 week study
- Currently pregnant or intent to become pregnant in the next 12 weeks or currently breastfeeding.
- Major cardiovascular event or cardiovascular procedure within the prior 6 weeks
- History of Chronic Obstructive Pulmonary Disease or Reactive Airway Disease
- Known hypersensitivity to sildenafil
- Current use of medications known to be a potent inhibitor of CYP3A4 (e.g., ritonavir, ketoconazole, itraconazole)
- Current or recent (within 6 months) use of organic nitrate medications (e.g. isosorbide dinitrate, sublingual nitroglycerin)
- Known diagnosis of pulmonary veno-occlusive disease or non-arteritic anterior ischemic optic neuropathy
Sites / Locations
- Clinical Translational Science Center
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
Sildenafil
Arm Description
All patients will receive open-label treatment with sildenafil.
Outcomes
Primary Outcome Measures
Change in 6-minute walk distance
Secondary Outcome Measures
Changes in peak oxygen consumption (measured by cardiopulmonary exercise testing)
Change in the level of neurohormones (b-type natriuretic peptide, catecholamines, ET-1),
Change in quality of life
Full Information
NCT ID
NCT00793338
First Posted
November 17, 2008
Last Updated
June 23, 2023
Sponsor
University of New Mexico
1. Study Identification
Unique Protocol Identification Number
NCT00793338
Brief Title
Evaluation of Sildenafil for the Treatment of Moderate Congestive Heart Failure
Official Title
Evaluation of Sildenafil for the Treatment of Moderate Congestive Heart Failure
Study Type
Interventional
2. Study Status
Record Verification Date
June 2023
Overall Recruitment Status
Withdrawn
Why Stopped
The project was not funded and could not be initiated.
Study Start Date
November 2008 (undefined)
Primary Completion Date
November 2010 (Anticipated)
Study Completion Date
February 2011 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of New Mexico
4. Oversight
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
The purpose of the study is to evaluate whether sildenafil helps treat heart failure. Some patients with heart failure have high blood pressure in the lungs (referred to as "pulmonary hypertension"). Sildenafil is a medication that is used to treat high blood pressure in the lungs and may reduce symptoms of heart failure. Studies have looked at the short-term benefit of sildenafil in patients with congestive heart failure, but this study will look at the longer-term benefits of 12 weeks of therapy with sildenafil.
Detailed Description
Objective: To determine the effect of acute and long-term treatment with sildenafil on the clinical status of patients with moderate HF. Secondary Objectives: To determine the effect of acute and long-term treatment with sildenafil on cardiopulmonary exercise performance, the effect of acute and long-term treatment with sildenafil on neurohormonal activation, the effect of acute and long-term treatment with sildenafil on hemodynamics, and the effect of long-term treatment with sildenafil on quality of life. Background: Secondary pulmonary hypertension (PH) is a frequent manifestation of heart failure resulting in impaired vascular reactivity and permeability which contributes to the symptoms of HF. Levels of endothelin-1 (ET-1), a potent vasoconstrictor, are increased in patients with HF. At the same time, pulmonary artery nitric oxide (NO) production is decreased. NO increases concentrations of the second messenger cyclic-GMP, ultimately leading to vasodilation. This imbalance between NO-dependent vasodilation and ET-1 induced vasoconstriction likely contributes to the development of secondary pulmonary hypertension. cGMP is metabolized by the type 5 isoform of phosphodiesterase (PDE5) an enzyme that is highly expressed in the lung. Sildenafil, a selective PDE5 inhibitor, has been used extensively for the treatment of erectile dysfunction and has recently been approved for use in the treatment of PH. Recent studies of short-term administration of sildenafil in HF patients with secondary PH have demonstrated reductions in pulmonary arterial pressure, pulmonary vascular resistance, pulmonary capillary wedge pressure, and systemic vascular resistance while increasing cardiac index and exercise performance. However, it remains to be seen if sildenafil is safe and effective in the long-term treatment of heart failure. Methods: This will be an open-label, pilot study designed to evaluate the safety and efficacy of sildenafil for the treatment of moderate heart failure. The primary endpoint will be change in 6-minute walk test distance. Secondary endpoints will be changes in peak oxygen consumption (measured by cardiopulmonary exercise testing), neurohormones (b-type natriuretic peptide, catecholamines, ET-1), quality of life scores. Additionally, we will attempt to analyze responsiveness to sildenafil on the basis of PDE5 polymorphisms. Study procedures will be performed at the UNM General Clinical Research Center and the UNM Congestive Heart Failure Clinic. Patients will be hospitalized for 3 days to analyze safety and efficacy of sildenafil administered three times daily. Patients will complete exercise testing, neurohormone, and hemodynamic assessments at baseline (day 1) and following 24 hours of sildenafil treatment. The patients will then be discharged to complete a 12-week maintenance phase of treatment. At the conclusion of the maintenance phase the patients will be readmitted for 2 day to have repeat measurements performed. The main analysis will be done using paired t-tests. All statistical analysis will be performed using SAS v6.12.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Heart Failure
Keywords
Heart failure, Sildenafil, Cardiopulmonary exercise test, quality of life, 6 minute walk test
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
0 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Sildenafil
Arm Type
Experimental
Arm Description
All patients will receive open-label treatment with sildenafil.
Intervention Type
Drug
Intervention Name(s)
Sildenafil
Other Intervention Name(s)
Heart failure, Cardiopulmonary exercise test
Intervention Description
Sildenafil 20mg three times a day for 3 months.
Primary Outcome Measure Information:
Title
Change in 6-minute walk distance
Time Frame
24 hours and 3 months
Secondary Outcome Measure Information:
Title
Changes in peak oxygen consumption (measured by cardiopulmonary exercise testing)
Time Frame
24 hours and 3 months
Title
Change in the level of neurohormones (b-type natriuretic peptide, catecholamines, ET-1),
Time Frame
24 hours and 3 months
Title
Change in quality of life
Time Frame
3 months
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
99 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Age greater than 18 years
Diagnosis of chronic heart failure with an ejection fraction less than or equal to 45% per either an echocardiogram, nuclear cardiolyte stress test, or cardiac catheterization performed within the past 6 months.
New York Heart Association Functional Class III
Must be on optimal heart failure therapy according to AHA/ACC heart failure guidelines, including treatment with ACEI and beta-blocker therapy, or have documented rationale for variation, including intolerance, contraindication, patient preference, or personal physician's judgment
Exclusion Criteria:
Comorbid disease or behavioral or other limitations that: 1) interfere with performing exercise test, or 2) prevent completion of 12 week study
Currently pregnant or intent to become pregnant in the next 12 weeks or currently breastfeeding.
Major cardiovascular event or cardiovascular procedure within the prior 6 weeks
History of Chronic Obstructive Pulmonary Disease or Reactive Airway Disease
Known hypersensitivity to sildenafil
Current use of medications known to be a potent inhibitor of CYP3A4 (e.g., ritonavir, ketoconazole, itraconazole)
Current or recent (within 6 months) use of organic nitrate medications (e.g. isosorbide dinitrate, sublingual nitroglycerin)
Known diagnosis of pulmonary veno-occlusive disease or non-arteritic anterior ischemic optic neuropathy
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Joe R Anderson, PharmD
Organizational Affiliation
University of New Mexico College of Pharmacy
Official's Role
Principal Investigator
Facility Information:
Facility Name
Clinical Translational Science Center
City
Albuquerque
State/Province
New Mexico
ZIP/Postal Code
87131
Country
United States
12. IPD Sharing Statement
Plan to Share IPD
Undecided
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Evaluation of Sildenafil for the Treatment of Moderate Congestive Heart Failure
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