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Sacubitril/Valsartan in Left Ventricular Assist Device Recipients (ENVAD-HF)

Primary Purpose

Heart Failure

Status
Recruiting
Phase
Phase 4
Locations
International
Study Type
Interventional
Intervention
Sacubitril-Valsartan
Standard of care
Sponsored by
University of Zagreb
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Heart Failure focused on measuring LVAD (Left Ventricular Assist Device), sacubitril/valsartan, heart failure

Eligibility Criteria

18 Years - 90 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Written informed consent must be obtained before any assessment is performed.
  2. ≥18 years of age, male or female
  3. Recently implanted HeartMate 3 LVAD recipients, in stable condition and deemed ready for discharge or chronic, stable, ambulatory HeartMate 3 LVAD carriers implanted within 1 year prior to enrolment

1. Current acute decompensated HF (including right ventricular failure) requiring therapy with intravenous diuretics or vasodilators and/or inotropic drugs within the past 48 hours 2. History of hypersensitivity to sacubitril/valsartan or to drugs of similar chemical classes, patients with a known history of angioedema 3. Patients with mean blood pressure ≤75 mmHg (systolic blood pressure i.e. Doppler opening blood pressure ≤90 mmHg in those pulsatile and measured by Doppler method) or symptomatic hypotension 4. eGFR < 30 mL/min/1.73m2 as calculated by the Modification in Diet in Renal Disease (MDRD) formula at Visit 1 5. Patients with serum potassium >5.4 mmol/L (mEq/L) at Visit 1 6. Hemodynamically unstable patients or those with ongoing MCS other than LVAD or those with planned biventricular support 7. Hemodynamically significant aortic insufficiency in the opinion of the investigator 8. Irreversible end-organ dysfunction 9. Previous sacubitril/valsartan use while on LVAD support 10. Acute coronary syndrome, stroke, transient ischemic attack, cardiac, carotid or other major CV surgery, percutaneous coronary intervention (PCI) or carotid angioplasty within 30 days prior to enrolment 11. Life-threatening or uncontrolled dysrhythmia, including symptomatic or sustained ventricular tachycardia and atrial fibrillation or flutter with a resting ventricular rate >110 bpm at enrolment 12. Any surgical or medical condition, which in the opinion of the Investigator, may place the patient at higher risk from his/her participation in the study, or is likely to prevent the patient from complying with the requirements of the study or completing the study 13. Active infection with hemodynamic compromise 14. hemoglobin (Hgb) <8 g/dl 15. body mass index (BMI) > 45 kg/m2 16. Congenital heart disease 17. Coronary or carotid artery disease or valvular heart disease likely to require surgical or percutaneous intervention within the 6 months after enrolment 18. Evidence of hepatic disease as determined by any one of the following: SGOT (AST) or SGPT (ALT) values exceeding 3x ULN, bilirubin >1.5 mg/dl at Visit 1 19. Pregnant or nursing (lactating) women and women of child-bearing potential unless they are using highly effective methods of contraception

Sites / Locations

  • University Hospital Centre ZagrebRecruiting
  • University Hospital DubravaRecruiting
  • Erasmus Medical CentreRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

sacubitril/valsartan

Standard of care

Arm Description

Standard of care for treating blood pressure per center protocols

Outcomes

Primary Outcome Measures

Freedom from all-cause death, deterioration in renal function (reaching end-stage renal disease (ESRD), renal death or 50% decline in eGFR), hyperkalemia or symptomatic hypotension
End-stage renal disease defined as one of the following: Initiation of dialysis (e.g., hemodialysis, peritoneal dialysis, or continuous venovenous hemodialysis), continuing for ≥ 20 days without known recovery of renal function Initiation of dialysis with death before 30 days (excludes dialysis events associated with acute kidney injury with death before 30 days) A drop in eGFR from baseline (randomization, i.e. Visit 101) to a value <15 mL/min/1.73m2 on two consecutive measurements separated by≥ 20 days Occurrence of kidney transplantation 50% sustained decline in eGFR: 50% decline from baseline (Randomization, Visit 101) as determined by 2 consecutive post-baseline measurements separated by ≥ 20 days Hyperkalemia: serum potassium ≥6.0 mmol/L [mEq/L]) Hypotension: symptomatic reduction in blood pressure requiring withdrawal of study medication or any BP lowering medication

Secondary Outcome Measures

Change in NT-proBNP from enrolment to 8 weeks
Change in Burden of hemocompatibility (hemocompatibility score)
Number of RV failure events
Time to first unplanned hospitalisation
Number of unplanned hospitalizations
Change in blood-pressure lowering medications
Change in eGFR values

Full Information

First Posted
September 20, 2019
Last Updated
January 17, 2022
Sponsor
University of Zagreb
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1. Study Identification

Unique Protocol Identification Number
NCT04103554
Brief Title
Sacubitril/Valsartan in Left Ventricular Assist Device Recipients
Acronym
ENVAD-HF
Official Title
A Multicenter, Randomized, Open-label, Parallel Group, Pilot Study to Evaluate the Use of Sacubitril/Valsartan in HeartMate 3 LVAD Recipients
Study Type
Interventional

2. Study Status

Record Verification Date
January 2022
Overall Recruitment Status
Recruiting
Study Start Date
February 5, 2021 (Actual)
Primary Completion Date
November 2022 (Anticipated)
Study Completion Date
August 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Zagreb

4. Oversight

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

5. Study Description

Brief Summary
The primary objective of this study is to assess the safety and tolerability of sacubitril/valsartan compared with standard of care used for treating BP in patients that have been implanted with the Heart Mate 3 LVAD (events of special interest - all cause death, right ventricular failure, bleeding events, deterioration in renal function, hyperkalemia, symptomatic hypotension).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Heart Failure
Keywords
LVAD (Left Ventricular Assist Device), sacubitril/valsartan, heart failure

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
60 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
sacubitril/valsartan
Arm Type
Experimental
Arm Title
Standard of care
Arm Type
Active Comparator
Arm Description
Standard of care for treating blood pressure per center protocols
Intervention Type
Drug
Intervention Name(s)
Sacubitril-Valsartan
Intervention Description
Sacubitril-Valsartan 24/26 mg BID, 49/51 mg BID, 97/103 mg BID
Intervention Type
Drug
Intervention Name(s)
Standard of care
Intervention Description
standard of care used for treating BP
Primary Outcome Measure Information:
Title
Freedom from all-cause death, deterioration in renal function (reaching end-stage renal disease (ESRD), renal death or 50% decline in eGFR), hyperkalemia or symptomatic hypotension
Description
End-stage renal disease defined as one of the following: Initiation of dialysis (e.g., hemodialysis, peritoneal dialysis, or continuous venovenous hemodialysis), continuing for ≥ 20 days without known recovery of renal function Initiation of dialysis with death before 30 days (excludes dialysis events associated with acute kidney injury with death before 30 days) A drop in eGFR from baseline (randomization, i.e. Visit 101) to a value <15 mL/min/1.73m2 on two consecutive measurements separated by≥ 20 days Occurrence of kidney transplantation 50% sustained decline in eGFR: 50% decline from baseline (Randomization, Visit 101) as determined by 2 consecutive post-baseline measurements separated by ≥ 20 days Hyperkalemia: serum potassium ≥6.0 mmol/L [mEq/L]) Hypotension: symptomatic reduction in blood pressure requiring withdrawal of study medication or any BP lowering medication
Time Frame
3 months
Secondary Outcome Measure Information:
Title
Change in NT-proBNP from enrolment to 8 weeks
Time Frame
8 weeks
Title
Change in Burden of hemocompatibility (hemocompatibility score)
Time Frame
3 months, 12 months
Title
Number of RV failure events
Time Frame
3 months, 12 months
Title
Time to first unplanned hospitalisation
Time Frame
3 months, 12 months
Title
Number of unplanned hospitalizations
Time Frame
3 months, 12 months
Title
Change in blood-pressure lowering medications
Time Frame
3 months, 12 months
Title
Change in eGFR values
Time Frame
3 months, 12 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
90 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Written informed consent must be obtained before any assessment is performed. ≥18 years of age, male or female Recently implanted HeartMate 3 LVAD recipients, in stable condition and deemed ready for discharge or chronic, stable, ambulatory HeartMate 3 LVAD carriers implanted within 1 year prior to enrolment 1. Current acute decompensated HF (including right ventricular failure) requiring therapy with intravenous diuretics or vasodilators and/or inotropic drugs within the past 48 hours 2. History of hypersensitivity to sacubitril/valsartan or to drugs of similar chemical classes, patients with a known history of angioedema 3. Patients with mean blood pressure ≤75 mmHg (systolic blood pressure i.e. Doppler opening blood pressure ≤90 mmHg in those pulsatile and measured by Doppler method) or symptomatic hypotension 4. eGFR < 30 mL/min/1.73m2 as calculated by the Modification in Diet in Renal Disease (MDRD) formula at Visit 1 5. Patients with serum potassium >5.4 mmol/L (mEq/L) at Visit 1 6. Hemodynamically unstable patients or those with ongoing MCS other than LVAD or those with planned biventricular support 7. Hemodynamically significant aortic insufficiency in the opinion of the investigator 8. Irreversible end-organ dysfunction 9. Previous sacubitril/valsartan use while on LVAD support 10. Acute coronary syndrome, stroke, transient ischemic attack, cardiac, carotid or other major CV surgery, percutaneous coronary intervention (PCI) or carotid angioplasty within 30 days prior to enrolment 11. Life-threatening or uncontrolled dysrhythmia, including symptomatic or sustained ventricular tachycardia and atrial fibrillation or flutter with a resting ventricular rate >110 bpm at enrolment 12. Any surgical or medical condition, which in the opinion of the Investigator, may place the patient at higher risk from his/her participation in the study, or is likely to prevent the patient from complying with the requirements of the study or completing the study 13. Active infection with hemodynamic compromise 14. hemoglobin (Hgb) <8 g/dl 15. body mass index (BMI) > 45 kg/m2 16. Congenital heart disease 17. Coronary or carotid artery disease or valvular heart disease likely to require surgical or percutaneous intervention within the 6 months after enrolment 18. Evidence of hepatic disease as determined by any one of the following: SGOT (AST) or SGPT (ALT) values exceeding 3x ULN, bilirubin >1.5 mg/dl at Visit 1 19. Pregnant or nursing (lactating) women and women of child-bearing potential unless they are using highly effective methods of contraception
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Filip Puskaric, MD
Phone
385997505240
Email
filip.puskaric@mef.hr
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Maja Cikes, MD, PhD
Organizational Affiliation
University of Zagreb School of Medicine
Official's Role
Principal Investigator
Facility Information:
Facility Name
University Hospital Centre Zagreb
City
Zagreb
ZIP/Postal Code
10000
Country
Croatia
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Nina Jakush, MD
Phone
+385915605795
Email
nina.jakush@gmail.com
First Name & Middle Initial & Last Name & Degree
Maja Cikes, MD, PhD
Facility Name
University Hospital Dubrava
City
Zagreb
ZIP/Postal Code
10000
Country
Croatia
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Gloria Šestan, MD
Phone
+385989783892
Email
gloria.sestan@gmail.com
First Name & Middle Initial & Last Name & Degree
Igor Rudež, MD, PhD
Facility Name
Erasmus Medical Centre
City
Rotterdam
ZIP/Postal Code
3015 GD
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Elisabeth J. Huijskens
Phone
0107039307
Email
e.huijskens@erasmusmc.nl
First Name & Middle Initial & Last Name & Degree
Jasper J. Brugts, MD, PhD

12. IPD Sharing Statement

Plan to Share IPD
Undecided

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Sacubitril/Valsartan in Left Ventricular Assist Device Recipients

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