Impact of Diabetes on Left Ventricular Remodeling
P3
Phase 2/3 Study of Effect of AT1RB Versus ACE Inhibitor in Addition to XO Inhibitor on Progression of LV Remodeling and Dysfunction in Diabetic Patients With Acute MI.
1 other identifier
interventional
72
1 country
1
Brief Summary
The investigators hypothesize that in patients with diabetes and acute myocardial infarction (MI), Ang II type-1 receptor blockade (AT1RB) attenuates left ventricle (LV) remodeling to a greater extent than angiotensin converting enzyme (ACE) inhibitor therapy and that the addition of xanthine oxidase (XO) inhibitor, Allopurinol, results in further improvement in LV remodeling and function in the follow-up phase after MI.
Trial Health
Trial Health Score
Automated assessment based on enrollment pace, timeline, and geographic reach
participants targeted
Target at P50-P75 for phase_2 diabetes
Started Jul 2005
Longer than P75 for phase_2 diabetes
1 active site
Health score is calculated from publicly available data and should be used for screening purposes only.
Trial Relationships
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Study Timeline
Key milestones and dates
Study Start
First participant enrolled
July 1, 2005
CompletedFirst Submitted
Initial submission to the registry
January 15, 2010
CompletedFirst Posted
Study publicly available on registry
January 20, 2010
CompletedPrimary Completion
Last participant's last visit for primary outcome
November 1, 2010
CompletedStudy Completion
Last participant's last visit for all outcomes
November 1, 2010
CompletedResults Posted
Study results publicly available
December 17, 2012
CompletedDecember 17, 2012
November 1, 2012
5.3 years
January 15, 2010
March 20, 2012
November 16, 2012
Conditions
Keywords
Outcome Measures
Primary Outcomes (7)
Left Ventricular End Diastolic Volume Indexed to Body Surface Area (LVEDV/BSA)
LVEDV/BSA: As an indicator of heart size, the blood volume of the heart is related to the body size. The relation of heart blood volume to body size is more accurate in determining pathology because larger people require a larger heart blood volume. The values that are too high or too low indicate a diseased myocardium. This is a measure of LV Diastolic Function. Since some visits did not occur at the scheduled 6 month intervals, the results have been divided into 3-month visit intervals.
5 visits per Participant over 2 years (about every 6 months)
Left Ventricular End-Diastolic Radius to Wall Thickness (LVED Radius/Wall Thickness)
LVED Radius/Wall thickness As an indicator of heart muscle mass and heart volume chamber diameter, the end-diastolic radius indexed to end diastolic wall thickness determines whether there is an adequate amount of heart muscle to pump the heart blood volume obtained from a two-dimensional analysis. The values that are too high or too low indicate a diseased myocardium. This is a measure of LV Geometry. Since some visits did not occur at the scheduled 6 month intervals, the results have been divided into 3-month visit intervals for reporting purposes.
5 visits per Participant over 2 years (about every 6 months)
Left Ventricular End-diastolic Mass Indexed to Left Ventricular End-diastolic Volume (LVED Mass/LVEDV)
LVED Mass/LVEDV: As an indicator of heart muscle mass and heart blood volume, the mass indexed to end diastolic volume determines whether there is an adequate amount of heart muscle to pump the heart blood volume obtained from a three-dimensional analysis. The values that are too high or too low indicate a diseased myocardium. This is a measure of LV Geometry. Since some visits did not occur at the scheduled 6 month intervals, the results have been divided into 3-month visit intervals for reporting purposes.
5 visits per Participant over 2 years (about every 6 months)
Left Ventricular Ejection Fraction (LVEF)
LVEF is a calculation of heart pump function determined from the volume after complete filling minus the volume after complete contraction divided by the volume after complete filling. A value of 55% or greater is normal. This is a measure of LV Systolic Function. Since some visits did not occur at the scheduled 6 month intervals, the results have been divided into 3-month visit intervals for reporting purposes
5 visits per Participant over 2 years (about every 6 months)
Left Ventricular End Systolic Volume Indexed to Body Surface Area (LVESV/BSA)
LVESV/BSA: The end systolic volume is the blood volume of the heart at the end of contraction and is an index of the pump function of the heart. This relation to body size is more accurate in determining pathology because larger people require a larger heart blood volume. The values that are too high or too low indicate a diseased myocardium. This is a measure of LV Systolic Function. Since some visits did not occur at the scheduled 6 month intervals, the results have been divided into 3-month visit intervals.
5 visits per Participant over 2 years (about every 6 months)
LV End Systolic Maximum Shortening (LVES Max Shortening)
By identifying three points in three different planes in the heart muscle, the maximum shortening is the average of the difference between the distance between these three points at the end of filling of the heart and the end of contraction divided by the length at the end of filling times 100. The maximum shortening is a three dimensional analysis. The higher values indicate a healthy heart. This is a measure of LV Systolic Function. Since some visits did not occur at the scheduled 6 month intervals, the results have been divided into 3-month visit intervals for reporting purposes.
5 visits per Participant over 2 years (about every 6 months)
Peak Early Filling Rate Normalized to EDV
The Peak Early Filling Rate Normalized to EDV is calculated from the slope of the volume during the early filling of the heart with respect to time. The higher values indicate a very healthy heart muscle and lower values are indicative of a very stiff muscle. This is a measure of LV Diastolic Function. Since some visits did not occur at the scheduled 6 month intervals, the results have been divided into 3-month visit intervals for reporting purposes.
5 visits per Participant over 2 years (about every 6 months)
Study Arms (4)
Ramipril
ACTIVE COMPARATORThe starting dose of Ramipril will be 2.5 mg once daily and rapidly titrated upward to 5 mg once daily after 5 days if systolic blood pressure is greater than 100 mmHg. After one month the patient will return to clinic for blood pressure check and will be titrated up to 10 mg once daily.
Candesartan cilexetil
ACTIVE COMPARATORThe starting dose of Candesartan cilexetil will be 4 mg or 8 mg once daily and doubled every 2 weeks, if systolic blood pressure is greater than 100 mmHg, to a maximum dose of 32 mg once daily. After one month the patient will return to clinic for blood pressure check and will be titrated up to 32 mg once daily.
Ramipril and Allopurinol
ACTIVE COMPARATORThe starting dose of Ramipril will be 2.5 mg once daily and rapidly titrated upward to 5 mg once daily after 5 days if systolic blood pressure is greater than 100 mmHg. After one month the patient will return to clinic for blood pressure check and will be titrated up to 10 mg once daily. It is anticipated that the starting dose of each drug will be initiated in hospital and that the second dose will be implemented prior to discharge from the hospital. The starting dose of Allopurinol is 300 mg daily.
Candesartan cilexetil and Allopurinol
ACTIVE COMPARATORThe starting dose of Candesartan cilexetil will be 4 mg or 8 mg once daily and doubled every 2 weeks, if systolic blood pressure is greater than 100 mmHg, to a maximum dose of 32 mg once daily. After one month the patient will return to clinic for blood pressure check and will be titrated up to 32 mg once daily. The starting dose of Allopurinol is 300 mg daily.
Interventions
The starting dose of Ramipril will be 2.5 mg once daily and rapidly titrated upward to 5 mg once daily after 5 days if systolic blood pressure is greater than 100 mmHg. After one month the patient will return to clinic for blood pressure check and will be titrated up to 10 mg once daily.
The starting dose of Candesartan cilexetil will be 4 mg or 8 mg once daily and doubled every 2 weeks, if systolic blood pressure is greater than 100 mmHg, to a maximum dose of 32 mg once daily. After one month the patient will return to clinic for blood pressure check and will be titrated up to 32 mg once daily.
The starting dose of Allopurinol is 300 mg daily.
Eligibility Criteria
You may qualify if:
- years old or older
- MI documented by increase in troponin \> 0.78 ng/ml or CKMB ≥ 3% of total CK
- Patients who have Type-2 diabetes defined by any one of the following:
- Confirmed (i.e., two or more readings) fasting blood glucose \>126mg/dl; or
- Random glucose ≥200mg/dl; or
- hour glucose ≥200mg/dl following 75g of glucose; or
- Current treatment with diet or oral agents directed at the control of hyperglycemia either alone or in combination with insulin; or
- Current treatment with insulin with no prior history of diabetic ketoacidosis.
You may not qualify if:
- Type-1 diabetes.
- Class III or IV heart failure.
- Cardiomyopathy (including hypertrophic and amyloidosis).
- Congenital or pericardial diseases.
- Intolerance to either ACE inhibitor, AT1-RB or allopurinol.
- Renal failure with creatinine \> 2.5 mg/dl.
- Renal artery stenosis.
- Severe comorbidity such as liver disease or malignancy.
- Pregnancy (negative pregnancy test and effective contraceptive methods are required prior to enrollment of females of childbearing potential (not post-menopausal or surgically sterilized).
- Chronic steroid use.
- Unable to understand or cooperate with protocol requirements.
- Severe claustrophobia.
- Presence of a pacemaker or non-removable hearing aid.
- Presence of metal clips in the body.
Contact the study team to confirm eligibility.
Sponsors & Collaborators
- University of Alabama at Birminghamlead
- National Heart, Lung, and Blood Institute (NHLBI)collaborator
- AstraZenecacollaborator
Study Sites (1)
University of Alabama at Birmingham
Birmingham, Alabama, 35294-2180, United States
Related Publications (39)
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PMID: 10361050BACKGROUNDEffect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. The Acute Infarction Ramipril Efficacy (AIRE) Study Investigators. Lancet. 1993 Oct 2;342(8875):821-8.
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PMID: 11532907BACKGROUNDde Jong JW, Schoemaker RG, de Jonge R, Bernocchi P, Keijzer E, Harrison R, Sharma HS, Ceconi C. Enhanced expression and activity of xanthine oxidoreductase in the failing heart. J Mol Cell Cardiol. 2000 Nov;32(11):2083-9. doi: 10.1006/jmcc.2000.1240.
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PMID: 11742938BACKGROUNDRouleau JL, Pitt B, Dhalla NS, Dhalla KS, Swedberg K, Hansen MS, Stanton E, Lapointe N, Packer M; Canadian Prospective RandOmized FlosequInan Longevity Evaluation Investigators. Prognostic importance of the oxidized product of catecholamines, adrenolutin, in patients with severe heart failure. Am Heart J. 2003 May;145(5):926-32. doi: 10.1016/s0002-8703(02)94782-4.
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PMID: 10676683BACKGROUND
MeSH Terms
Conditions
Interventions
Condition Hierarchy (Ancestors)
Intervention Hierarchy (Ancestors)
Results Point of Contact
- Title
- Louis . J. Dell'Italia, M.D
- Organization
- University of Alabama at Birmingham
Study Officials
- PRINCIPAL INVESTIGATOR
Louis J. Dell'Italia, M.D.
University of Alabama at Birmingham
Publication Agreements
- PI is Sponsor Employee
- No
- Restrictive Agreement
- No
Study Design
- Study Type
- interventional
- Phase
- phase 2
- Allocation
- RANDOMIZED
- Masking
- NONE
- Purpose
- TREATMENT
- Intervention Model
- FACTORIAL
- Sponsor Type
- OTHER
- Responsible Party
- PRINCIPAL INVESTIGATOR
- PI Title
- Principal Investigator
Study Record Dates
First Submitted
January 15, 2010
First Posted
January 20, 2010
Study Start
July 1, 2005
Primary Completion
November 1, 2010
Study Completion
November 1, 2010
Last Updated
December 17, 2012
Results First Posted
December 17, 2012
Record last verified: 2012-11