Study of the Acute Effects of Triheptanoin in Heart Failure
NCT ID: NCT01787851
Last Updated: 2018-12-14
Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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WITHDRAWN
PHASE1/PHASE2
INTERVENTIONAL
2013-02-28
2014-02-28
Brief Summary
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Detailed Description
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Patients will randomly be assigned to receive either triheptanoin oil or control treatment (sugar syrup) four times a day one hour before meals and at night for five days. All patients will be given a low fat, low simple sugar diet to avoid potential substrate competition from high serum levels of fats and glucose for the duration of the study procedure. Participants will be blinded to their treatment assignment.
Treatment arm: The standard dose of triheptanoin oil for adults is 1-2gm/kg/24 hours. For purposes of this study, we will administer 0.25mg/kg four-times per day. The liquid study drug will be mixed into sugar-free, low fat yogurt, pudding or nutritional supplement shake, depending on patient preference.
Control arm: One tablespoon of sugar syrup will be mixed into sugar-free, low fat yogurt, pudding or nutritional supplement shake four-times per day before meals.
Thermodilution cardiac index and PCWP will be measured from the indwelling PA catheter at baseline and hourly for the first six hours. During this time, initiation or upward titration of vasodilator and inotropic mediations will be discouraged although the medications will be continued in patients previously on these medications. Patients requiring such vasoactive medications on an urgent basis will have been excluded from study participation (see below). After the first six hours, measurements will be recorded once a day, 90 minutes following ingestion of study medication for the four days of treatment, as well as for the following day off study medication (in order to assess off-treatment hemodynamics). Number and dose of intravenous vasoactive medications will be recorded daily.
The main outcome of interest is the change in cardiac index over the first 6 hours of the study period (before initiation of any other vasoactive medications). Pre-and post-cardiac index will be compared with a paired t-test. With 10 patients per study group, we have 80% power to detect a clinically significant 20% difference (0.4L/min/m2) in cardiac index between treatment assignments. Assuming the need for a non-parametric analysis a "standard" 20% increase in sample size will need sought.
Additionally, the change in cardiac output and PCWP over the five day study period will be compared between group assignments (control vs. triheptanoin oil). Either Friedman's test or ANOVA for repeated measures (depending on satisfaction of the normality assumption) will be employed to detect serial changes between each treatment. Between-group differences at each time-point will be assessed by a two-sample t-test or the Wilcoxon signed rank test. We will also measure off-treatment effects by comparing day 4 (final treatment day) cardiac output and PCWP with day 6 (one day off treatment).
Five (5) cc of blood will be collected into EDTA tubes from the PA catheter at baseline and hourly for the first six hours of the study. An additional 5cc of blood will be obtained on day 4 and day 5. Serum will be isolated and stored at -80C until completion of the study. At that time, the samples will be assayed for metabolic profiles, to include acylcarnitine and fatty acid metabolites. Prior work has demonstrated significant increases in serum odd-chain fatty acids, acyl-carnitines and ketones following ingestion.These data will inform on the pharmacodynamics of triheptanoin metabolism in the setting of HF. At baseline and on day 4 a urine sample will be obtained and assayed for species related to proprionate metabolism.
Conditions
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Keywords
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Study Design
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RANDOMIZED
PARALLEL
TREATMENT
SINGLE
Study Groups
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Triheptanoin oil
The standard dose of triheptanoin oil for adults is 1-2gm/kg/24 hours. For purposes of this study, we will administer 0.25mg/kg four-times per day. The liquid study drug will be mixed into sugar-free, low fat yogurt, pudding or nutritional supplement shake, depending on patient preference.
Triheptanoin oil
Simple sugar
0.25mg/kg of sugar syrup will be mixed into sugar-free, low fat yogurt, pudding or nutritional supplement shake four-times per day before meals.
Triheptanoin oil
Interventions
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Triheptanoin oil
Eligibility Criteria
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Inclusion Criteria
1. DCM with left ventricular ejection fraction (LVEF) ≤40%
2. New York Heart Association (NYHA) class III-IV symptoms
3. age ≥18
4. an indwelling PA catheter
5. and an anticipated clinical requirement for a PA catheter for at least five days.
Exclusion Criteria
1. urgent (\<6 hr) need for (or increase in) inotropic support (INTERMACS profile 1)
2. diabetes mellitus
3. known disorder of the respiratory chain or mitochondrial cardiomyopathy
4. significant hyperlipidemia with triglyceride value \>300mg/dL
5. normal cardiac index (\>2.5L/min/m2) on initial right heart catheterization
6. indwelling intra-aortic balloon pump
7. chronic liver disease
8. severe renal dysfunction (CKD stage IV-V) with creatinine clearance \<30 mL/min/1.73m2
9. more than moderate valvular stenosis or regurgitation
10. pregnancy or breastfeeding
11. peripartum cardiomyopathy diagnosed within the past year
12. inability to provide informed consent
18 Years
ALL
No
Sponsors
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University of Texas Southwestern Medical Center
OTHER
Responsible Party
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Aslan Turer
Assistant Professor of Medicine
Principal Investigators
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Aslan T Turer, MD, MHS
Role: PRINCIPAL_INVESTIGATOR
UT-Southwestern
Locations
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University of Texas-Southwestern
Dallas, Texas, United States
Countries
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Other Identifiers
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UTSW 65827-1
Identifier Type: -
Identifier Source: org_study_id