Natalia Berry1, Laura Mauri1, Ted Feldman2, Jan Komtebedde3, Dirk J van Veldhuisen4, Scott D Solomon1, Joseph M Massaro5, Sanjiv J Shah6. 1. Brigham and Women's Hospital, Boston, MA. 2. NorthShore University Health System, Evanston, IL. 3. Corvia Medical, Tewksbury, MA. 4. University of Groningen, Groningen, the Netherlands. 5. Boston University, Boston, MA. 6. Northwestern University Feinberg School of Medicine, Chicago, IL. Electronic address: sanjiv.shah@northwestern.edu.
Abstract
BACKGROUND: A randomized, sham-controlled trial in patients with heart failure (HF) and left ventricular ejection fraction (LVEF) ≥40% demonstrated reductions in pulmonary capillary wedge pressure (PCWP) with a novel transcatheter InterAtrial Shunt Device (IASD). Whether this hemodynamic effect will translate to an improvement in cardiovascular outcomes and symptoms requires additional study. STUDY DESIGN AND OBJECTIVES: REDUCE Elevated Left Atrial Pressure in Patients with Heart Failure II (REDUCE LAP HF-II) is a multicenter, prospective, randomized, sham-controlled, blinded trial designed to evaluate the clinical efficacy of the IASD in symptomatic HF and elevated left atrial pressures. Up to 608 HF patients age ≥ 40 years with LVEF ≥40%, PCWP ≥25 mm Hg during supine ergometer exercise, and PCWP ≥5 mm Hg higher than right atrial pressure will be randomized 1:1 to the IASD versus sham control. Key exclusion criteria include hemodynamically significant valvular disease, evidence of pulmonary arterial hypertension, and right heart dysfunction. The primary endpoint is a hierarchical composite, analyzed by the Finkelstein-Schoenfeld methodology, that includes (1) cardiovascular mortality or first nonfatal ischemic stroke through 12 months; (2) total (first plus recurrent) HF hospitalizations or healthcare facility visits for intravenous diuretics up to 24 months, analyzed when the last randomized patient completes 12 months of follow-up; and (3) change in Kansas City CardiomyopathyQuestionnaire overall summary score from baseline to 12 months. Follow-up echocardiography will be performed at 6, 12, and 24 months to evaluate shunt flow and cardiac chamber size/function. Patients will be followed for a total of 5 years after the index procedure. CONCLUSIONS: REDUCE LAP-HF II is designed to evaluate the clinical efficacy of the IASD device in patients with symptomatic HF with elevated left atrial pressure and LVEF ≥40%.
RCT Entities:
BACKGROUND: A randomized, sham-controlled trial in patients with heart failure (HF) and left ventricular ejection fraction (LVEF) ≥40% demonstrated reductions in pulmonary capillary wedge pressure (PCWP) with a novel transcatheter InterAtrial Shunt Device (IASD). Whether this hemodynamic effect will translate to an improvement in cardiovascular outcomes and symptoms requires additional study. STUDY DESIGN AND OBJECTIVES: REDUCE Elevated Left Atrial Pressure in Patients with Heart Failure II (REDUCE LAP HF-II) is a multicenter, prospective, randomized, sham-controlled, blinded trial designed to evaluate the clinical efficacy of the IASD in symptomatic HF and elevated left atrial pressures. Up to 608 HF patients age ≥ 40 years with LVEF ≥40%, PCWP ≥25 mm Hg during supine ergometer exercise, and PCWP ≥5 mm Hg higher than right atrial pressure will be randomized 1:1 to the IASD versus sham control. Key exclusion criteria include hemodynamically significant valvular disease, evidence of pulmonary arterial hypertension, and right heart dysfunction. The primary endpoint is a hierarchical composite, analyzed by the Finkelstein-Schoenfeld methodology, that includes (1) cardiovascular mortality or first nonfatal ischemic stroke through 12 months; (2) total (first plus recurrent) HF hospitalizations or healthcare facility visits for intravenous diuretics up to 24 months, analyzed when the last randomized patient completes 12 months of follow-up; and (3) change in Kansas City Cardiomyopathy Questionnaire overall summary score from baseline to 12 months. Follow-up echocardiography will be performed at 6, 12, and 24 months to evaluate shunt flow and cardiac chamber size/function. Patients will be followed for a total of 5 years after the index procedure. CONCLUSIONS: REDUCE LAP-HF II is designed to evaluate the clinical efficacy of the IASD device in patients with symptomatic HF with elevated left atrial pressure and LVEF ≥40%.
Authors: Barry A Borlaug; John Blair; Martin W Bergmann; Heiko Bugger; Dan Burkhoff; Leonhard Bruch; David S Celermajer; Brian Claggett; John G F Cleland; Donald E Cutlip; Ira Dauber; Jean-Christophe Eicher; Qi Gao; Thomas M Gorter; Finn Gustafsson; Chris Hayward; Jan van der Heyden; Gerd Hasenfuß; Scott L Hummel; David M Kaye; Jan Komtebedde; Joseph M Massaro; Jeremy A Mazurek; Scott McKenzie; Shamir R Mehta; Mark C Petrie; Marco C Post; Ajith Nair; Andreas Rieth; Frank E Silvestry; Scott D Solomon; Jean-Noël Trochu; Dirk J Van Veldhuisen; Ralf Westenfeld; Martin B Leon; Sanjiv J Shah Journal: Circulation Date: 2022-03-31 Impact factor: 39.918
Authors: Henrik Fox; Takayuki Gyoten; Sebastian V Rojas; Marcus-André Deutsch; René Schramm; Volker Rudolph; Jan F Gummert; Michiel Morshuis Journal: J Cardiovasc Transl Res Date: 2021-10-28 Impact factor: 3.216