This study examines the effect of Entresto on central hemodynamic parameters during exercise in patients with diastolic dysfunction following acute myocardial infarction. Half of the patients will receive Entresto and the other half will receive placebo.
In patients with acute myocardial infraction (AMI) only 25-33% have entirely normal left ventricular (LV) systolic and diastolic function. Studies have show that echocardiographic signs of increased LV filling pressure (diastolic dysfunction) are associated with poor outcome after AMI. The optimal management of this group of patients is currently not known. LCZ696 is a novel combination drug consisting of two antihypertensives, sacubitril and valsartan. LCZ696 have demonstrated to reduce mortality in patients with systolic heart failure. In patients with heart failure with preserved ejection fraction a positive effect has been demonstrated on natriuretic peptides and left atrial remodelling when treated with LCZ696, further, experimental data suggest inhibition of cardiac fibrosis. Hypothesis: LCZ696 compared with placebo will improve central hemodynamics (reduce pulmonary capillary wedge pressure (PCWP)), and increase cardiac index (CI) during exercise in patients with diastolic dysfunction following AMI. A beneficial effect that is attributed to improved cardiac remodelling (attenuation of cardiac fibrosis). Primary objective To asses the effect of 6 months treatment with LCZ696 compared with placebo on ratio of PCWP/CI during exercise in patients with a recent AMI and Doppler echocardiographic signs of diastolic dysfunction and preserved systolic function.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
51
NO other interventions
Department of Cardiology, Rigshospitalet
Copenhagen, Denmark
Department of Cardiology, Odense Universityhospital
Odense, Denmark
Central hemodynamics
The primary endpoint will be the ratio of mean PCWP at peak exercise divided by cardiac index at peak exercise.
Time frame: 26 weeks
cardiac MRI
Amount of hyperenhancement on cardiac MRI using a semiquantitative assessment of late gadolinium hyperenhancement in a 17 segment model of the LV.
Time frame: 26 weeks
Biomarker 1
ST2 concentration at rest.
Time frame: 26 weeks
Biomarker 2
MR-proANP at rest.
Time frame: 26 weeks
Biomarker 3
NT-proBNP at rest.
Time frame: 26 weeks
Echocardiographic 1
Left atrial volume by echocardiography and left atrial emptying fraction by echocardiography at rest.
Time frame: 26 weeks
Echocardiographic 2
Proportion of patients with moderate or severe diastolic dysfunction at rest.echocardiography at rest.
Time frame: 26 weeks
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