Efficacy of Furosemide Versus Vascular Filling in Patients With Acute Myocardial Infarction

Study Overview
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Brief Summary
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Right ventricular necrosis increases patient in hospital mortality and can be observed in 20-50% of patients admitted for during acute myocardial infarction. Current guidelines recommend managing cardiogenic shock related to right ventricular necrosis by optimizing RV load using fluid expansion and if insufficient adding inotropic support. However, several experimental studies reported a potential deleterious effect of right ventricular dilation related to fluid expansion because right and left ventricular interaction decreases stroke volume and cardiac output. Consistently with these finding, a study on a small patient sample conducted at Henri Mondor Hospital demonstrates the safety and efficiency of furosemide in patients with right ventricular necrosis. The present study is a phase 3, interventional, prospective, randomized, multicenter, double-blind analysis by intention to treat. The main objective is to demonstrate improved hemodynamic parameters in the short term in patients admitted for acute myocardial infarction with extension RV treated with furosemide. The primary endpoint is compare the change in cardiac output in patients admitted and treated by either fluid expansion or furosemide. The study population will consist in 88 patients and the duration of subjects' participation will be one month.

Official Title
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Efficacy of Furosemide Versus Vascular Filling in Patients With Acute Myocardial Infarction With Right Ventricular Extension: A Multicentric Randomized Controlled Trial

Conditions
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Acute Myocardial Infarction With Right Ventricular Extension

Intervention / Treatment
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* Drug: Furosemide
* Drug: Placebo filling
* Drug: Placebo furosemide
* Drug: Vascular filling


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria Age >18 years Inferior acute myocardial infarction (≤J + 7) Right ventricular extension defined by one following echocardiographic criteria: Dilatation of the right ventricle (RV/LV area> 0.9) RV dysfunction defined by TAPSE <16mm or S velocity <10cm.s-1 Akinesia or hypokinesia of two contiguous segments of the right ventricle Decrease of pitch on lung failure flow <150ms Inferior vena cava dilatation (≥20mm) and non-compliant (changes <50%) associated with one hemodynamic instability criteria: Oliguria (diuresis <800mL/24h or 0.5mL/kg/min) Systolic blood pressure <100mmHg Oxygen saturation <91% on room air Bradycardia (heart rate <60/min, not valid for patients on beta-blockers). Informed consent for study participation signed. Exclusion Criteria Minor and pregnant woman Mechanical complications of myocardial infarct Patients who received> 40mg diuretic /day during the last 15 days Hypersensitivity to furosemide or any of its excipients Aortic stenosis (area <1 cm² or mean gradient> 40mmHg), mitral or aortic regurgitation grade ≥3 Catecholamine support for left ventricular failure with left ventricular ejection fraction <35% Renal impairment defined by a serum creatinine> 200μmol / mL Sodium and water retention Urinary tract obstruction Hypovolemia or dehydration Severe hypokalemia (K + <3 mmol / L) Severe hyponatremia (Na + <125 mmol / L) Hepatitis ongoing, liver failure or hepatic encephalopathy No affiliation to a social security scheme or other social protection scheme Private Patient of liberty or under legal protection (guardianship) Inability or refusal to understand or refusal to sign the informed consent from study participation

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Furosemide<br>Furosemide and Placebo filling (Glucose 5%). | Drug: Furosemide<br>* Furosemide: Special LASILIX (250 mg/25 ml) solution for injection reconditioned glass bottle like penicillin of 80mg/8mL. Injection by slow intravenous (1 to 2 minutes per 80mg vial)<br>* Other names: Diuretics, LASILIX.;Drug: Placebo filling<br>* Placebo filling: Glucose 5%, 500mL infused over 30 minutes.<br>* Other names: G5;|
| Active Comparator: Fluid expansion<br>Placebo furosemide (Glucose 5%) and Vascular filling The vascular filling is the gold standard in the treatment of acute myocardial infarction | Drug: Placebo furosemide<br>* Placebo furosemide: glucose 5% for injection reconditioned glass bottle like penicillin of 80mg/8mL. Injection by slow intravenous (1 to 2 minutes per 80mg vial).<br>* Other names: G5;Drug: Vascular filling<br>* Vascular filling: Sodium 0.9% 500mL infused over 30 minutes.<br>* Other names: Fluid expansion, Sodium Chloride NaCl 0.9%.;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Improvement in cardiac output (measured by Doppler method) defined by an increase of more than 10% 24 hours after administration of the treatment in patients admitted and treated by either fluid expansion or furosemide. |  | At Hour 24 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Intra-hospital mortality |  | an average of 10 days after inclusion | 
| Rate of inotropic support |  | an average of 10 days after inclusion | 
| Number of hemodynamic instability requiring fluid expansion |  | an average of 10 days after inclusion | 
| Change in systolic blood |  | Hour 24 | 
| Change in heart rate |  | Hour 24 | 
| Urine output |  | Hour 24 | 
| The duration of hospitalization in intensive care |  | an average of month 1 | 
| Hospitalizations for cardiovascular reason one month after acute myocardial infarction |  | month 1 | 
| One month mortality |  | month 1 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Acute Myocardial Infarction, Right ventricular infarction, Diuretic, Fluid Expansion