Trimetazidine in Pulmonary Artery Hypertension

Study Overview
=================
Brief Summary
-----------------
Pulmonary artery hypertension (PAH) is a chronic and progressive disease that affects 15 persons per million. Although current therapy has improve disease prognosis, PAH still has a poor survival, with a median survival of 2.8 years after diagnosis. In the last few years new key elements in PAH pathogenesis have been discovered, such as the role of metabolism in disease onset and progression. In fact, PAH pulmonary smooth muscle cells switch into a glycolytic phenotype which resembles the metabolism of cancer cells. The investigators hypothesis is that fatty acid oxidation inhibition reverts the PAH adverse phenotype by restoring mitochondrial function and morphology, decreasing proliferation and restoring apoptosis susceptibility in pulmonary smooth muscle cells 

Official Title
-----------------
Comprehensive Evaluation of Right Ventricular Function, Ventricular Remodeling and Micro RNA Profiling in Pulmonary Artery Hypertension: Effects of a Fatty Acid Oxidation Inhibitor

Conditions
-----------------
Pulmonary Artery Hypertension

Intervention / Treatment
-----------------
* Drug: Trimetazidine


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: PAH patients belonging to the following subgroups of the updated Dana Point Classification Group 1 Idiopathic PAH Heritable PAH Drug or toxin-induced PAH PAH associated with connective tissue disease PAH associated to congenital heart disease with simple systemic-to-pulmonary shunt at least 1 year after surgical repair PAH associated to HIV infection Documented hemodynamic diagnosis of PAH by right ventricular catheterization performed any time prior to screening Signed informed consent Exclusion Criteria: Patients belonging to the subgroups of the updated Dana Point Classification Group I not listed in the inclusion criteria Patients belonging to the groups 2-5 of the updated Dana Point Classification Group Moderate to severe chronic pulmonary obstructive disease Documented left ventricular dysfunction Severe renal impairment (Serum creatinine > 2.5 mg/dL) Patients who are receiving or have been receiving any investigational drugs within 1 month before the baseline visit Acute or chronic impairment (other than dyspnea) limiting the ability to comply with study requirements Psychotic, addictive or other disorder limiting the ability to provide informed consent or to comply with study requirements Life expectancy less than 12 months Females who are lactating or pregnant or those who plan to become pregnant during the study Known hypersensitivity to any of the excipients of the drug formulation

Ages Eligible for Study
-----------------
Minimum Age: 18 Years
Maximum Age: 75 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

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


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Placebo Comparator: Sugar pill<br>Placebo 1 pill bid, 3 months | |
| Experimental: Trimetazidine<br>Trimetazidine 35 mg bid for 3 months | Drug: Trimetazidine<br> <br> * Other names: Vastarel;|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in right ventricular (RV) function | Changes in RV function assessed by echo 3d (strain-strain rate) | 3 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in exercise capacity | Changes in exercise capacity assessed by 6 minute walk test | 3 months | 
| Changes in symptoms | Changes in Borg dyspnea index | 3 months | 
| Changes in biomarkers | Changes in B-type natriuretic peptide, galectin-3 and rho-kinase activity | 3 months | 
| Time to clinical worsening | Time to first PAH related medical event (ER evaluation, hospitalization or death) | 3 months |