Clinical trial NCT05428631: Tolerability and Safety of CARDIOMEMS™ Intracardiac Continuous Cardiac Hemodynamic Monitoring Device in Patients with Cardio Renal Syndrome with Severe Renal Impairment
Official title: Evaluation of the Tolerability and Safety of the CARDIOMEMS™ Intracardiac Continuous Cardiac Hemodynamic Monitoring Device in Patients with Cardio Renal Syndrome with Severe Renal Impairment
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: NA
Conditions: Heart Failure
Renal Insufficiency
Keywords: Renal insufficiency,
heart failure,
medical device
blood pressure monitoring
tolerance
Lead sponsor: Centre Hospitalier Universitaire de Nīmes
Sponsor class: OTHER
Collaborators: name: CHU Arnaud de Villeneuve MONTPELLIER
First posted: 2022-06-23
Enrollment: 10
Sex: ALL
Minimum age (years): 18
Maximum age (years): 85
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Intervention model description: Patients will be pre-selected (pre-inclusion visit) during hospitalizations in the cardiology and nephrology departments of the Nîmes University Hospital. The study will be offered to any patient with class NYHA III heart failure who has been hospitalized in the previous 12 months for cardiac decompensation (current indication for the CARDIOMEMS™ system) and with advanced chronic renal failure with GFR (CKD-EPI) \< 30 ml/min/1.73m2 persisting for more than 3 months and confirmed by Iohexol clearance.
Primary purpose: PREVENTION

Brief summary: Renal failure is present in 40% of heart failure patients, and is one of the main comorbidities of heart failure. Follow-up with pulmonary artery pressure (PAP) monitoring has shown a reduction in mortality and frequency of hospitalization in patients with heart failure alone in the CHAMPION trial. Patients with New York Heart Association class III heart failure and a hospitalization in the previous 12 months were included in that study. They benefited from the "CardioMEMS™ HF" device with a sensor implanted in the pulmonary artery to measure PAP. According to that study, the information led to more precise and early adaptation of therapy by avoiding the onset of heart failure symptoms and reducing the number of hospitalizations. However, in that study, patients with impaired renal function (Glomerular Filtration Rate\<25 mL/min/1.73m2) were excluded, limiting the indication for treatment in those patients, and the evolution of renal function during the study was not reported.

Patients with heart failure AND advanced renal failure are defined as having a cardio-renal syndrome, with strong interaction between these 2 organs. In the event of predominant right heart failure, they may require treatment by renal replacement or dialysis. There seems to be a link between high venous pressure, renal repercussions and the need for dialysis. Additional follow-up data in this clinical situation are needed to confirm this link and to suggest the interest of continuous PAP monitoring to improve the management of these patients with cardio-renal syndrome with severe renal impairment defined by a Glomerular Filtration Rate\< 30 ml/min/1.73m2 (KDIGO Cardio-renal 2019). This pilot study aims to evaluate how tolerable the "CARDIOMEMS™ HF" device in patients with cardio-renal syndrome and obtain the first information on the relationship between cardiac hemodynamics and renal function in this population.

Detailed description: There are currently 1.5 million heart failure patients in France. The high morbidity and mortality make it a major public health issue. Renal failure, present in 40% of these patients, is one of the main comorbidities of heart failure and makes its management more complex. Medical follow-up with pulmonary artery pressure (PAP) monitoring has shown a reduction in mortality and frequency of hospitalization in patients with heart failure alone in the CHAMPION trial. Patients with New York Heart Association class III heart failure and a hospitalization in the previous 12 months were included in this study. They benefited from the "CardioMEMS™ HF" device with implantation of a sensor in the pulmonary artery allowing direct and continuous measurement of PAP. According to this study, this information allowed for more precise and early adaptation of therapy by avoiding the occurrence of heart failure symptoms and reducing the frequency of hospitalizations. In this study, patients with impaired renal function were excluded (Glomerular Filtration Rate \<25 mL/min/1.73m2), limiting the indication for treatment in these patients, and the evolution of renal function during the study was not reported.

Patients with heart failure associated with advanced renal failure are defined as having a cardio-renal syndrome, with a strong interaction between these 2 organs that may, in particular in the case of predominant right heart failure, require treatment by renal replacement or dialysis. According to the data available to date, the predominant hypothesis is a link between high venous pressure, renal repercussions and the need for dialysis. Additional follow-up data in this clinical situation are needed to confirm this link and to suggest the interest of continuous monitoring of PAP to improve the management of these patients with cardio-renal syndrome with severe renal impairment defined by a Glomerular Filtration Rate\< 30 ml/min/1.73m2 (KDIGO Cardio-renal 2019). Therefore, the investigators wish to initiate a pilot study evaluating the tolerability of the "CARDIOMEMS™ HF" device in patients with cardio renal syndrome and obtain the first information on the relationship between cardiac hemodynamics and renal function in this population.

This is the first pilot study on the safety and tolerability of the use of the CardioMEMS™ HF medical device in cardio renal syndrome with severe renal impairment (documented by Glomerular Filtration Rate \< 30 mL/min/1.73m2 measured by Iohexol clearance) treated medically and without renal replacement therapy.

In this study, the CARDIOMEMS™ HF device, the most successful implanted pulmonary arterial pressure monitoring system currently available on the market will be implemented. Its teletransmitted information can guide the treatment of patients with heart failure.This system, by responding to the recent international recommendations which advocate a better understanding of the hemodynamic situation in this pathology with in particular the link between pulmonary arterial pressure and renal function, could help us to identify innovative evaluation tools with a view to improving therapeutic management with the new treatments available in heart failure (AA House et al: HF in kidney disease: a KDIGO conference report).

Eligibility criteria: Inclusion Criteria:

* Patient with class NYHA III heart failure having been hospitalized in the previous 12 months for cardiac decompensation (the current indication for the CARDIOMEMS™ system), right heart failure or biventricular heart failure with the definition of TAPSE\<15mm and/or SDTI\<9.5cm/s regardless of LVEF, NtproBNP\>1500 pg/ml.
* Patient with advanced renal failure with GFR (CKD-EPI) \< 30 ml/min/1.73m2 for more than 3 months confirmed by GFR measurement (Iohexol clearance)
* Patient with a pulmonary artery greater than 7 mm in diameter.
* The patient has been informed of the study set-up, objectives, constraints and patient rights.
* The patient must have given free and informed consent and signed the consent form.
* The patient must be affiliated or a beneficiary of a health insurance plan. Precautions: if the patient is on anticoagulant therapy, an International Normalized Ratio \<1.5 is recommended before right heart catheterization and any implantation procedure

Exclusion Criteria:

* Patients with a contraindication to the CARDIOMEMS™ HF system (pulmonary embolism with sequelae, artery less than 7 mm, active infection).
* Patients already on renal replacement therapy.
* Patients with a history of acute venous thrombosis.
* Patients unable to tolerate right heart catheterization.
* Patients with a major cardiovascular event (i.e., myocardial infarction, stroke) within 2 months of the initial examination.
* Patients with congenital heart disease or mechanical right heart valve(s).
* Patients with known hypersensitivity or allergy to aspirin and/or clopidogrel.
* Patients with a body mass index \>35. Measure the patient's chest circumference at the armpit: if the patient's chest circumference is \> 165 cm, the sensor should not be implanted.
* Patients unable to take dual anti-platelet therapy or anticoagulant therapy for one month after implantation
* Patient hypersensitive or allergic to iohexol.
* Patient is participating in another Class I interventional study, or has participated in another interventional study within the last 3 months.
* Patient is in an exclusion period determined by a previous study.
* Patient is under guardianship, conservatorship, or conservatorship.
* The patient refuses to sign the consent form.
* It is impossible to give the patient informed information.
* The patient is pregnant or nursing.

Primary outcomes:
measure: Adverse events
timeFrame: On the day of implanting the Cardiomems device
measure: Adverse events
timeFrame: One month after implanting the Cardiomems device
measure: Adverse events
timeFrame: Two months after implanting the Cardiomems device
measure: Adverse events
timeFrame: Three months after implanting the Cardiomems device
measure: Adverse events
timeFrame: Four months after implanting the Cardiomems device
measure: Adverse events
timeFrame: Five months after implanting the Cardiomems device
measure: Adverse events
timeFrame: Six months after implanting the Cardiomems device
measure: Adverse events
timeFrame: Seven months after implanting the Cardiomems device
measure: Adverse events
timeFrame: Eight months after implanting the Cardiomems device
measure: Adverse events
timeFrame: Nine months after implanting the Cardiomems device
measure: Adverse events
timeFrame: Ten months after implanting the Cardiomems device
measure: Adverse events
timeFrame: Eleven months after implanting the Cardiomems device
measure: Adverse events
timeFrame: Twelve months after implanting the Cardiomems device
Secondary outcomes:
measure: Estimated effect on renal function
timeFrame: Between 1 day to 1 month before implanting the device.
measure: Measured effect on renal function
timeFrame: Between 1 day to 1 month before implanting the device.
measure: Estimated effect on renal function
timeFrame: Day 0 (day of implanting the device)
measure: Measured effect on renal function
timeFrame: Day 0 (day of implanting the device)
measure: Estimated effect on renal function
timeFrame: Month 3
measure: Measured effect on renal function
timeFrame: Month 3
measure: Estimated effect on renal function
timeFrame: Month 6
measure: Measured effect on renal function
timeFrame: Month 6
measure: Estimated effect on renal function
timeFrame: Month 9
measure: Measured effect on renal function
timeFrame: Month 9
measure: Estimated effect on renal function
timeFrame: Month 12
measure: Measured effect on renal function
timeFrame: Month 12
measure: Re-hospitalizations
timeFrame: Month 12
measure: Vital status
timeFrame: Month 12
measure: Link between cardiac hemodynamics and renal function: Pulmonary Arterial Pressure
timeFrame: From Day 0 (day of implanting the device) to the end of Month 12
measure: Link between cardiac hemodynamics and renal function: Glomerular Filtration Rate
timeFrame: Day 0
measure: Link between cardiac hemodynamics and renal function: Pulmonary Arterial Pressure
timeFrame: Month 3
measure: Link between cardiac hemodynamics and renal function: Glomerular Filtration Rate
timeFrame: Month 3
measure: Link between cardiac hemodynamics and renal function: Pulmonary Arterial Pressure
timeFrame: Month 6
measure: Link between cardiac hemodynamics and renal function: Glomerular Filtration Rate
timeFrame: Month 6
measure: Link between cardiac hemodynamics and renal function: Pulmonary Arterial Pressure
timeFrame: Month 9
measure: Link between cardiac hemodynamics and renal function: Glomerular Filtration Rate
timeFrame: Month 9
measure: Link between cardiac hemodynamics and renal function: Pulmonary Arterial Pressure
timeFrame: Month 12
measure: Link between cardiac hemodynamics and renal function: Glomerular Filtration Rate
timeFrame: Month 12
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: exertional dyspnea
timeFrame: Day 0
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: exertional dyspnea
timeFrame: Month 3
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: exertional dyspnea
timeFrame: Month 6
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: exertional dyspnea
timeFrame: Month 9
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: exertional dyspnea
timeFrame: Month 12
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: NT-pro-BNP biomarkers
timeFrame: Day 0
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: NT-pro-BNP biomarkers
timeFrame: Month 3
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: NT-pro-BNP biomarkers
timeFrame: Month 6
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: NT-pro-BNP biomarkers
timeFrame: Month 9
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: NT-pro-BNP biomarkers
timeFrame: Month 12
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: left ventricular ejection fraction
timeFrame: Day 0
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: left ventricular ejection fraction
timeFrame: Month 3
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: left ventricular ejection fraction
timeFrame: Month 6
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: left ventricular ejection fraction
timeFrame: Month 9
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: left ventricular ejection fraction
timeFrame: Month 12
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: E/A
timeFrame: Month 0
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: E/A
timeFrame: Month 3
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: E/A
timeFrame: Month 6
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: E/A
timeFrame: Month 9
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: E/A
timeFrame: Month 12
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: E/e'
timeFrame: Month 0
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: E/e'
timeFrame: Month 3
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: E/e'
timeFrame: Month 6
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: E/e'
timeFrame: Month 9
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: E/e'
timeFrame: Month 12
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: Indexed left atrial volume
timeFrame: Month 0
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: Indexed left atrial volume
timeFrame: Month 3
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: Indexed left atrial volume
timeFrame: Month 6
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: Indexed left atrial volume
timeFrame: Month 9
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: Indexed left atrial volume
timeFrame: Month 12
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: Tricuspid Annular Plane Systolic Excursion
timeFrame: Month 0
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: Tricuspid Annular Plane Systolic Excursion
timeFrame: Month 3
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: Tricuspid Annular Plane Systolic Excursion
timeFrame: Month 6
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: Tricuspid Annular Plane Systolic Excursion
timeFrame: Month 9
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: Tricuspid Annular Plane Systolic Excursion
timeFrame: Month 12
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: Tissue Doppler S-wave
timeFrame: Month 0
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: Tissue Doppler S-wave
timeFrame: Month 3
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: Tissue Doppler S-wave
timeFrame: Month 6
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: Tissue Doppler S-wave
timeFrame: Month 9
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: Tissue Doppler S-wave
timeFrame: Month 12
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: Right atrium area
timeFrame: Month 0
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: Right atrium area
timeFrame: Month 3
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: Right atrium area
timeFrame: Month 6
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: Right atrium area
timeFrame: Month 9
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: Right atrium area
timeFrame: Month 12
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: Systolic pulmonary artery pressure
timeFrame: Month 0
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: Systolic pulmonary artery pressure
timeFrame: Month 3
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: Systolic pulmonary artery pressure
timeFrame: Month 6
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: Systolic pulmonary artery pressure
timeFrame: Month 9
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: Systolic pulmonary artery pressure
timeFrame: Month 12
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: Right atrial pressure
timeFrame: Month 0
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: Right atrial pressure
timeFrame: Month 3
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: Right atrial pressure
timeFrame: Month 6
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: Right atrial pressure
timeFrame: Month 9
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: Right atrial pressure
timeFrame: Month 12
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: Stroke volume
timeFrame: Day 0
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: Stroke volume
timeFrame: Month 3
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: Stroke volume
timeFrame: Month 6
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: Stroke volume
timeFrame: Month 9
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: Stroke volume
timeFrame: Month 12
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: Heart rate
timeFrame: Day 0
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: Heart rate
timeFrame: Month 3
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: Heart rate
timeFrame: Month 6
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: Heart rate
timeFrame: Month 9
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: Heart rate
timeFrame: Month 12
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: cardiac output
timeFrame: Day 0
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: cardiac output
timeFrame: Month 3
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: cardiac output
timeFrame: Month 6
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: cardiac output
timeFrame: Month 9
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: cardiac output
timeFrame: Month 12
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: ventricular ejection time
timeFrame: Day 0
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: ventricular ejection time
timeFrame: Month 3
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: ventricular ejection time
timeFrame: Month 6
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: ventricular ejection time
timeFrame: Month 9
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: ventricular ejection time
timeFrame: Month 12
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: pre-ejection period
timeFrame: Day 0
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: pre-ejection period
timeFrame: Month 3
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: pre-ejection period
timeFrame: Month 6
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: pre-ejection period
timeFrame: Month 9
measure: Comparison of cardiac hemodynamic monitoring data with the clinical picture: pre-ejection period
timeFrame: Month 12
measure: Patient quality of life
timeFrame: Day 0
measure: Patient quality of life
timeFrame: Month 3
measure: Patient quality of life
timeFrame: Month 6
measure: Patient quality of life
timeFrame: Month 9
measure: Patient quality of life
timeFrame: Month 12
Other outcomes:
measure: Age of patients
timeFrame: Day 0
measure: Weight of patients
timeFrame: Day 0
measure: Height of patients
timeFrame: Day 0
measure: Patient's cardiac history
timeFrame: Day 0
measure: Cardiovascular risk factors
timeFrame: Day 0
measure: Cardiac devices
timeFrame: Day 0
measure: Etiology of renal disease
timeFrame: Day 0
measure: Renal history
timeFrame: Day 0
measure: Medication received
timeFrame: Day 0
measure: Diuretics received
timeFrame: Day 0
measure: Iron supplementation received
timeFrame: Day 0
measure: Transferrin
timeFrame: Month 6
measure: Transferrin
timeFrame: Month 12
measure: Ferritin
timeFrame: Month 6
measure: Ferritin
timeFrame: Month 12
Locations:
city: Nîmes
country: France
facility: Centre Hospitalier Universitaire de Nîmes
state: Gard
city: Montpellier
country: France
facility: CHRU de Montpellier - Hôpital Arnaud de Villeneuve
Study officials:
affiliation: Nîmes University Hospital
name: Jean-Etienne RICCI, Dr.
role: PRINCIPAL_INVESTIGATOR
affiliation: CHU Arnaud de Villeneuve MONTPELLIER
name: François ROUBILLE, Prof.
role: PRINCIPAL_INVESTIGATOR
affiliation: Nîmes University Hospital
name: Guillaume CAYLA, Prof.
role: PRINCIPAL_INVESTIGATOR
affiliation: CHU Arnaud de Villeneuve MONTPELLIER
name: Sylvain AGUILHON, Dr.
role: PRINCIPAL_INVESTIGATOR
affiliation: Nîmes University Hospital
name: Sylvain CARIOU, Dr.
role: PRINCIPAL_INVESTIGATOR
References: