The Safety and Efficacy of Istaroxime for Pre-Cardiogenic Shock

Completed · Phase 2 · Has a placebo group

Conditions studied: Cardiogenic Shock

In brief

This is a pilot, multinational, randomized, double-blind, placebo-controlled, 2-part safety and efficacy study. Subjects will consist of patients hospitalized for acute decompensated heart failure with persistent hypotension.

Key facts

Study ID: NCT04325035
Run by: Windtree Therapeutics
People needed: 90
Starts: 2020-09-28
Expected to finish: 2024-10-30
Last updated by the study team: 2025-02-04

Who can join

Age: 18 and older, up to 85. Sex: any. Healthy volunteers: not accepted.

You may qualify if…

Clinical presentation consistent with SCAI Stage B pre-cardiogenic shock caused by acute decompensation of chronic systolic heart failure (due to arterial hypertension, ischemic heart disease or dilated cardiomyopathy), without evidence for an acute coronary syndrome.
Signed informed consent form (ICF);
Males and females, 18 to 85 years of age (inclusive);
An admission for acute decompensated heart failure (ADHF) episode within 36 hours prior to randomization, defined as:
Dyspnea, at rest or with minimal exertion;
Congestion on chest x-ray or lung US with B-type natriuretic peptide (BNP) ≥ 400 pg/mL or NT-proBNP ≥ 1400 pg/mL; Elective admissions for medications tune up or procedures do not qualify as an ADHF admission.
History of left ventricular ejection fraction (LVEF) ≤ 40%;
Persistent hypotension defined as:
SBP of 75 to 90 mmHg (Part A) or 70 to 100 mmHg (Part B) for ≥ 2 hours prior to Screening;
SBP does not decrease by > 7 mmHg on two separate measurements during the last 2 hours prior to randomization;
Heart rate 75 to 150 bpm. If the subject is on a beta-blocker, the range is 60 to 150 bpm;
Echocardiogram during initial hospitalization confirming ejection fraction ≤ 40% and no evidence of other pathology to confound interpretation of cardiac physiology (e.g., pericardial effusion);
Subject is monitored by a Pulmonary Artery Catheter (PAC) at the time of randomization (Part B only).

You may not qualify if…

Cardiogenic shock of SCAI Stage C or worse
Cardiogenic shock due to any other condition besides acute decompensation of chronic heart failure.
Any of the following in the past 30 days: acute coronary syndrome, coronary revascularization, myocardial infarction (MI), coronary artery bypass graft (CABG), or percutaneous coronary intervention;
Current (within 6 hours of Screening) or anticipated need for treatment with positive inotropic agents or vasopressors, renal support including ultrafiltration, or mechanical circulatory, ventilatory or renal support (intra-aortic balloon pump, endotracheal intubation, mechanical ventilation, or any ventricular assist device);
Venous Lactate > 2 mmol/L;
History of heart transplant or United Network for Organ Sharing (UNOS) priority 1a heart transplant listing
Ongoing treatment with digoxin (if digoxin was stopped before signing the ICF and the digoxin plasma level is < 0.5 ng/ml, the patient may be enrolled);
Severe renal impairment (estimated glomerular filtration rate (eGFR) < 30 ml/min, calculated by the Modification of Diet in Renal Disease (MDRD) formula);
Hypersensitivity to the study medication or any of its excipients (including known lactose hypersensitivity) or any related medication;
Stroke or transient ischemic attack (TIA) within 3 months;
Active coronary ischemia;
Any significant valvular disease (including any moderate or severe valvular stenosis, moderate or severe aortic or pulmonary regurgitation, stenosis or regurgitation);severe tricuspid or mitral regurgitation);
Primary hypertrophic or restrictive cardiomyopathy or systemic illness known to be associated with infiltrative heart disease;
Admission for AHF triggered primarily by a correctable etiology such as significant arrhythmia, (inclusive of atrial fibrillation as the main reason for admission), infection, severe anemia, acute coronary syndrome, pulmonary embolism, exacerbation of chronic obstructive pulmonary disease (COPD), planned admission for device implantation, or over-diuresis as a cause of hypotension;
Pericardial constriction or active pericarditis;
Life-threatening ventricular arrhythmia or implantable cardioverter defibrillator (ICD) shock within the past month or history of sudden death within 6 months;
Cardiac resynchronization therapy (CRT), ICD, or pacemaker implantation (or planned implantation) within the past 3 months;
Sustained ventricular tachycardia in the last 3 months with no defibrillator;
Sustained hypotension (SBP < 70 mmHg) for at least 30 minutes from the time of arrival to the hospital;
Severe pulmonary disease or cor pulmonale or other causes of isolated right-sided HF or not related to left ventricular dysfunction;
Acute respiratory distress syndrome;
Suspected sepsis; fever > 38°C or active infection requiring IV antimicrobial treatment;
Body weight < 40 kg or ≥ 150 kg;
Laboratory exclusions:
Hemoglobin < 9 g/dl,

Where it is running

Tufts Medical Center — Boston, Massachusetts, United States
Hospital Italiano de Bueno Aires — Capital Federal, Buenos Aires, Argentina
Santorio Guemes — Capital Federal, Buenos Aires, Argentina
Hospital Privado de Rosario — Rosario, Sante Fe, Argentina
Instituto Cardiovascular de Rosario — Rosario, Sante Fe, Argentina
Santorio de la Trinidad Palermo — Buenos Aires, Argentina
Azienda Ospedaliera Santi Antonio e Biagio e Cesare Arrigo — Alessandria, Italy
UOC Cardiologia, ASST degli Spedali Civili di Brescia Pizzale Spedali Civili 1 — Brescia, Italy
IRCCS San Raffaele Scientific Institute — Milan, Italy
Uniwersytecki Szpital Kliniczny, Centrum Chorub Serca — Wroclaw, Lower Silesian Voivodeship, Poland
Uniwersytecki Szpital Kliniczny w Białymstoku — Bialystok, Poland
Uniwersytecki Szpital Kliniczny w Opolu — Opole, Poland
4 Wojskowy Szpital Kliniczny — Wroclaw, Poland

Full record on ClinicalTrials.gov

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