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Hypothesis:
Patients with a Fontan type palliation are limited by preload, or the rate at which blood returns to the heart after passively traversing the pulmonary capillary bed. By decreasing pulmonary vascular resistance using an endothelin receptor antagonist, both ventricular filling pressures and volumes will increase with a simultaneous decrease in systemic impedance to flow and decrease in central venous pressures, leading to an improved capacity to increase cardiac output, and thereby an improvement in patient functional status.
Patients who are candidates for the study will be randomized to a double-blind single crossover study. Therapy with either ambrisentan or placebo will be continued for 12 weeks, with a 2 week washout period between treatment periods. Subjects will be subjected to a VO2 max test to evaluate exercise capacity at enrolment, and on the last day of each treatment period. As a component of the VO2 max testing the patient's VE, VCO2, VE/VCO2 slope, ventilatory anaerobic threshold (VAT), peak work, efficiency, and other physiologic parameters as typically obtained from cardiopulmonary testing will be assessed. In addition, each patient will be asked to complete an SF-36 quality of life questionnaire at enrollment, and on the last day of each study period.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Ambrisentan first, Placebo second | Other | These patients will be randomized to have ambrisentan during the first study period, and placebo during the second study period. |
|
| Placebo first, Ambrisentan second | Other | These patients will be randomized to have placebo during the first study period, and ambrisentan during the second study period. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Ambrisentan | Drug |
|
|
| Measure | Description | Time Frame |
|---|---|---|
| Change in VO2 Max | Baseline compared to 12 weeks therapy with either ambrisentan or placebo |
| Measure | Description | Time Frame |
|---|---|---|
| Quality of Life | Change in Rand 36-item Short Form (SF-36) physical function score (0-100). On the Rand SF-36 questionnaire, a score closer to 100 (higher) suggests lesser disability, while a score closer to 0 (lower) suggests more disability. | 12 weeks |
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Inclusion Criteria:
Patients over 18 years of age followed at the Center for Adults with Congenital Heart Disease at Washington University School of Medicine or at Saint Louis Childrens Hospital who have had a Fontan-type of palliation with single ventricular physiology.
Patients must not within the last year have been treated with an endothelin receptor antagonist, phosphodiesterase 5 antagonist, or prostacyclin analogue.
Female patients must not be pregnant, and during the study period must be using effective contraception (including barrier method with spermicide, intrauterine device, implanon, oral contraceptives) if fertile.
In the physicians opinion patients must be able to complete a VO2 max test to achieve an RER of >1.0
In the physicians opinion patients must be socially and intellectually able to adhere to the treatment regimen and follow-up
Patients must be intellectually able to reliably complete an SF-36 questionnaire on quality of life.
Patients must be clinically stable for at least 3 months prior to enrolment.
Patients must not have had surgery within 6 months prior to enrolment, and have no planned surgery for the study period.
Patients must provide informed consent.
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Exclusion Criteria:
Patients under 18 years of age.
Patients who are pregnant, nursing, or who in the physician's opinion are likely to become pregnant.
Patients who are clinically unstable.
Patients who have previously been treated with either an endothelin receptor antagonist and stopped due to adverse side effects.
Patients with an AST or ALT of >3 x normal.
Patients having any known contraindication to the initiation of ambrisentan.
Patients with a calculated creatinine clearance of <60ml/min
Patients with a serum hemoglobin concentration of <10mg/dl
Patients with a poorly controlled cardiac arrhythmia
Patients who are unable to provide independent informed consent.
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Washington University School of Medicine | St Louis | Missouri | 63110 | United States |
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Patients were recruited from Washington University School of Medicine Adult Congenital Heart Disease clinic between 10/2012 and 11/2014
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| ID | Title | Description |
|---|---|---|
| FG000 | Ambrisentan First, Placebo Second | These patients will be randomized to have ambrisentan during the first study period, and placebo during the second study period. Ambrisentan |
| FG001 | Placebo First, Ambrisentan Second | These patients will be randomized to have placebo during the first study period, and ambrisentan during the second study period. Ambrisentan |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Ambrisentan First, Placebo Second | These patients will be randomized to have ambrisentan during the first study period, and placebo during the second study period. Ambrisentan |
| BG001 | Placebo First, Ambrisentan Second |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Categorical | Count of Participants |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Change in VO2 Max | In this crossover study, all patients received both ambrisentan and placebo. Data was analyzed comparing baseline measures to those after the period on ambrisentan and baseline measures to those after the period on placebo. | Posted | Mean | 95% Confidence Interval | Change in ml/kg min | Baseline compared to 12 weeks therapy with either ambrisentan or placebo |
|
During the study period and for one month after the completion of the study protocol, an average of 30 weeks.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | On Ambrisentan Therapy | Events that occurred while on ambrisentan therapy | 0 |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Gastroenteritis and acidosis | Gastrointestinal disorders | Non-systematic Assessment | Subject developed a viral gastroenteritis not related to drug therapy which provoked drug discontinuation and hospitalization. The subject was still interested in participating and after recovering restarted the study protocol without problems. |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Rhinitis or Pharyngitis | Respiratory, thoracic and mediastinal disorders | Non-systematic Assessment |
Large dropout rate. Small sample size. Many individuals did not achieve the target RER during cardiopulmonary exercise testing.
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Ari Cedars | UT Southwestern | 3149224788 | acedars97@gmail.com |
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| ID | Term |
|---|---|
| C467894 | ambrisentan |
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These patients will be randomized to have placebo during the first study period, and ambrisentan during the second study period.
Ambrisentan
| BG002 | Total | Total of all reporting groups |
| Participants |
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| Sex: Female, Male | Count of Participants | Participants |
|
| Units | Counts |
|---|
| Participants |
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| Secondary | Quality of Life | Change in Rand 36-item Short Form (SF-36) physical function score (0-100). On the Rand SF-36 questionnaire, a score closer to 100 (higher) suggests lesser disability, while a score closer to 0 (lower) suggests more disability. | In this crossover study, all patients received both therapies. Analysis was performed comparing baseline to after indicated therapy | Posted | Mean | 95% Confidence Interval | Change in score from baseline | 12 weeks |
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|
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| 19 |
| 1 |
| 19 |
| 13 |
| 19 |
| EG001 | On Placebo | Events that occurred while on placebo therapy | 0 | 19 | 0 | 19 | 14 | 19 |
|
| edema | Skin and subcutaneous tissue disorders | Non-systematic Assessment |
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| rash | Skin and subcutaneous tissue disorders | Non-systematic Assessment |
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| arthralgia | Musculoskeletal and connective tissue disorders | Non-systematic Assessment |
|
| cough/dyspnea | Respiratory, thoracic and mediastinal disorders | Non-systematic Assessment |
|
| nausea | Gastrointestinal disorders | Non-systematic Assessment |
|
| chest pain | Cardiac disorders | Non-systematic Assessment |
|
| fatigue | General disorders | Non-systematic Assessment |
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| abdominal pain | Gastrointestinal disorders | Non-systematic Assessment |
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| diarrhea | Gastrointestinal disorders | Non-systematic Assessment |
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