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This study will test the central hypothesis that postmenopausal women will demonstrate increased oxygen extraction in active leg muscle during leg cycling exercise while receiving an infusion of Esmolol, a fast-acting β1 selective antagonist, when compared to premenopausal women
This study will test the central hypothesis that postmenopausal women will demonstrate increased oxygen extraction in active leg muscle during leg cycling exercise while receiving an infusion of Esmolol, a fast-acting β1 selective antagonist, when compared to premenopausal women. β1 selective antagonists (or "β1 blockers") are used to lower heart rate and improve O2 supply-to-demand balance in patients with coronary artery disease. By using esmolol to attenuate the central sympathetic response to exercise (increased heart rate and cardiac output) we can examine peripheral mechanisms of O2 delivery. The current project will evaluate how older postmenopausal women adjust active muscle O2 supply to an acute reduction in systemic O2 delivery during large muscle dynamic exercise when compared to younger premenopausal women.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Esmolol Infusion | Active Comparator | Drug: Esmolol Hydrochloride Dosage form: Intravenous Infusion Dosage/Frequency: 0.5 mg/(kg Fat Free Mass·min) for 3 min followed by a maintenance infusion of 0.25 mg/(kg Fat Free Mass·min) for remainder of trial, up to a maximum of 1 hour. |
|
| Saline Infusion | Placebo Comparator | Saline infusion volume/rate matched to the calculated dose of esmolol. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Esmolol infusion | Drug | The Esmolol loading dose will be 0.5 mg/kg fat free mass/min administered over the first 3 minutes, followed by a maintenance dose of 0.25 mg/kg fat free mass/min for the remainder of the protocol (maximum of 60 minutes). |
| Measure | Description | Time Frame |
|---|---|---|
| Tissue Saturation Index (TSI) - Active Leg Muscle | The primary outcome variable is the change in skeletal muscle oxygenation (∆TSI%) in the active leg muscle from baseline during recumbent cycling using near-infrared spectroscopy. TSI% represent the percentage of oxygenated hemoglobin relative to total hemoglobin in the tissue beneath the NIRS probe. Lower values represent a greater reduction in tissue oxygenation from baseline (greater oxygen extraction and/or reduced oxygen delivery). TSI% = oxy[heme] / total[heme] x 100 | Last 60 seconds of Rest, Moderate exercise, and Heavy Exercise. |
| Measure | Description | Time Frame |
|---|---|---|
| Tissue Saturation Index - Inactive Forearm Muscle | The change in skeletal muscle oxygenation (∆TSI%) in the inactive forearm from baseline during recumbent cycling using near-infrared spectroscopy. TSI% represent the percentage of oxygenated hemoglobin relative to total hemoglobin in the tissue beneath the NIRS probe. Lower values represent a greater reduction in tissue oxygenation from baseline (greater oxygen extraction and/or reduced oxygen delivery). TSI% = oxy[heme] / total[heme] x 100 |
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3.1 Inclusion Criteria
3.2 Exclusion Criteria
Participants who will not be studied are those who:
10. Severe lung disease (i.e., on supplemental oxygen or frequently use rescue inhalers) 11. Diagnosed bleeding or clotting disorder or recent blood transfusion 12. Have asthma, history of thyroid issues or hyperkalemia 13. Known use of recreational drugs 14. Methylphenidate use
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Noll Laboratory | University Park | Pennsylvania | 16803 | United States |
30 participants were considered enrolled and 27 participants were randomized. The 3 participants who were not randomized dropped out of the study prior to the infusion visit.
37 Participants were screened for eligibility between February 2, 2022 and April 25, 2023 at the Clinical Research Center in University Park, Pennsylvania (PA). Of these, 30 were considered enrolled.
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| ID | Title | Description |
|---|---|---|
| FG000 | Esmolol, Then Saline | Participants first received esmolol hydrochloride via intravenous infusion. Dosage/Frequency: 0.5 mg/(kg Fat Free Mass·min) for 3 min followed by a maintenance infusion of 0.25 mg/(kg Fat Free Mass·min) for remainder of trial, up to a maximum of 1 hour. After a washout period of 45 mins, they then received saline via intravenous infusion (volume/rate matched to the calculated dose of esmolol). |
| FG001 | Saline, Then Esmolol | Participants first received saline via intravenous infusion (volume/rate matched to the calculated dose of esmolol). After a washout period of 45 mins, they then received esmolol hydrochloride via intravenous infusion. Dosage/Frequency: 0.5 mg/(kg Fat Free Mass·min) for 3 min followed by a maintenance infusion of 0.25 mg/(kg Fat Free Mass·min) for remainder of trial, up to a maximum of 1 hour. |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| First Intervention (up to 1 Hour) |
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| Washout (45 Mins) |
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| Second Intervention (up to 1 Hour) |
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| ID | Title | Description |
|---|---|---|
| BG000 | Esmolol, Then Saline | Participants first received esmolol hydrochloride via intravenous infusion. Dosage/Frequency: 0.5 mg/(kg Fat Free Mass·min) for 3 min followed by a maintenance infusion of 0.25 mg/(kg Fat Free Mass·min) for remainder of trial, up to a maximum of 1 hour. After a washout period of 45 mins, they then received saline via intravenous infusion (volume/rate matched to the calculated dose of esmolol). |
| Units | Counts |
|---|---|
| Participants |
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| 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 | Tissue Saturation Index (TSI) - Active Leg Muscle | The primary outcome variable is the change in skeletal muscle oxygenation (∆TSI%) in the active leg muscle from baseline during recumbent cycling using near-infrared spectroscopy. TSI% represent the percentage of oxygenated hemoglobin relative to total hemoglobin in the tissue beneath the NIRS probe. Lower values represent a greater reduction in tissue oxygenation from baseline (greater oxygen extraction and/or reduced oxygen delivery). TSI% = oxy[heme] / total[heme] x 100 | 11 younger and 12 older at two different exercise intensities (Moderate and Heavy) | Posted | Mean | Standard Deviation | % Total Labile Signal | Last 60 seconds of Rest, Moderate exercise, and Heavy Exercise. |
|
Participants were monitored for safety during the course of each study visit, up to 6 weeks. Duration of study visits varied, but never exceeded four hours in length. During the infusion visit, participants were monitored by a clinician from the start of infusion until blood pressure and heart rate returned to baseline levels following the end of the infusion. Infusion time never exceeded one hour.
No adverse events.
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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 | Esmolol | Participants received esmolol hydrochloride via intravenous infusion. Dosage/Frequency: 0.5 mg/(kg Fat Free Mass·min) for 3 min followed by a maintenance infusion of 0.25 mg/(kg Fat Free Mass·min) for remainder of trial, up to a maximum of 1 hour. |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. David Proctor | The Pennsylvania State University | (814)863-0724 | dnp3@psu.edu |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Oct 17, 2023 | Jun 17, 2024 | Prot_SAP_000.pdf |
| ICF | No | No | Yes | Informed Consent Form | Nov 18, 2022 | Jun 17, 2024 | ICF_001.pdf |
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| ID | Term |
|---|---|
| D009043 | Motor Activity |
| ID | Term |
|---|---|
| D001519 | Behavior |
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| ID | Term |
|---|---|
| C036604 | esmolol |
| D000077330 | Saline Solution |
| ID | Term |
|---|---|
| D000077324 | Crystalloid Solutions |
| D007552 | Isotonic Solutions |
| D012996 | Solutions |
| D004364 | Pharmaceutical Preparations |
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The participants, investigators, and data analysts (outcomes assessors) will be blinded to the treatment (drug) order. The care providers (research nurse and physician) will be aware of the treatment order for safety reasons i.e., they will be assessing heart rate, blood pressure and symptoms before, during, and after the infusion.
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| Saline infusion | Drug | Saline will be rate/volume matched to the calculated esmolol dose. |
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| Pre exercise baseline | Other | Subject rests quietly while drug infusion begins (3 min loading dose followed by 10 min of maintenance dose) until heart rate and blood pressure stabilize. |
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| Isometric handgrip exercise | Other | The subject will grip at 40% of their maximum and maintain that grip for 90 seconds. Once at rest and once during heavy intensity cycling. |
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| Semi-recumbent cycling | Other | Subjects will pedal for 2-4 minutes at a very light intensity (20W), followed immediately by 5 minutes at a moderate intensity (at a workload intended to elicit 85% of the oxygen consumption observed at the lactate threshold), and 5 minutes of cycling at a heavy intensity (at a workload estimated to elicit oxygen consumption half way between those observed at the lactate threshold and respiratory compensation point). Subjects will then continue cycling at the heavy intensity for 90 seconds while performing isometric handgrip exercise. |
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| Last 60 seconds of Rest, Moderate exercise, and Heavy Exercise. |
| Systolic Blood Pressure | Systolic Blood Pressure recorded via an automatic sphygmomanometer (SunTech Tango) | At rest and 3 minutes into moderate exercise and heavy exercise. |
| Heart Rate | Heart rate recorded via EKG | Last 60 seconds of Rest, Moderate exercise, and Heavy Exercise. |
| Cardiac Output | Cardiac Output recorded using bioimpedance cardiography | Last 60 seconds of Rest, Moderate exercise, and Heavy Exercise. |
| Diastolic Blood Pressure | Diastolic Blood Pressure recorded via an automatic sphygmomanometer (SunTech Tango) | At rest and 3 minutes into moderate exercise and heavy exercise. |
| Mean Arterial Pressure | Mean Arterial Pressure recorded via an automatic sphygmomanometer (SunTech Tango) | At rest and 3 minutes into moderate exercise and heavy exercise. |
| Stroke Volume | Stroke Volume recorded using bioimpedance cardiography | Last 60 seconds of Rest, Moderate exercise, and Heavy Exercise. |
| Systemic Vascular Conductance | Systemic Vascular Conductance recorded using bioimpedance cardiography | Last 60 seconds of Rest, Moderate exercise, and Heavy Exercise. |
| ∆HHb - Inactive Forearm | Change in deoxygenated hemoglobin (∆HHb) in the inactive forearm muscle from baseline during recumbent cycling exercise using near-infrared spectroscopy (NIRS) relative to the Total Labile Signal. ∆HHb is an index of oxygen extraction obtained using NIRS. The total labile signal is defined as the difference between the highest observed HHb value during 5 minutes of limb occlusion at 250 mmHg and the lowest observed HHb value observed during reperfusion following removal of the occlusion. Greater ∆HHb values indicate greater oxygen extraction in the tissue under the NIRS probe. | Last 60 seconds of Moderate and Heavy Exercise |
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| BG001 | Saline, Then Esmolol | Participants first received saline via intravenous infusion (volume/rate matched to the calculated dose of esmolol). After a washout period of 45 mins, they then received esmolol hydrochloride via intravenous infusion. Dosage/Frequency: 0.5 mg/(kg Fat Free Mass·min) for 3 min followed by a maintenance infusion of 0.25 mg/(kg Fat Free Mass·min) for remainder of trial, up to a maximum of 1 hour. |
| BG002 | Total | Total of all reporting groups |
| Participants |
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| Age, Continuous | Mean | Standard Deviation | Years |
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| Sex: Female, Male | Count of Participants | Participants |
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| Ethnicity (NIH/OMB) | Count of Participants | Participants |
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| Race (NIH/OMB) | Count of Participants | Participants |
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| Region of Enrollment | Number | participants |
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| OG001 | Saline Infusion | Saline infusion volume/rate matched to the calculated dose of esmolol. Saline infusion: Saline will be rate/volume matched to the calculated esmolol dose. Pre exercise baseline: Subject rests quietly while drug infusion begins (3 min loading dose followed by 10 min of maintenance dose) until heart rate and blood pressure stabilize. Isometric handgrip exercise: The subject will grip at 40% of their maximum and maintain that grip for 90 seconds. Once at rest and once during heavy intensity cycling. Semi-recumbent cycling: Subjects will pedal for 2-4 minutes at a very light intensity (20W), followed immediately by 5 minutes at a moderate intensity (at a workload intended to elicit 85% of the oxygen consumption observed at the lactate threshold), and 5 minutes of cycling at a heavy intensity (at a workload estimated to elicit oxygen consumption half way between those observed at the lactate threshold and respiratory compensation point). Subjects will then continue cycling at the heavy intensity for 90 seconds while performing isometric handgrip exercise. |
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| Secondary | Tissue Saturation Index - Inactive Forearm Muscle | The change in skeletal muscle oxygenation (∆TSI%) in the inactive forearm from baseline during recumbent cycling using near-infrared spectroscopy. TSI% represent the percentage of oxygenated hemoglobin relative to total hemoglobin in the tissue beneath the NIRS probe. Lower values represent a greater reduction in tissue oxygenation from baseline (greater oxygen extraction and/or reduced oxygen delivery). TSI% = oxy[heme] / total[heme] x 100 | 11 younger, 11 older | Posted | Mean | Standard Deviation | % Total Labile Signal | Last 60 seconds of Rest, Moderate exercise, and Heavy Exercise. |
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| Secondary | Systolic Blood Pressure | Systolic Blood Pressure recorded via an automatic sphygmomanometer (SunTech Tango) | 13 younger, 13 older | Posted | Mean | Standard Deviation | mmHg | At rest and 3 minutes into moderate exercise and heavy exercise. |
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| Secondary | Heart Rate | Heart rate recorded via EKG | 13 Younger, 14 Older | Posted | Mean | Standard Deviation | Beats/minute | Last 60 seconds of Rest, Moderate exercise, and Heavy Exercise. |
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| Secondary | Cardiac Output | Cardiac Output recorded using bioimpedance cardiography | 13 younger, 13 older | Posted | Mean | Standard Deviation | Liters/minute | Last 60 seconds of Rest, Moderate exercise, and Heavy Exercise. |
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| Secondary | Diastolic Blood Pressure | Diastolic Blood Pressure recorded via an automatic sphygmomanometer (SunTech Tango) | 13 younger, 13 older | Posted | Mean | Standard Deviation | mmHg | At rest and 3 minutes into moderate exercise and heavy exercise. |
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| Secondary | Mean Arterial Pressure | Mean Arterial Pressure recorded via an automatic sphygmomanometer (SunTech Tango) | 13 younger, 13 older | Posted | Mean | Standard Deviation | mmHg | At rest and 3 minutes into moderate exercise and heavy exercise. |
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| Secondary | Stroke Volume | Stroke Volume recorded using bioimpedance cardiography | 13 younger, 13 older | Posted | Mean | Standard Deviation | mL/beat | Last 60 seconds of Rest, Moderate exercise, and Heavy Exercise. |
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| Secondary | Systemic Vascular Conductance | Systemic Vascular Conductance recorded using bioimpedance cardiography | 13 younger, 13 older | Posted | Mean | Standard Deviation | mL/minute/mmHg | Last 60 seconds of Rest, Moderate exercise, and Heavy Exercise. |
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| Secondary | ∆HHb - Inactive Forearm | Change in deoxygenated hemoglobin (∆HHb) in the inactive forearm muscle from baseline during recumbent cycling exercise using near-infrared spectroscopy (NIRS) relative to the Total Labile Signal. ∆HHb is an index of oxygen extraction obtained using NIRS. The total labile signal is defined as the difference between the highest observed HHb value during 5 minutes of limb occlusion at 250 mmHg and the lowest observed HHb value observed during reperfusion following removal of the occlusion. Greater ∆HHb values indicate greater oxygen extraction in the tissue under the NIRS probe. | 9 younger, 12 older | Posted | Mean | Standard Deviation | % Total Labile Signal | Last 60 seconds of Moderate and Heavy Exercise |
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| 0 |
| 27 |
| 0 |
| 27 |
| 0 |
| 27 |
| EG001 | Saline | Participants received saline via intravenous infusion (volume/rate matched to the calculated dose of esmolol). | 0 | 27 | 0 | 27 | 0 | 27 |
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