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Heart Failure With Normal Ejection FractionTRAINING-HFNCT02638961

Inspiratory Muscle Training and Functional Electrical Stimulation for Treatment of HFpEF

A study testing IMT, FES and Standard treatment in people with Heart Failure With Normal Ejection Fraction, run by Universitat Jaume I at 1 site in Spain.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Heart failure (HF) with preserved ejection fraction (HFpEF) has become the most prevalent form of HF in developed countries. Despite its increasing in prevalence, there is no evidence-based effective therapy for HFpEF The purpose of this study was to evaluate whether inspiratory muscle training (IMT), functional… Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
IMT, FES and Standard treatment
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
52 participants
Where
1 siteSpain
Study dates
Oct 2015to Mar 2017
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Previous history of symptomatic heart failure NYHA (New York Heart Association )functional class ≥II with Normal left ventricular ejection fraction:
  • ejection fraction >0.50 by Simpson method
  • end-diastolic diameter <60 mm
  • Structural heart disease:
  • left ventricle hypertrophy/left atrial enlargement and/or
  • diastolic dysfunction estimated by 2D echocardiography
  • Previous admission for acute heart failure
  • Clinical stability, without hospital admissions in the past 3 month

Who cannot join

  • Perform a valid baseline exercise test
  • Significant primary moderate to severe valvular disease
  • Acute coronary syndrome or cardiac surgery within the previous three months
  • Signs of ischemia during cardiopulmonary exercise testing
  • Significant primary pulmonary disease; including pulmonary arterial hypertension, chronic thromboembolic pulmonary disease or chronic obstructive pulmonary disease
  • Any other comorbidity with an expectancy of life less than one year

Trial locations and contacts

1 site in 1 country.

Spain1 site
  • Hospital clínico universitario de Valencia

    Valencia, 46010

Other trials in Spain

About this study

Official title: Inspiratory Muscle Training and Functional Electrical Stimulation for Treatment of Heart Failure With Preserved Ejection Fraction

Heart failure (HF) with preserved ejection fraction (HFpEF) has become the most prevalent form of HF in developed countries. Despite its increasing in prevalence, there is no evidence-based effective therapy for HFpEF The purpose of this study was to evaluate whether inspiratory muscle training (IMT), functional electrical stimulation (FES), or combination of both improve exercise capacity as well as left ventricular diastolic function, biomarkers' profile, quality of life (QoL) and prognosis in patients with HFpEF.

Read the detailed description

This study was designed as a prospective, controlled, randomized, four-armed, efficacy trial of patients with the diagnosis of HFpEF and New York Heart Association functional class II-III/IV, diagnosed according to criteria of the European Society of Cardiology. A computer-generated randomization scheme was used to allocate participants (in a 1:1:1:1 ratio) to receive: 1) a home-based 12-week program of inspiratory muscle training (IMT) or; 2) a 12-week program of functional electrical stimulation (FES) of lower limb muscles or; 3) standard treatment (ST) alone or; 4) combination of IMT and FES. The study is being conducted in a single center in Spain. Independently of staggered entry, the minimum duration of a patient's participation is 6 months (from first to last visit). All patients will provide signed informed consent and the protocol has been approved by the research ethics committee of our center in accordance with the principles of the Declaration of Helsinki and national regulations.

Study population Candidate patients are selected from the outpatient's clinics of HF of the Hospital Clínico Universitario of Valencia.

Study objectives The primary endpoint of the study is a clinical endpoint of three and six months change in peak oxygen uptake (peak VO2).

Secondary endpoints are three and six month changes in echocardiogram parameters, QoL and prognostic biomarkers. The investigators also will specifically focus on number of episodes of worsening HF at 6 months:

  1. Change in E/e' after three and six months.
  2. Change in left atrial volume index after three and six months.
  3. Change in health-related QoL measured by the Minnesota Living With Heart Failure Questionnaire (MLHF) after three and six months.
  4. Change in natriuretic peptide (NT-proBNP) after three and six months.
  5. Change in minute ventilation/carbon dioxide production (VE/VCO2) slope after three and six months.
  6. Number of episodes of acute HF hospitalizations and number of episodes of worsening HF not requiring hospitalization at 6 months.

Intervention

Eligibility assessment and screening visit After reviewing the inclusion/exclusion criteria and signing the informed consent form, a comprehensive medical history, physical examination, anthropometry and examination tests will be performed. The examination tests include: electrocardiogram (ECG) echocardiography, cardiopulmonary exercise testing (CPET), 6-minute walk test (6-MWT), inspiratory muscle function test, QoL assessment by the Minnesota Living With Heart Failure Questionnaire (MLHF) and blood samples for a panel of baseline biomarkers.

Finally, patients are randomized (1:1:1:1) to four groups: 1) ST alone or; 2) a home-based 12-week program of IMT or; 3) a 12-week program of FES or; 4) combination of IMT and FES (IMT+FES) during 12 weeks.

12-week and six months visits All patients will be evaluated after 12-week supervised training, and six months after randomization. Evaluation will include medical history, physical examination, anthropometry and functional and QoL assessment tests (ECG, CPET, 6-MWT, inspiratory muscle function test, MLHF and blood tests).

Being tested
IMT, FES, Standard treatment
Keywords
heart failure with preserved ejection fraction, physical therapy, exercise capacity, quality of life

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • IMTOther

    Also called Inspiratory muscular training

    Patients allocated to IMT arm will receive standard medical treatment and will be instructed to train at home twice daily, for 20 minutes each session, and during 12 weeks using a threshold inspiratory muscle trainer (Threshold IMT®, Respironics Inc.). All of them will be instructed by a respiratory therapist and educated to maintain a diaphragmatic breathing during the training period. The subjects start breathing at a resistance equal to 25-30% of their maximal inspiratory pressure (MIP) for 1 week. The respiratory therapist examines the patients at weekly intervals by checking the diary card and measuring their MIP each time. The resistance is modified each session according to their 25-30% of their MIP measured.

  • FESOther

    Also called Functional electrostimulation of lower limbs

    Patients allocated to FES arm will receive standard medical treatment and will be trained in a FES program of both legs by a physiotherapist for 45 minutes a day, 2 days per week for a total of 12 weeks. Eight adhesive electrodes are positioned on the skin over the quadriceps and gastrocnemius muscles of both legs. The stimulator is configured to deliver a direct electrical current at 25 Hz for 5 seconds followed by a 5-second rest. The intensity of the stimulation is adjusted to achieve a visible muscle contraction without discomfort.

  • Standard treatmentOther

    Patients allocated to this arm will not receive any physical therapy, only standard medical treatment. They will be checked weekly by a physiotherapist who measures their maximal inspiratory mouth pressure each time.

Study groups in NCT02638961
Study groupRoleWhat they receive
Standard treatmentPlacebo comparatorOnly standard medical treatment
Receives: Other: Standard treatment
IMT groupActive comparatorStandard medical treatment associated to Inspiratory muscle training
Receives: Other: IMT
FES groupActive comparatorStandard medical treatment associated to functional electrostimulation of both legs for 45 minutes a day, 2 days per week for a total of 12 weeks.
Receives: Other: FES
IMT+FES groupActive comparatorStandard medical treatment associated to combination of inspiratory muscle training and functional electrostimulation of both legs
Receives: Other: IMT; Other: FES

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Functional capacity measured as peak oxygen uptake (peak VO2) in ml/min/kg .

    Maximal functional capacity will be evaluated with an incremental and symptom-limited cardiopulmonary exercise testing (CORTEX Metamax 3B) on a bicycle ergometer, beginning with a workload of 10 W and increasing stepwise at 10-W increments every 1 min. During exercise, patients were continuously monitored with twelve-lead electrocardiogram and blood pressure measurements every 2 min. Gas exchange data and cardiopulmonary variables were averaged every 10 seconds values. Peak VO2 is considered the highest value of VO2 during the last 20 s of exercise.

    The improvement > of 10% in peak VO2 will be considered clinically meaningful

    Measured: changes at 12 weeks and 6 months

Secondary outcomes (6)
  1. Functional capacity measured as distance walked in 6 minutes

    Patients will be instructed to cover the maximum distance (meters) possible in six minutes, at a self-graded walking speed, pausing to rest when needed. Each subject will undergo 4 tests. The goal of the first one was to allow the patient to familiarize with the test.

    Measured: changes at 12 weeks and 6 months

  2. Change in echocardiographic parameter of diastolic disfunction: e' septal (cm/s)

    Doppler echocardiogram examination of e' septal (cm/s) will be performed under resting conditions using 2D echocardiography (iE33, Philips). e' septal (cm/s) parameter will be measured according to current guidelines of the European Society of Echocardiography:

    Only significant improvements in this parameter will be considered

    Measured: changes in rest at 12 weeks and 6 months

  3. Change in echocardiographic parameter of diastolic disfunction: left atrial volume index (mm/m2)

    Doppler echocardiogram examination of left atrial volume index (mm/m2) will be performed under resting conditions using 2D echocardiography (iE33, Philips). Left atrial volume index (mm/m2) will be measured according to current guidelines of the European Society of Echocardiography.

    Only significant improvements in this parameter will be considered

    Measured: changes in rest at 12 weeks and 6 months

  4. Change in echocardiographic parameter of diastolic disfunction: E/e' ratio

    Doppler echocardiogram examination of E/e' ratio will be performed under resting conditions using 2D echocardiography (iE33, Philips). E/e' ratio parameter will be measured according to current guidelines of the European Society of Echocardiography.

    Only significant improvement in this parameter will be considered

    Measured: changes in rest at 12 weeks and 6 months

  5. Change in health-related QoL

    Change in health-related QoL will be measured by the Minnesota Living With Heart Failure Questionnaire (no units) Only significant improvements in these parameters will be considered

    Measured: changes at 12 weeks and 6 months

  6. Number of rehospitalizations or worsening HF at 6 months

    Number of episodes of acute HF hospitalizations and number of episodes of worsening HF not requiring hospitalization at 6 months among different arms.

    Measured: changes at 6 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted23 Dec 2015 (estimated)
  2. Study startOct 2015
  3. Primary completionJan 2017
  4. Study completionMar 2017

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
52 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02638961
Sponsor's protocol ID
IMT-FES 01
Acronym
TRAINING-HF
Status last verified
May 2017
First submitted
1 Dec 2015
Last updated
18 May 2017
Results posted
No
Data monitoring committee
Yes

Publications

  • Palau P, Dominguez E, Nunez E, Schmid JP, Vergara P, Ramon JM, Mascarell B, Sanchis J, Chorro FJ, Nunez J. Effects of inspiratory muscle training in patients with heart failure with preserved ejection fraction. Eur J Prev Cardiol. 2014 Dec;21(12):1465-73. doi: 10.1177/2047487313498832. Epub 2013 Jul 17.

    PubMed 23864363
  • Palau P, Nunez E, Dominguez E, Sanchis J, Nunez J. Physical therapy in heart failure with preserved ejection fraction: A systematic review. Eur J Prev Cardiol. 2016 Jan;23(1):4-13. doi: 10.1177/2047487314562740. Epub 2014 Dec 8.

    PubMed 25488549
  • Palau P, Lopez L, Dominguez E, de La Espriella R, Campuzano R, Castro A, Minana G, Fernandez-Cisnal A, Sanchis J, Nunez J. Exercise training response according to baseline ferrokinetics in heart failure with preserved ejection fraction: A substudy of the TRAINING-HF trial. J Cachexia Sarcopenia Muscle. 2024 Apr;15(2):681-689. doi: 10.1002/jcsm.13419. Epub 2024 Jan 15.

    PubMed 38225218
  • Palau P, Dominguez E, Lopez L, Ramon JM, Heredia R, Gonzalez J, Santas E, Bodi V, Minana G, Valero E, Mollar A, Bertomeu Gonzalez V, Chorro FJ, Sanchis J, Lupon J, Bayes-Genis A, Nunez J. Inspiratory Muscle Training and Functional Electrical Stimulation for Treatment of Heart Failure With Preserved Ejection Fraction: The TRAINING-HF Trial. Rev Esp Cardiol (Engl Ed). 2019 Apr;72(4):288-297. doi: 10.1016/j.rec.2018.01.010. Epub 2018 Mar 16. English, Spanish.

    PubMed 29551699

Questions about this trial

What is this clinical trial studying?

A study testing IMT, FES and Standard treatment in people with Heart Failure With Normal Ejection Fraction, run by Universitat Jaume I at 1 site in Spain.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 8 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 18 May 2017. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Spain. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Functional capacity measured as peak oxygen uptake (peak VO2) in ml/min/kg . (time frame: changes at 12 weeks and 6 months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02638961, which also lists 4 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 18 May 2017.

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