Therapy to Maintain Remission in Dilated Cardiomyopathy

Launched by IMPERIAL COLLEGE LONDON · Oct 17, 2023

Keywords

ClinConnect Summary

The TRED-HF trial is studying how stopping certain heart medications affects patients who have previously improved from heart failure caused by dilated cardiomyopathy. In earlier research, they found that about 40% of patients experienced a return of their heart issues within six months after their treatment was stopped. This new study aims to see if withdrawing medications like SGLT2 inhibitors and mineralocorticoid receptor antagonists is safe and helps maintain recovery in patients who are currently doing well.

To be eligible for this trial, participants should have a history of dilated cardiomyopathy, previous heart function below 40%, and current heart function above 50%. They should also be stable and on specific heart medications. This study is open to all adults aged 65 to 74 years, and participants can expect to be closely monitored for their heart health and any changes during the trial. It’s important to note that certain conditions, such as a history of irregular heartbeats or specific genetic factors, may exclude someone from joining.

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • 1. a diagnosis of dilated cardiomyopathy,
• • 2. previous left ventricular ejection fraction (LVEF) \<40% (on echocardiography or cardiovascular magnetic resonance \[CMR\]),
• • 3. current LVEF \>50% with normal left ventricular end-diastolic volume (LVEDV),
• • 4. plasma NT-pro-BNP\<250ng/L,
• • 5. New York Heart Association (NYHA) class I,
• • 6. sinus rhythm,
• • 7. taking a beta-blocker and an angiotensin converting enzyme inhibitor (ACEi), angiotensin receptor blocker (ARB) or sacubitril-valsartan, along with either a mineralocorticoid receptor antagonist (MRA) and/or sodium glucose co-transporter 2 inhibitor (SGLT2i).
• Exclusion Criteria:
• • 1. Atrial fibrillation,
• • 2. prior sustained ventricular tachycardia or fibrillation,
• • 3. a known likely pathogenic or pathogenic variant in LMNA/DSP/FLNC/RBM20,
• • 4. sudden cardiac or heart failure death in a first degree relative \<50 years,
• • 5. contraindication to CMR,
• • 6. estimated glomerular filtration rate (eGFR) \<60mls/min,
• • 7. planned pregnancy,8) active myocardial inflammation,
• • 9) diabetes mellitus managed with an SGLT2i, 10) urinary albumin-to-creatine ratio of 200-5000 (mg:g) and eGFR\< 75mls/min.