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Home > "E" Clinical Trials Conditions > Enalapril After Anthracycline Cardiotoxicity  Enalapril After Anthracycline Cardiotoxicity
Enalapril After Anthracycline Cardiotoxicity
For Condition: Cardiovascular Diseases,Heart Diseases,Heart Failure,Myocardial Diseases
Status: Completed
Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) ,
Synopsis: To determine if the chronic administration of enalapril, an inhibitor of angiotensin converting enzyme (ACE), reduces progression of cardiac dysfunction in pediatric oncology patients who have received anthracyclines, and who are not currently on digoxin, diuretics, or vasodilators for heart failure.
Details: BACKGROUND: Pediatric oncology patients who have been treated with anthracycline therapy as a part of their chemotherapeutic regimen often subsequently develop left ventricular failure. The optimal medical management is not known. This trial will be the first to provide comprehensive data on a well characterized population regarding the role of afterload reduction using enalapril to treat ventricular dysfunction after anthracycline chemotherapy DESIGN NARRATIVE: Randomized, double-blind. Randomization was stratified by total anthracycline dose, follow-up time from treatment, and age at time of treatment. All patients received the following baseline tests: Maximal Cardiac Index (MCI) on cycle ergometry; echocardiogram/Doppler determined left ventricular end systolic wall stress (ESWS); gated nuclear angiography (GNA) to determine left ventricular ejection fraction; Holter monitoring for 24 hour ECG monitoring. Patients were randomized to either enalapril or placebo. Follow-up visits were conducted to ensure compliance and screen for side effects. MCI and ESWS were measured twice yearly, while all four tests were repeated at the conclusion of the trial, after four to five years of treatment. The primary outcome variables were the rate of decline in MCI and the rate of increase in ESWS. Secondary outcomes were the change in left ventricular ejection fraction and the incidence of arrhythmias. A second aim of the study was to develop an algorithm to determine indications for enalapril use if the study succeeded in showing a treatment effect. This required modeling the probability of cardiac dysfunction given patient characteristics at treatment, treatment type, cardiac status during treatment and at follow-up, and the development of cost effectiveness and medical decision making models testing the proposed algorithm.
Eligibility:
Study Type: Interventional, Treatment, Randomized, Double-Blind, Placebo Control
Minimum Age/Maximum Age: 1 Year/17 Years
Genders: Both
Protocol Entry Criteria: Boy and girl pediatric oncology patients, at least two years off treatment, with some cardiac dysfunction, but not congestive heart failure, after receiving anthracyclines. Patients were not on digoxin, diuretics, or vasodilators for heart failure.
Total Enrollment:
Location and Contact Information:
Overall Study Official:
JeffreySilber, , Children's Hospital of Philadelphia
Additional Information:
Study ID Numbers: 91;
Study Start Date: April 1994
Record last reviewed: January 2003
Additional information available at: clinicaltrials.gov
Clinicaltrials.gov Reference link: NCT00000547
Other Heart Failure Studies:
1. Cholesterol Reduction in Seniors Program (CRISP)
2. Beta-Blocker Evaluation in Survival Trial (BEST)
3. Multidisciplinary Study of Right Ventricular Dysplasia
4. The safety and efficacy of adjunct carvedilol in children with moderate heart failure
5. Providers for Smoking Prevention Programs
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Enalapril After Anthracycline Cardiotoxicity
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