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Cleland JGF, Teerlink JR, Senior R, Nifontov EM, Mc Murray JJV, Lang CC, Tsyrlin VA, Greenberg BH, Mayet J, Francis DP, Shaburishvili T, Monaghan M, Saltzberg M, Neyses L, Wasserman SM, Lee JH, Saikali KG, Clarke CP, Goldman JH, Wolff AA, Malik FI. The effects of the cardiac myosin activator, omecamtiv mecarbil, on cardiac function in systolic heart failure: a double-blind, placebo-controlled, crossover, dose-ranging phase 2 trial. Lancet 2011; 378:676-83. [PMID: 21856481 DOI: 10.1016/s0140-6736(11)61126-4] [Citation(s) in RCA: 246] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Many patients with heart failure remain symptomatic and have a poor prognosis despite existing treatments. Decreases in myocardial contractility and shortening of ventricular systole are characteristic of systolic heart failure and might be improved by a new therapeutic class, cardiac myosin activators. We report the first study of the cardiac myosin activator, omecamtiv mecarbil, in patients with systolic heart failure. METHODS We undertook a double-blind, placebo-controlled, crossover, dose-ranging, phase 2 trial investigating the effects of omecamtiv mecarbil (formerly CK-1827452), given intravenously for 2, 24, or 72 h to patients with stable heart failure and left ventricular systolic dysfunction receiving guideline-indicated treatment. Clinical assessment (including vital signs, echocardiograms, and electrocardiographs) and testing of plasma drug concentrations took place during and after completion of each infusion. The primary aim was to assess safety and tolerability of omecamtiv mecarbil. This study is registered at ClinicalTrials.gov, NCT00624442. FINDINGS 45 patients received 151 infusions of active drug or placebo. Placebo-corrected, concentration-dependent increases in left ventricular ejection time (up to an 80 ms increase from baseline) and stroke volume (up to 9·7 mL) were recorded, associated with a small reduction in heart rate (up to 2·7 beats per min; p<0·0001 for all three measures). Higher plasma concentrations were also associated with reductions in end-systolic (decrease of 15 mL at >500 ng/mL, p=0·0026) and end-diastolic volumes (16 mL, p=0·0096) that might have been more pronounced with increased duration of infusion. Cardiac ischaemia emerged at high plasma concentrations (two patients, plasma concentrations roughly 1750 ng/mL and 1350 ng/mL). For patients tolerant of all study drug infusions, no consistent pattern of adverse events with either dose or duration emerged. INTERPRETATION Omecamtiv mecarbil improved cardiac function in patients with heart failure caused by left ventricular dysfunction and could be the first in class of a new therapeutic agent. FUNDING Cytokinetics Inc.
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Affiliation(s)
- John G F Cleland
- Department of Cardiology, Hull York Medical School, University of Hull, Hull, UK.
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Shen YT, Malik FI, Zhao X, Depre C, Dhar SK, Abarzúa P, Morgans DJ, Vatner SF. Improvement of Cardiac Function by a Cardiac Myosin Activator in Conscious Dogs With Systolic Heart Failure. Circ Heart Fail 2010; 3:522-7. [DOI: 10.1161/circheartfailure.109.930321] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- You-Tang Shen
- From CV Dynamics, Inc (Y.-T.S., P.A., S.F.V.), North Brunswick, NJ; Cytokinetics, Inc (F.I.M., D.J.M.), South San Francisco, Calif; the Department of Cell Biology and Molecular Medicine and Cardiovascular Research Institute (Y.-T.S., X.Z., C.D., S.F.V.), New Jersey Medical School, UMDNJ, Newark, NJ; and the Department of Mathematical Sciences (S.K.D.), New Jersey Institute of Technology, Newark, NJ
| | - Fady I. Malik
- From CV Dynamics, Inc (Y.-T.S., P.A., S.F.V.), North Brunswick, NJ; Cytokinetics, Inc (F.I.M., D.J.M.), South San Francisco, Calif; the Department of Cell Biology and Molecular Medicine and Cardiovascular Research Institute (Y.-T.S., X.Z., C.D., S.F.V.), New Jersey Medical School, UMDNJ, Newark, NJ; and the Department of Mathematical Sciences (S.K.D.), New Jersey Institute of Technology, Newark, NJ
| | - Xin Zhao
- From CV Dynamics, Inc (Y.-T.S., P.A., S.F.V.), North Brunswick, NJ; Cytokinetics, Inc (F.I.M., D.J.M.), South San Francisco, Calif; the Department of Cell Biology and Molecular Medicine and Cardiovascular Research Institute (Y.-T.S., X.Z., C.D., S.F.V.), New Jersey Medical School, UMDNJ, Newark, NJ; and the Department of Mathematical Sciences (S.K.D.), New Jersey Institute of Technology, Newark, NJ
| | - Christophe Depre
- From CV Dynamics, Inc (Y.-T.S., P.A., S.F.V.), North Brunswick, NJ; Cytokinetics, Inc (F.I.M., D.J.M.), South San Francisco, Calif; the Department of Cell Biology and Molecular Medicine and Cardiovascular Research Institute (Y.-T.S., X.Z., C.D., S.F.V.), New Jersey Medical School, UMDNJ, Newark, NJ; and the Department of Mathematical Sciences (S.K.D.), New Jersey Institute of Technology, Newark, NJ
| | - Sunil K. Dhar
- From CV Dynamics, Inc (Y.-T.S., P.A., S.F.V.), North Brunswick, NJ; Cytokinetics, Inc (F.I.M., D.J.M.), South San Francisco, Calif; the Department of Cell Biology and Molecular Medicine and Cardiovascular Research Institute (Y.-T.S., X.Z., C.D., S.F.V.), New Jersey Medical School, UMDNJ, Newark, NJ; and the Department of Mathematical Sciences (S.K.D.), New Jersey Institute of Technology, Newark, NJ
| | - Patricio Abarzúa
- From CV Dynamics, Inc (Y.-T.S., P.A., S.F.V.), North Brunswick, NJ; Cytokinetics, Inc (F.I.M., D.J.M.), South San Francisco, Calif; the Department of Cell Biology and Molecular Medicine and Cardiovascular Research Institute (Y.-T.S., X.Z., C.D., S.F.V.), New Jersey Medical School, UMDNJ, Newark, NJ; and the Department of Mathematical Sciences (S.K.D.), New Jersey Institute of Technology, Newark, NJ
| | - David J. Morgans
- From CV Dynamics, Inc (Y.-T.S., P.A., S.F.V.), North Brunswick, NJ; Cytokinetics, Inc (F.I.M., D.J.M.), South San Francisco, Calif; the Department of Cell Biology and Molecular Medicine and Cardiovascular Research Institute (Y.-T.S., X.Z., C.D., S.F.V.), New Jersey Medical School, UMDNJ, Newark, NJ; and the Department of Mathematical Sciences (S.K.D.), New Jersey Institute of Technology, Newark, NJ
| | - Stephen F. Vatner
- From CV Dynamics, Inc (Y.-T.S., P.A., S.F.V.), North Brunswick, NJ; Cytokinetics, Inc (F.I.M., D.J.M.), South San Francisco, Calif; the Department of Cell Biology and Molecular Medicine and Cardiovascular Research Institute (Y.-T.S., X.Z., C.D., S.F.V.), New Jersey Medical School, UMDNJ, Newark, NJ; and the Department of Mathematical Sciences (S.K.D.), New Jersey Institute of Technology, Newark, NJ
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Uechi M, Hori Y, Fujimoto K, Ebisawa T, Yamano S, Maekawa S. Cardiovascular effects of a phosphodiesterase III inhibitor in the presence of carvedilol in dogs. J Vet Med Sci 2006; 68:549-53. [PMID: 16820710 DOI: 10.1292/jvms.68.549] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to determine whether dobutamine, dopamine, or milrinone (a phosphodiesterase [PDE] III inhibitor) would support cardiac function that had been attenuated by administration of the beta-blocker, carvedilol (0.2, 0.4, or 0.8 mg/kg). Hemodynamic and cardiac parameters including the heart rate (HR), left-ventricular fractional shortening (FS), and arterial pressure were measured in six healthy dogs without cardiac disease. Carvedilol did not affect FS or arterial pressure, but decreased the HR significantly. The positive inotropic and chronotropic responses to dobutamine and dopamine were attenuated by carvedilol, whereas arterial pressure was unaffected. Milrinone did not affect the HR and decreased arterial pressure, whereas FS was significantly greater both in the control and carvedilol-treated groups. Although milrinone affect the negative chronotropic effects of carvedilol, milrinone increased FS and prevented the decrease in arterial pressure. These results suggest that inhibition of PDE III preserves cardiac contractility and hemodynamic function in the presence of carvedilol.
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Affiliation(s)
- Masami Uechi
- Veterinary Teaching Hospital, School of Veterinary Medicine & Animal Science, Kitasato University, Aomori, Japan
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