Quantifying Congestion by Ultrasound (QUEST-HF)

NHS Trust

Status: Unknown

Conditions: Heart Failure

Treatments: Other: Diuretics

Study type: Interventional

Funder types: Other

Identifiers

NCT05090137

GN18CA427

Details and patient eligibility

About

The investigators will determine the feasibility of identifying and quantifying changes in interstitial and intravascular congestion by imaging in participants with heart failure. The investigators will either continue or temporarily suspend both loop diuretics and mineralo-corticoid antagonists (MRA) for 48 hours in participants with heart failure that is both stable and mild and compare measurements of interstitial (B-lines) and intra-vascular fluids (IVC and JV diameter and renal venous flow) by ultrasound and, in a subset of participants without contra-indications, by cardiac MRI.

Enrollment: 20 estimated patients

Sex: All

Ages: 19 to 100 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Clinical diagnosis of heart failure
• Plasma NT-proBNP >125ng/L or BNP >35 ng/l
• Left ventricular ejection fraction (LVEF) <50% on prior imaging test
• Treated routinely with a daily dose of loop diuretic
• Receiving other guideline-indicated therapy for heart failure
• Willing to sign the informed consent form
• Greater than 18 years of age

Exclusion criteria

• Chronic Kidney Disease Stage 4 or worse (eGFR <30 mL/min/1.73 m²)
• Atrial fibrillation
• Significant valve disease (investigators opinion)
• Breathlessness or chest pain at rest or minor exertion
• Patients unable to lie flat
• Patients deemed too unstable to miss treatment with diuretics for 48 hours
• Patients taking part in another interventional trial
• Any other concomitant condition that in the opinion of the investigator would not allow a safe participation in the study (ie:-pregnancy, significant frailty)
• Patients unwilling or unable to consent
• For patients willing to undergo MRI; contraindication to MRI including claustrophobia, metalworkers, and intra-orbital or intracranial metal (eg:- stents), and non-MRI compliant device.

Trial design

Primary purpose: Diagnostic

Allocation: Randomized

Interventional model: Crossover Assignment

Masking: None (Open label)

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20 participants in 2 patient groups

Diuretic cessation

Other group

Description:

Participants will be asked to withhold their diuretic therapy (loop diuretics and mineralocorticoid receptor antagonists) 48 hours prior to visit

Treatment:

Other: Diuretics

Usual diuretic regimen

Other group

Description:

Participants will take their usual diuretic regimen prior to study visit. At least one week is required between cross-over visits

Treatment:

Other: Diuretics