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Heart FailureNCT04942548

Reverse HFpEF: Ketogenic Reversal of Heart Failure With Preserved Ejection Fraction Study

A study testing Ketogenic Diet in people with Heart Failure, run by National Jewish Health at 2 sites in United States.

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

This protocol is a prospective pilot study utilizing the intervention of a medically supervised, registered nurse and registered diabetes educator coached low-carbohydrate, ketogenic diet to examine the impact it has as a treatment for heart failure with preserved ejection fraction. Read more about this study

Who is it for?
Ages 21 to 80 years
Conditions the study is for
Heart Failure
What is being tested?
Ketogenic Diet
Could I receive a placebo?
No, everyone receives an active treatment
How many people
16 participants
Where
2 sitesUnited States
Study dates
25 Jul 2019to 24 Jul 2023
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 21 to 80 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Adults (age 21-80) who meet clinical signs and symptoms of heart failure based on clinical assessment.
  • The subject must meet at least one of the following hemodynamic criteria for HFpEF of PH-HFpEF by right heart catheterization (RHC) within 6 months of screening visit;
  • HFpEF:
  • At rest: mean pulmonary artery occlusions pressure (PAOP) > 15, pulmonary vascular resistance (PVR) < 3 Wood Units, or
  • HFpEF with fluid challenge, defined as increase in PAOP post 500 cc fluid bolus: mean PAOP > 18, PVR < 3 Wood Units, or
  • HFpEF with exercise, defined as peak mean PAOP > 17, PVR < 3 Wood Units if age < 50 or peak mean PAOP > 19 and PVR < 3 Wood Units if age >= 50
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  • PH-HFpEF:
  • At rest: mean pulmonary artery occlusion pressure (PAOP) > 15, mean pulmonary artery pressure (PAP) >= 25, pulmonary vascular resistance (PVR) > 3 Wood Units, or
  • PH-HFpEF with fluid challenge, defined as increase in PAOP post 500 cc fluid bolus: mean PAOP > 18, mean PAP >= 25, PVR > 3 Wood Units, or
  • PH-HFpEF with exercise, defined as peak mean PAOP > 17, peak mean PAP > 30, peak PVR > 1.34 Wood Units if age < 50 or peak mean PAOP > 19, peak mean PAP > 33, and PVR < 2.1 Wood Units if age >= 50
  • The subject also must meet criteria for metabolic syndrome, defined as: Abdominal obesity (BMI > 30 kg/m2 or abdominal obesity, waist circumference > 102 cm men, > 88 cm women) AND 2 of the following;
  • Currently being treated for systemic hypertension or blood pressure (BP) >= 135/85 b. Glucose intolerance with diagnosis of type 2 diabetes, or fasting blood glucose 110-125 mg/dL or hemoglobin A1c > 6% c. Triglycerides >= 150, or on treatment for high triglycerides d. HDL < 40 men, < 50 women, or on treatment for high triglycerides
  • If the subject is on pulmonary hypertension specific vasodilators, they must be on stable medical therapy without changes to pulmonary vasodilator medication within 3 months prior to screening visit.
  • The subject must have also had a cardiopulmonary exercise test within 6 months of screening visit.
  • The subject must have also had an echocardiogram within 6 months of screening visit.
  • The subject must have demonstrated stable weight (less that 5% weight loss) 3 months prior to screening visit. (They cannot already be losing weight).
  • The subject owns and uses a smartphone or tablet.
  • Must speak English

Who cannot join

  • The subject is already on a significant weight loss trajectory prior to study entry.
  • The subject cannot be on an alternative diet plan or strategy (e.g., Weight Watchers, Nutrisystem, Ornish).
  • Left ventricular ejection fraction < 50%.
  • Severe valvular disease by echocardiogram or dysfunctional prosthetic valve.
  • Active pericardial disease (moderate or large pericardial effusion or constrictive pericarditis).
  • Active coronary ischemia defined by abnormal stress test, angiogram, or coronary CT angiography per investigator.
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  • Prolonged corrected QT interval (QTc) > 450 ms
  • Significant lung disease on pulmonary function tests (PFT's) within the 6 months of screening visit, (Both post-bronchodilator values and pre-bronchodilator values must meet exclusion criteria. If either post- or pre-bronchodilator values do not, the subject may be included) defined as either:
  • Irreversible obstructive airways disease (post-bronchodilator forced expiratory volume/forced vital capacity (FEV1/FVC) < 70% predicted) or
  • Restrictive lung disease (FVC < 70% predicted. If total lung capacity (TLC) is >= 70%, it is acceptable to have an FVC of < 70%) or
  • More than mild radiographic pulmonary disease as determine don CT scan within the past 2 years per investigator.
  • History of non-adherence to diuretics within 3 months of screening visit.
  • History or recurrent severe hypokalemia, potassium < 3.0 mg/dL.
  • History of kidney stones, gout, or gallbladder disease unless in the opinion of the investigator it will not impact the safety of the patient
  • C-peptide < 0.5 ng/mL (increased risk of diabetic ketoacidosis (DKA))
  • Uncorrected anemia (hemoglobin < 10 g/dL).
  • Unable to participate in the comprehensive ketogenic diet program, including biometric data acquisition and data entry (glucometer self-stick and smartphone use).
  • Unable or unwilling to prepare meals for self.
  • Unable to perform quantitative cardia testing regimen (cardiopulmonary exercise testing, 6-minute walk).
  • Subject is pregnant or planning to become pregnant in the next 14 months.

Trial locations and contacts

2 sites in 1 country.

United States2 sites
  • National Jewish Health and University of Colorado Denver

    Denver, Colorado, 80206

  • Saint Joseph Hospital

    Denver, Colorado, 80218

Other trials in United States

About this study

This protocol is a prospective pilot study utilizing the intervention of a medically supervised, registered nurse and registered diabetes educator coached low-carbohydrate, ketogenic diet to examine the impact it has as a treatment for heart failure with preserved ejection fraction.

Conditions
Heart Failure
Being tested
Ketogenic Diet
Keywords
obese, keto, diet, cardiac
Medical subject headings
Heart Failure, Obesity

What participants receive

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

  • Ketogenic DietOther

    Ketogenic diet intervention that is high in fat and low in carbohydrates, causing the body to induce a state of metabolic ketosis, whereby fat is broken down into ketones to provide an energy source for the body.

Study groups in NCT04942548
Study groupRoleWhat they receive
HFpEFExperimentalPatients diagnosed with obesity related heart failure with preserved ejection fraction(HFpEF)
Receives: Other: Ketogenic Diet
PH-HFpEFExperimentalPatients diagnosed with obesity related pulmonary hypertension heart failure with preserved ejection fraction (PH-HFpEF)
Receives: Other: Ketogenic Diet

What is being measured

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

  1. MLHFQ Questionnaire

    Change in score on the Minnesota Living with Heart Failure Quality of Life (MLHFQ) Questionnaire for the HFpEF cohort.

    • Max. Score = 105
    • Min. Score = 0
    • A reduced score means improvement of heart failure symptoms; better outcome

    Measured: 6 Months

  2. PAH-SYMPACT Questionnaire

    Change in score on the Pulmonary Arterial Hypertension-Symptoms and Impact (PAH-SYMPACT) Questionnaire for the PH-HFpEF cohort.

    • Max. Score = 89
    • Min. Score = 0
    • A reduced score means improvement of pulmonary hypertension heart failure symptoms; better outcome

    Measured: 6 Months

Secondary outcomes (36)
  1. Change in Metabolic Health: Weight

    Weight in kilograms (kg)

    Measured: 6 Months

  2. Change in Metabolic Health: Glucose

    Glucose in milligrams per deciliter (mg/dL)

    Measured: 6 Months

  3. Change in Metabolic Health: Insulin

    Insulin in microinternational unit per milliliter (uIU/mL)

    Measured: 6 Months

  4. Change in Metabolic Health: Homeostatic Model Assessment for Insulin Resistance (HOMA-IR)

    Insulin and glucose are multiplied then divided by 405 to report HOMA-IR

    Measured: 6 Months

  5. Change in Metabolic Health: Albumin

    Albumin in grams per deciliter (g/dL)

    Measured: 6 Months

  6. Change in Metabolic Health: Bilirubin total

    Bilirubin total in milligrams per deciliter (mg/dL)

    Measured: 6 Months

  7. Change in Metabolic Health: Alanine Transaminase (ALT)

    ALT in units per liter (U/L)

    Measured: 6 Months

  8. Change in Metabolic Health: Aspartate Aminotransferase (AST)

    AST in units per liter (U/L)

    Measured: 6 Months

  9. Change in Metabolic Health: Alkaline Phosphatase (ALP)

    ALP in units per liter (U/L)

    Measured: 6 Months

  10. Change in Metabolic Health: High Sensitivity C-Reactive Protein (HS-CRP)

    HS-CRP in milligrams per deciliter (mg/dL)

    Measured: 6 Months

  11. Change in Metabolic Health: Triglycerides

    triglyceride in milligrams per deciliter (mg/dL)

    Measured: 6 Months

  12. Change in Metabolic Health: High Density Lipoprotein (HDL)

    HDL in milligrams per deciliter (mg/dL)

    Measured: 6 Months

  13. Change in Metabolic Health: Hemoglobin A1c

    hemoglobin A1c in percent (%)

    Measured: 6 Months

  14. Change in Metabolic Health: Body Mass Index (BMI)

    Weight and height will be combined to report BMI in kg/m^2

    Measured: 6 Months

  15. Changes in Physical Function: 6 Minute Walk Test (6MWT)

    6-minute walk test is reported in meters (m) of how far a subject walks in 6 minutes

    Measured: 6 Months

  16. Changes in Physical Function: Maximum Oxygen Consumption (VO2max)

    VO2 max is reported in liters per minute (L/min) while performing a cardiopulmonary exercise test (CPET)

    Measured: 6 Months

  17. Changes in Physical Function: Maximum Work

    Maximum work achieved while performing a cardiopulmonary exercise test (CPET) is reported in watts (W)

    Measured: 6 Months

  18. Changes in Physical Function: 30 Second Sit-to-Stand test (30s STS)

    30s STS is reported in quantity of how many times the subject can come to a full stand from a seated position in 30 seconds (s)

    Measured: 6 Months

  19. Changes in Physical Function: Leg Press - 1 Repetition Maximum

    Leg press is reported in kilograms (kg)

    Measured: 6 Months

  20. Changes in Physical Function: Chest Press - 1 Repetition Maximum

    Chest press is reported in kilograms (kg)

    Measured: 6 Months

  21. Changes in Physical Function: Leg Extension - 1 Repetition Maximum

    Leg extension is reported in kilograms (kg)

    Measured: 6 Months

  22. Cardiac Remodeling: Changes in the Left Ventricle (LV) size

    This is determined by the internal diameter measurement of the LV, reported in centimeters (cm) from a subject performed echocardiogram

    Measured: 6 Months

  23. Cardiac Remodeling: Changes in the Left Ventricle (LV) thickness

    This is determined by a measurement of the LV wall, reported in millimeters (mm) from an echocardiogram.

    Measured: 6 Months

  24. Cardiac Remodeling: Changes in the Left Ventricle (LV) mass

    This is determined by a combination formula of the interventricular septum diastole (IVSd), left ventricle diastole (LVd), and posterior wall diastole (PWd), calculated by an echocardiogram and reported in grams (g).

    Measured: 6 Months

  25. Cardiac Remodeling: Changes in Left Atrium (LA) size

    This is determined by the internal diameter measurement of the LA, reported in centimeters (cm) from a subject performed echocardiogram.

    Measured: 6 Months

  26. Cardiac Remodeling: Changes in Inferior Vena Cava (IVC) size

    This is determined by the internal diameter perpendicular to the long axis of the IVC at the end-expiration, reported in centimeters (cm) from the echocardiogram.

    Measured: 6 Months

  27. Cardiac Remodeling: Changes in estimated Right Atrial Pressure (RAP)

    This is determined by a combination equation subtracting the venous return (VR) from the central venous pressure (CVP), reported in millimeters of mercury (mmHg) from the echocardiogram.

    Measured: 6 Months

  28. Cardiac Remodeling: Changes in Right Ventricle Systolic Pressure (RVSP)

    This estimates the pressure inside the artery that supplies the lung with blood, reported in millimeters of mercury (mmHg) from the echocardiogram.

    Measured: 6 Months

  29. Changes in the rate of mitral annulus velocity (e')

    e' is reported in centimeters per second (cm/s) based on a subject performed echocardiogram

    Measured: 6 Months

  30. Changes in the ratio of transmitral early peak velocity (E) by pulsed wave Doppler over e' (E/e')

    E/e' is reported as an integer based on the transmitral early peak velocity (E) over the mitral annulus velocity (e') from a subject performed echocardiogram.

    Measured: 6 Months

  31. PH-HFpEF Only Hemodynamics: Changes in Right Atrial Pressure (RAP)

    This is determined by a combination equation subtracting the venous return (VR) from the central venous pressure (CVP), reported in millimeters of mercury (mmHg) from the echocardiogram.

    Measured: 6 Months

  32. PH-HFpEF Only Hemodynamics: Changes in Pulmonary Artery Pressure (PAP)

    This is calculated from systolic, by Tricuspid Regurgitation maximum (TRmax) and diastolic, by Pulmonary Regurgitation-end velocity (PR-end) pulmonary artery pressures, reported in millimeters of mercury (mmHg) from the echocardiogram.

    Measured: 6 Months

  33. PH-HFpEF Only Hemodynamics: Changes in Pulmonary Artery Occlusive Pressure (PAOP)

    This is determined by the pressure value of the pulmonary artery once it's occluded during a Right Heart Catheterization (RHC), measured in millimeters of mercury (mmHg).

    Measured: 6 Months

  34. PH-HFpEF Only Hemodynamics: Changes in Pulmonary Vascular Resistance (PVR)

    Left Atrial Pressure (LAP), Pulmonary Artery Pressure (PAP) and Cardiac Output (CO) are combined to report the PVR in Wood Units (WU) from a Right Heart Catheterization (RHC).

    Measured: 6 Months

  35. PH-HFpEF Only Hemodynamics: Changes in Cardiac Output (CO)

    Stoke Volume (SV) and Heart Rate (HR) are combined to report CO in liters per minute (L/min) from the right heart catheterization.

    Measured: 6 Months

  36. PH-HFpEF Only Hemodynamics: Changes in Cardiac Index (CI)

    Cardiac Output (CO) and Body Surface Area (BSA) are combined to report CI in liters per minute per meters squared (L/min/m^2) from a Right Heart Catherization (RHC).

    Measured: 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 posted28 Jun 2021
  2. Study start25 Jul 2019
  3. Primary completion24 Jul 2023
  4. Study completion24 Jul 2023

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
16 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04942548
Sponsor's protocol ID
HS-3243 Keto
Status last verified
Apr 2024
First submitted
25 May 2021
Last updated
3 Apr 2024
Results posted
No
FDA-regulated drug
No
FDA-regulated device
No

Publications

  • Kodur N, Nguyen C, Tang WHW. Therapeutic Ketosis for Heart Failure: A State-of-the-Art Review. J Card Fail. 2025 Jul;31(7):1051-1061. doi: 10.1016/j.cardfail.2025.01.028. Epub 2025 Mar 3.

    PubMed 40043832

Questions about this trial

What is this clinical trial studying?

A study testing Ketogenic Diet in people with Heart Failure, run by National Jewish Health at 2 sites in United States.

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 18 inclusion and 20 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 3 Apr 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in United States. 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. 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?

MLHFQ Questionnaire (time frame: 6 Months). The study lists 2 primary outcomes in all. 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 NCT04942548, which also lists 1 linked publication.

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 3 Apr 2024.

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