Rationale and Design of the EPISODE Trial: A Randomized Controlled Trial on the Effect of PCSK9 Inhibitors in Calcific Aortic Valve Stenosis.

IF 5.3 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Journal of the American Heart Association Pub Date : 2025-10-07 Epub Date: 2025-09-19 DOI:10.1161/JAHA.125.042112
Yang Zheng, Qiuxuan Li, Yuxiu Yang, Jingyao Yang, Zaiqiang Liu, Xiaoteng Ma, Zhijian Wang
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引用次数: 0

Abstract

Background: Calcific aortic valve stenosis (CAVS) can lead to cardiac adverse outcomes; however, currently, no effective pharmacological interventions are available to prevent or delay disease progression. Emerging evidence has identified significant associations between CAVS and key biomarkers, including Lp(a) (lipoprotein [a]), low-density lipoprotein cholesterol, and PCSK9 (proprotein convertase subtilisin/kexin type 9). However, robust evidence from randomized controlled trials is still lacking to substantiate these associations.

Methods: The EPISODE (Effect of PCSK9 Inhibitors on Calcific Aortic Valve Stenosis) trial is a prospective, evaluator-blinded, randomized controlled trial designed to assess the therapeutic efficacy of PCSK9 inhibitors in patients with CAVS. A total of 160 patients with mild-to-moderate or asymptomatic severe CAVS will be randomly assigned to receive either statin monotherapy or a combination of statins and PCSK9 inhibitors. Participants will undergo follow-up assessments at 3-month intervals for 24 months, including transthoracic ultrasonic cardiogram, computed tomography, and quality-of-life evaluations using the EuroQol-5 Dimension-3 Level questionnaire. The primary end point is the annualized change in peak aortic jet velocity, whereas secondary end points encompass changes in aortic valve area, calcification score, incidence of heart valve surgery, and quality of life. Safety end points include all-cause mortality and cardiovascular events.

Conclusions: The trial aims to evaluate the efficacy of PCSK9 inhibitors in modulating disease progression, reducing adverse cardiovascular events, and improving clinical outcomes in patients with CAVS. The anticipated findings are expected to provide critical insights for developing novel therapeutic strategies for early intervention in CAVS.

Registration: URL: https://www.clinicaltrials.gov; Unique Identifier: NCT04968509.

插曲试验的基本原理和设计:PCSK9抑制剂对钙化主动脉瓣狭窄影响的随机对照试验。
背景:钙化性主动脉瓣狭窄(CAVS)可导致心脏不良后果;然而,目前还没有有效的药物干预措施来预防或延缓疾病进展。新出现的证据已经确定了CAVS与关键生物标志物之间的显著关联,包括Lp(a)(脂蛋白[a])、低密度脂蛋白胆固醇和PCSK9(蛋白转化酶枯草杆菌素/ keexin 9型)。然而,仍然缺乏来自随机对照试验的有力证据来证实这些关联。方法:EPISODE (PCSK9抑制剂对钙化主动脉瓣狭窄的影响)试验是一项前瞻性、评估者盲法、随机对照试验,旨在评估PCSK9抑制剂对CAVS患者的治疗效果。共有160名轻中度或无症状重度CAVS患者将被随机分配接受他汀类药物单药治疗或他汀类药物和PCSK9抑制剂联合治疗。参与者将每隔3个月接受随访评估,为期24个月,包括经胸超声心动图、计算机断层扫描和使用EuroQol-5维度-3水平问卷进行生活质量评估。主要终点是主动脉喷射速度峰值的年化变化,而次要终点包括主动脉瓣面积、钙化评分、心脏瓣膜手术发生率和生活质量的变化。安全性终点包括全因死亡率和心血管事件。结论:该试验旨在评估PCSK9抑制剂在调节CAVS患者疾病进展、减少不良心血管事件和改善临床结局方面的疗效。预期的研究结果有望为开发CAVS早期干预的新治疗策略提供关键见解。注册:网址:https://www.clinicaltrials.gov;唯一标识符:NCT04968509。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of the American Heart Association
Journal of the American Heart Association CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
9.40
自引率
1.90%
发文量
1749
审稿时长
12 weeks
期刊介绍: As an Open Access journal, JAHA - Journal of the American Heart Association is rapidly and freely available, accelerating the translation of strong science into effective practice. JAHA is an authoritative, peer-reviewed Open Access journal focusing on cardiovascular and cerebrovascular disease. JAHA provides a global forum for basic and clinical research and timely reviews on cardiovascular disease and stroke. As an Open Access journal, its content is free on publication to read, download, and share, accelerating the translation of strong science into effective practice.
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