Evaluation of Integrated Cardiac Imaging in Ischemic Heart Disease

NCT ID: NCT00979199

Last Updated: 2014-07-21

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE4

Total Enrollment

697 participants

Study Classification

INTERVENTIONAL

Study Start Date

2009-02-28

Study Completion Date

2012-06-30

Brief Summary

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Main purpose of the study:

To comparatively assess the diagnostic performance of non invasive anatomical and functional imaging modalities to detect significant obstructive coronary artery disease as demonstrated at invasive coronary angiography and functional evaluation of coronary lesions (fractional flow reserve).

Detailed Description

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Objectives of the study

1. To test the accuracy of anatomical and functional non-invasive cardiac imaging in the diagnosis of IHD. To this purpose the "anatomical" information provided by CTA is obtained in every patient together with the "functional" information provided by stress radionuclide cardiac imaging (SPECT or PET), to assess myocardial perfusion, and/or by stress MRI or ECHO imaging to assess myocardial contraction. Non-invasive results are tested against invasive reference standards. The latter consists of invasive coronary angiography integrated by invasive measurement of fractional flow reserve (to assess the hemodynamic relevance of intermediate coronary stenoses).
2. To test the accuracy of integrated models, including clinical variables, risk factors and circulating biomarkers, to predict significant obstructive coronary artery disease in patients with chronic angina-like symptoms. To correlate biohumoral profiles with the coronary anatomical-functional phenotype as obtained by non invasive imaging in the same patients. To reach these goals the clinical characterization of patients (collected before non-invasive imaging) and the laboratory characterization (that includes novel biomarkers of cardiovascular risk) are compared with patient characterization derived from non invasive "anatomic-functional" imaging and with invasive diagnosis of significantly obstructive coronary disease.
3. To develop an advanced clinical and imaging reporting tool in cardiology. An informatics platform is developed to synthetically and clearly present the integrated clinical and imaging diagnostic profile of individual patients. A multimodal imaging reporting tool is developed including tools for "image fusion" of different imaging modalities (CT, SPECT, PET, MRI).
4. To define the most cost-effective work-up for the diagnosis and characterization of IHD. To this purpose the costs and the procedural risks (including radiation exposure) of non-invasive and invasive diagnostic procedures are prospectively collected. Cost-benefit and cost-effectiveness analyses is conducted alongside the EVINCI-study clinical trial.

Conditions

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Ischemic Heart Disease

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Primary Study Purpose

DIAGNOSTIC

Blinding Strategy

NONE

Study Groups

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Non invasive cardiac imaging

Intervention: Non invasive cardiac imaging. 'Anatomical' information provided by CTCA is obtained in every patient together with the 'functional' information provided by stress radionuclide cardiac imaging (SPECT or PET), to assess myocardial perfusion, and/or by stress MRI or ECHO imaging to assess myocardial contraction.

Group Type OTHER

Non invasive cardiac imaging

Intervention Type OTHER

Non invasive cardiac imaging consists of CTCA combined with one Stress Imaging Test

Interventions

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Non invasive cardiac imaging

Non invasive cardiac imaging consists of CTCA combined with one Stress Imaging Test

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Patients with intermediate (\>20%, \<90%) risk of IHD based on age,gender,symptoms and exercise stress test results

Exclusion Criteria

* Age \< 30 Yrs or \> 75 yrs
* Pregnancy (suspected or ascertained)
* LV Dysfunction (LVEF \< 35% by Echo or other method)
* Low (\< =20%) or high (\>=90%) probability of CAD
* Acute Coronary Syndrome
* Prolonged (\> 20 minutes) chest pain
* De novo or accelerated angina
* Hemodynamic or electrical instability
* Recent ST-T segment or T wave changes of ischemic nature
* Acute myocardial infarction with or without ST segment elevation
* Elevated serum cardiac markers of necrosis
* Known diagnosis of CAD
* Previously known myocardial infarction
* Previous PCI
* Previous CABG
* Persistent atrial fibrillation or advanced AV Block
* Asthma or chronic treatment with aminophylline
* Recent (\<6 months) cerebral ischemic attack
* Known significant carotid stenosis or vascular aneurisms
* Asthma or chronic treatment with aminophylline
* Active cancer
* Severe hypertension. Patients cannot withdraw therapy for 12 hours.
* Congenital heart disease
* Significant valvular disease
* Cardiomyopathy (e.g. DCM, HCM, ARVC, Amyloidosis)
* Inability to provide an informed consent
Minimum Eligible Age

30 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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European Commission

OTHER

Sponsor Role collaborator

Fondazione C.N.R./Regione Toscana "G. Monasterio", Pisa, Italy

OTHER_GOV

Sponsor Role lead

Responsible Party

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Danilo Neglia

MD

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Danilo Neglia, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Fondazione Toscana G. Monasterio, Pisa, Italy

Locations

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U.Turku

Turku, , Finland

Site Status

APHP

Paris, , France

Site Status

KAE Goeppingen

Göppingen, , Germany

Site Status

TUM

Munich, , Germany

Site Status

Ospedale Versilia

Viareggio, Lucca, Italy

Site Status

UniGE

Genova, , Italy

Site Status

UniNA

Naples, , Italy

Site Status

CNR

Pisa, , Italy

Site Status

FGM

Pisa, , Italy

Site Status

LUMC

Leiden, , Netherlands

Site Status

NIC

Warsaw, , Poland

Site Status

Huvhebron

Barcelona, , Spain

Site Status

SERMAS

Madrid, , Spain

Site Status

UZH

Zurich, , Switzerland

Site Status

QUEEN MARY Hospital London

London, , United Kingdom

Site Status

RBHT

London, , United Kingdom

Site Status

Countries

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Finland France Germany Italy Netherlands Poland Spain Switzerland United Kingdom

References

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Caselli C, De Caterina R, Smit JM, Campolo J, El Mahdiui M, Ragusa R, Clemente A, Sampietro T, Clerico A, Liga R, Pelosi G, Rocchiccioli S, Parodi O, Scholte A, Knuuti J, Neglia D; EVINCI and SMARTool. Triglycerides and low HDL cholesterol predict coronary heart disease risk in patients with stable angina. Sci Rep. 2021 Oct 20;11(1):20714. doi: 10.1038/s41598-021-00020-3.

Reference Type DERIVED
PMID: 34671067 (View on PubMed)

Caselli C, Del Turco S, Ragusa R, Lorenzoni V, De Graaf M, Basta G, Scholte A, De Caterina R, Neglia D. Association of PCSK9 plasma levels with metabolic patterns and coronary atherosclerosis in patients with stable angina. Cardiovasc Diabetol. 2019 Oct 31;18(1):144. doi: 10.1186/s12933-019-0949-3.

Reference Type DERIVED
PMID: 31672148 (View on PubMed)

Carpeggiani C, Picano E, Brambilla M, Michelassi C, Knuuti J, Kauffman P, Underwood SR, Neglia D; EVINCI Study Investigators. Variability of radiation doses of cardiac diagnostic imaging tests: the RADIO-EVINCI study (RADIationdOse subproject of the EVINCI study). BMC Cardiovasc Disord. 2017 Feb 16;17(1):63. doi: 10.1186/s12872-017-0474-9.

Reference Type DERIVED
PMID: 28202051 (View on PubMed)

Neglia D, Rovai D, Caselli C, Pietila M, Teresinska A, Aguade-Bruix S, Pizzi MN, Todiere G, Gimelli A, Schroeder S, Drosch T, Poddighe R, Casolo G, Anagnostopoulos C, Pugliese F, Rouzet F, Le Guludec D, Cappelli F, Valente S, Gensini GF, Zawaideh C, Capitanio S, Sambuceti G, Marsico F, Perrone Filardi P, Fernandez-Golfin C, Rincon LM, Graner FP, de Graaf MA, Fiechter M, Stehli J, Gaemperli O, Reyes E, Nkomo S, Maki M, Lorenzoni V, Turchetti G, Carpeggiani C, Marinelli M, Puzzuoli S, Mangione M, Marcheschi P, Mariani F, Giannessi D, Nekolla S, Lombardi M, Sicari R, Scholte AJ, Zamorano JL, Kaufmann PA, Underwood SR, Knuuti J; EVINCI Study Investigators. Detection of significant coronary artery disease by noninvasive anatomical and functional imaging. Circ Cardiovasc Imaging. 2015 Mar;8(3):e002179. doi: 10.1161/CIRCIMAGING.114.002179.

Reference Type DERIVED
PMID: 25711274 (View on PubMed)

Related Links

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Other Identifiers

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European Commission

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

FPVII grant 222915

Identifier Type: -

Identifier Source: secondary_id

EVINCI

Identifier Type: -

Identifier Source: org_study_id

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