Myocardial Oedema in Acute Myocardial Infarction (AMI)

NCT ID: NCT00987259

Last Updated: 2013-02-01

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

20 participants

Study Classification

OBSERVATIONAL

Study Start Date

2009-11-30

Study Completion Date

2011-10-31

Brief Summary

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Despite recent improvements in treatment, myocardial infarction (heart attack) is still a leading cause of illness and death in the UK. Following the acute event, it is difficult to predict which patients are at risk of further problems, such as heart failure and is therefore difficult to know which patients need more aggressive/intensive treatment and monitoring.

There needs to be a test which is safe, reliable and reproducible that can be used shortly after a heart attack to both predict future cardiac events and to allow the efficacy of new treatments to be assessed.

Myocardial oedema (swelling of the heart muscle) has been demonstrated using Cardiac Magnetic Resonance (CMR), to occur following a heart attack and has been suggested as a marker for future cardiac events. The optimum time to perform this scan, the method of data analysis and it's effectiveness as a predictor of future cardiac events has not been adequately assessed.

This trial will assess the amount and natural time-course of oedema in the first 10 days following a heart attack. It will also correlate the amount of oedema with the size of scar (damaged heart muscle) and left ventricular ejection fraction (heart function) at 3 months to assess if it is a predictive marker.

Detailed Description

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Conditions

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Myocardial Infarction

Study Design

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Observational Model Type

COHORT

Study Time Perspective

RETROSPECTIVE

Study Groups

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Post MI patients

Patients recruited following a successfully reperfused myocardial infarction using primary angioplasty.

No interventions assigned to this group

Eligibility Criteria

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Inclusion Criteria

1. Patients presenting to the London Chest Hospital with acute ST elevation myocardial infarction and treated with primary angioplasty and stent implantation within 12 hours of symptom onset
2. Acute PCI / stent implantation has been successful (residual stenosis visually \< 30% and TIMI flow ≥ 2)
3. At the time of inclusion, the patient no longer requires intravenous catecholamines or mechanical hemodynamic support (aortic balloon pump)
4. Serum troponin \>1ng/ml 12 hours after onset of pain
5. The patient is able to give written informed consent
6. The patient must be able to understand and communicate in English

Exclusion Criteria

1. Known cardiomyopathy
2. Previous documented myocardial infarction
3. Previous percutaneous coronary intervention or coronary artery bypass surgery
4. Significant renal dysfunction (EGFR\<30)
5. Systemic steroid therapy
6. Current non steroidal anti-inflammatory drug use
7. Chronic inflammatory disease
8. Neoplastic disease without documented remission within the past 5 years
9. Pregnancy
10. Reduced mental capacity leading to inability to obtain informed consent
11. Participation in another clinical trial within the last 30 days
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Barts & The London NHS Trust

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Thomas R Burchell, BSc, MB BS

Role: PRINCIPAL_INVESTIGATOR

Bart's and The London NHS Trust, United Kingdom

Locations

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The London Chest Hospital

London, Greater London, United Kingdom

Site Status

Countries

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United Kingdom

References

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Higgins CB, Herfkens R, Lipton MJ, Sievers R, Sheldon P, Kaufman L, Crooks LE. Nuclear magnetic resonance imaging of acute myocardial infarction in dogs: alterations in magnetic relaxation times. Am J Cardiol. 1983 Jul;52(1):184-8. doi: 10.1016/0002-9149(83)90093-0.

Reference Type BACKGROUND
PMID: 6858909 (View on PubMed)

Laine GA, Granger HJ. Microvascular, interstitial, and lymphatic interactions in normal heart. Am J Physiol. 1985 Oct;249(4 Pt 2):H834-42. doi: 10.1152/ajpheart.1985.249.4.H834.

Reference Type BACKGROUND
PMID: 4051019 (View on PubMed)

Nilsson JC, Nielsen G, Groenning BA, Fritz-Hansen T, Sondergaard L, Jensen GB, Larsson HB. Sustained postinfarction myocardial oedema in humans visualised by magnetic resonance imaging. Heart. 2001 Jun;85(6):639-42. doi: 10.1136/heart.85.6.639.

Reference Type BACKGROUND
PMID: 11359743 (View on PubMed)

Garcia-Dorado D, Oliveras J, Gili J, Sanz E, Perez-Villa F, Barrabes J, Carreras MJ, Solares J, Soler-Soler J. Analysis of myocardial oedema by magnetic resonance imaging early after coronary artery occlusion with or without reperfusion. Cardiovasc Res. 1993 Aug;27(8):1462-9. doi: 10.1093/cvr/27.8.1462.

Reference Type BACKGROUND
PMID: 8297415 (View on PubMed)

Bragadeesh T, Jayaweera AR, Pascotto M, Micari A, Le DE, Kramer CM, Epstein FH, Kaul S. Post-ischaemic myocardial dysfunction (stunning) results from myofibrillar oedema. Heart. 2008 Feb;94(2):166-71. doi: 10.1136/hrt.2006.102434. Epub 2007 Jul 16.

Reference Type BACKGROUND
PMID: 17639092 (View on PubMed)

Abdel-Aty H, Boye P, Zagrosek A, Wassmuth R, Kumar A, Messroghli D, Bock P, Dietz R, Friedrich MG, Schulz-Menger J. Diagnostic performance of cardiovascular magnetic resonance in patients with suspected acute myocarditis: comparison of different approaches. J Am Coll Cardiol. 2005 Jun 7;45(11):1815-22. doi: 10.1016/j.jacc.2004.11.069.

Reference Type BACKGROUND
PMID: 15936612 (View on PubMed)

Arai AE. Using magnetic resonance imaging to characterize recent myocardial injury: utility in acute coronary syndrome and other clinical scenarios. Circulation. 2008 Aug 19;118(8):795-6. doi: 10.1161/CIRCULATIONAHA.108.797373. No abstract available.

Reference Type BACKGROUND
PMID: 18711021 (View on PubMed)

Klem I, Kim RJ. Assessment of microvascular injury after acute myocardial infarction: importance of the area at risk. Nat Clin Pract Cardiovasc Med. 2008 Dec;5(12):756-7. doi: 10.1038/ncpcardio1373. Epub 2008 Oct 14.

Reference Type BACKGROUND
PMID: 18852712 (View on PubMed)

Tilak GS, Hsu LY, Hoyt RF Jr, Arai AE, Aletras AH. In vivo T2-weighted magnetic resonance imaging can accurately determine the ischemic area at risk for 2-day-old nonreperfused myocardial infarction. Invest Radiol. 2008 Jan;43(1):7-15. doi: 10.1097/RLI.0b013e3181558822.

Reference Type BACKGROUND
PMID: 18097272 (View on PubMed)

Aletras AH, Tilak GS, Natanzon A, Hsu LY, Gonzalez FM, Hoyt RF Jr, Arai AE. Retrospective determination of the area at risk for reperfused acute myocardial infarction with T2-weighted cardiac magnetic resonance imaging: histopathological and displacement encoding with stimulated echoes (DENSE) functional validations. Circulation. 2006 Apr 18;113(15):1865-70. doi: 10.1161/CIRCULATIONAHA.105.576025. Epub 2006 Apr 10.

Reference Type BACKGROUND
PMID: 16606793 (View on PubMed)

Friedrich MG, Abdel-Aty H, Taylor A, Schulz-Menger J, Messroghli D, Dietz R. The salvaged area at risk in reperfused acute myocardial infarction as visualized by cardiovascular magnetic resonance. J Am Coll Cardiol. 2008 Apr 22;51(16):1581-7. doi: 10.1016/j.jacc.2008.01.019.

Reference Type BACKGROUND
PMID: 18420102 (View on PubMed)

Schulz-Menger J, Gross M, Messroghli D, Uhlich F, Dietz R, Friedrich MG. Cardiovascular magnetic resonance of acute myocardial infarction at a very early stage. J Am Coll Cardiol. 2003 Aug 6;42(3):513-8. doi: 10.1016/s0735-1097(03)00717-4.

Reference Type BACKGROUND
PMID: 12906982 (View on PubMed)

Ripa RS, Nilsson JC, Wang Y, Sondergaard L, Jorgensen E, Kastrup J. Short- and long-term changes in myocardial function, morphology, edema, and infarct mass after ST-segment elevation myocardial infarction evaluated by serial magnetic resonance imaging. Am Heart J. 2007 Nov;154(5):929-36. doi: 10.1016/j.ahj.2007.06.038.

Reference Type BACKGROUND
PMID: 17967600 (View on PubMed)

Other Identifiers

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BLT006964

Identifier Type: -

Identifier Source: org_study_id

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