A Comparison of Advanced Imaging Techniques in Aortic Stenosis

NCT ID: NCT01775215

Last Updated: 2014-12-02

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

WITHDRAWN

Study Classification

OBSERVATIONAL

Study Start Date

2013-01-31

Study Completion Date

2016-01-31

Brief Summary

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In patients with aortic stenosis the valve through which blood is pumped out of the main heart chamber is narrowed. This results in heart muscle working harder to open the valve so blood can circulate around the body. The muscle adapts to the increased pressure load to maintain efficiency. This can cause long-term muscle damage. To predict when this deterioration will require a valve replacement is difficult and untimely operation exposes patients to unnecessary risk.

We aim to compare all validated techniques looking at different aspects of heart muscle strain in these patients. These will be a blood sample measuring a specific hormone (BNP) and enzyme (Troponin), a nuclear scan to assess nerve activation, an MRI identifying scarring and an exercise echocardiogram that measures heart muscle response and pressure changes across the valve. Tests will be performed at recruitment and either after one year or after valve replacement, which ever comes first.

In comparing these different imaging techniques we aim to identify patients who will benefit from an early operation, those whose muscle is likely to recover back to normal and which patients it is safe to wait longer for the surgery, avoiding unnecessary risk.

The results of the study will benefit patients as it will help doctors more accurately assess the timing of valve surgery and improve their prediction of long term heart muscle recovery. It may also increase convenience in clinical management by reducing unnecessary tests and hospital trips. This would translate into cost savings for the NHS.

Detailed Description

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Conditions

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Aortic Stenosis

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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A - Symptomatic severe AS

Patients with symptomatic severe aortic stenosis (AS) as per ESC guidelines, requiring aortic valve replacement.

Cardiac I123-MIBG Scintigraphy

Intervention Type RADIATION

Cardiac MRI

Intervention Type OTHER

Stress and rest Echocardiogram

Intervention Type OTHER

High Sensitivity Troponin I

Intervention Type OTHER

Brain Natriuretic Peptide

Intervention Type OTHER

B - Asymptomatic moderate to severe AS

Asymptomatic patients with moderate to severe aortic stenosis (AS) as per ESC guidelines ,with Left Ventricular ejection fraction \>50%, not yet requiring aortic valve replacement.

Cardiac I123-MIBG Scintigraphy

Intervention Type RADIATION

Cardiac MRI

Intervention Type OTHER

Stress and rest Echocardiogram

Intervention Type OTHER

High Sensitivity Troponin I

Intervention Type OTHER

Brain Natriuretic Peptide

Intervention Type OTHER

Interventions

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Cardiac I123-MIBG Scintigraphy

Intervention Type RADIATION

Cardiac MRI

Intervention Type OTHER

Stress and rest Echocardiogram

Intervention Type OTHER

High Sensitivity Troponin I

Intervention Type OTHER

Brain Natriuretic Peptide

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

(Group A)

* Asymptomatic patients with moderate to severe Aortic Stenosis
* Ejection fraction greater than 50%
* Not yet being considered for valve surgery

(Group B)

* Severe Aortic Stenosis (as per ESC guidelines)
* Listed for immediate aortic valve replacement

Exclusion Criteria

* Inability to provide informed consent
* Concurrent primary valve lesions greater than mild (as defined by ESC criteria)
* Previous myocardial infarction (regional wall motion abnormality on resting echo)
* Cardiomyopathy
* Congenital heart disease
* Previous cardiac surgery
* Renal failure (CKD stage 3, eGFR \>30ml/min/1.73m2)
* Pregnancy, risk of pregnancy, breast feeding
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Royal Brompton & Harefield NHS Foundation Trust

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Andrew Kelion, MRCP DM

Role: PRINCIPAL_INVESTIGATOR

Royal Brompton and Harefield NHS Foundation Trust

Locations

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Harefield Hospital

London, , United Kingdom

Site Status

Countries

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United Kingdom

Other Identifiers

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12/LO/1846

Identifier Type: -

Identifier Source: org_study_id