Evaluation of Dynamic Pulmonary Vascular Resistance in Patients With Closed Ventricular Septal Defect

NCT ID: NCT02648984

Last Updated: 2017-05-05

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 45 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2014-09-30
• Study Completion Date: 2017-01-31

Brief Summary

Pulmonary arterial hypertension (PAH) in patients with congenital heart disease usually develops secondary to chronic volume overload of the pulmonary circulation following left to right shunt. This overload leads to elevated pulmonary artery pressure (PAP) and later to increased pulmonary vascular resistance (PVR), leading to right ventricular dysfunction, considerable morbidity and even mortality.

Since PAH nowadays is mostly detected when symptoms occur and PAP are elevated, the disease already evolved to an advanced stage and treatment is often initiated too late. Our research group standardized the technique for the detection of early pulmonary vascular disease by bicycle stress echocardiography. The investigators now aim to assess this exercise technique in a group of patients with ventricular septal defect.

Detailed Description

Pulmonary arterial hypertension (PAH) in patients with congenital heart disease usually develops secondary to chronic volume overload of the pulmonary circulation following left to right shunt. This overload leads to elevated pulmonary artery pressure (PAP) and later to increased pulmonary vascular resistance (PVR). PAH may lead to right ventricular and right atrial dysfunction, which may implicate considerable morbidity and even mortality.

Since PAH nowadays is mostly detected when symptoms occur and PAP are elevated, the disease already evolved to an advanced stage and treatment is often initiated too late. Our research group standardized the technique for the detection of early pulmonary vascular disease by bicycle stress echocardiography. Exercise-induced pulmonary hypertension has been recognised as a clinical entity, but is not included in the current guidelines on pulmonary hypertension. Further research in this area might imply the need for revision of the current PAH detection and treatment strategy.

By performing stress echocardiography and cardiopulmonary exercise testing, the investigators want to reach the following objectives:

• To answer the question whether the abnormal increase in PAP during exercise, seen in patients with late atrial septal defect (ASD) type secundum closure, is also present in congenital heart disease (CHD) patients who were treated for other shunt lesions.
• To apply this early detection technique in a broader population of CHD patients and to better define the predictive value of an elevated PVR during exercise.

Conditions

Pulmonary Vascular Disease

Study Design

• Allocation Method: NON_RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: DIAGNOSTIC
• Blinding Strategy: NONE

Study Groups

Patient group

Patients with ventricular septal defect

Group Type: OTHER

The intervention is performing an exercise test

Intervention Type: OTHER

Patients and controls will undergo a bicycle stress echocardiography and a cardiopulmonary exercise test

Control group

Healthy control subjects

Group Type: OTHER

The intervention is performing an exercise test

Intervention Type: OTHER

Patients and controls will undergo a bicycle stress echocardiography and a cardiopulmonary exercise test

Interventions

The intervention is performing an exercise test

Patients and controls will undergo a bicycle stress echocardiography and a cardiopulmonary exercise test

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• Male or female subjects with ventricular septal defect (VSD) repair at least 6 months before study enrolment
• No discrimination in type of VSD repair will be made (percutaneous or surgical)
• Subjects must be able to perform exercise testing

Exclusion Criteria

• Other congenital heart disease
• PAH of any aetiology other than VSD
• Inclusion in other treatment protocols
• Impairment of organic function (renal, hepatic)
• Arterial hypotension (systolic blood pressure < 85 mmHg)
• Anaemia (Hb < 10 g/dl)
• Thrombocytopenia (< 50000/µl)
• Significant valvular disease, other than tricuspid or pulmonary regurgitation
• Chronic lung disease or total lung capacity < 80% of predicted value
• History of pulmonary embolism
• Cyanotic patients, patients in an unstable condition and patients who have to undergo re-intervention during the study

• Eligible Sex: ALL
• Accepts Healthy Volunteers: Yes

Sponsors

Universitaire Ziekenhuizen KU Leuven

OTHER

Sponsor Role: lead

Responsible Party

prof. dr. Werner Budts

Werner Budts, MD, PhD

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Werner Budts, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Universitaire Ziekenhuizen KU Leuven

Locations

University Hospitals Leuven

Leuven, , Belgium

Countries

Belgium

Other Identifiers

S56272

Identifier Type: -

Identifier Source: org_study_id