Identification of New Markers of Atrial Myopathy in Patients With Embolic Stroke of Undetermined Source (ESUS) From MRI 4D Data

NCT ID: NCT04717843

Last Updated: 2023-09-21

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

UNKNOWN

Clinical Phase

NA

Total Enrollment

40 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-03-01

Study Completion Date

2024-09-01

Brief Summary

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Atrial myopathy is considered to be the underlying cause of a large proportion of embolic strokes of undetermined source. However, the definition of this atrial condition is not well delineated while its identification could lead to prescription on anticoagulation in order to avoid stroke recurences. This study aims to identify new markers of atrial myopathy and choosed a multi parametric approach with electrical, echographical, biological and 4D flow CMR derived markers.

Detailed Description

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Conditions

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Embolic Stroke of Undetermined Source

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

BASIC_SCIENCE

Blinding Strategy

NONE

Study Groups

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Patients with embolic strokes of undetermined source.

Patients over 18 years old, with embolic strokes of undetermined source, fulfilling the TOAST criteria. The intervention consists of a 4D Flow MRI.

Group Type EXPERIMENTAL

4D Flow MRI

Intervention Type OTHER

Acquisitions of MR imagining with special contrast phase CMR sequences. There is no need for agent contrast injection. The CMR is performed at the time of inclusion.

Patients with non-paroxysmal AF.

Patients over 18 years old, with non-paroxysmal AF. The intervention consists of a 4D Flow MRI.

Group Type EXPERIMENTAL

4D Flow MRI

Intervention Type OTHER

Acquisitions of MR imagining with special contrast phase CMR sequences. There is no need for agent contrast injection. The CMR is performed at the time of inclusion.

Heathy volunteers

The control group will include volunteers over 45 years old with no history of cardio-vascular or neuro-vascular disease. The last will be certified by a pre inclusion protocol containing a medical consultation, a Holter ECG and a trans-thoracic echocardiography. The age of 45 was chosen to get comparable age group and set the analyses free of the age-related effect on the cardiac hemodynamic. The intervention consists of an ECG, holter ECG, Trans thoracic echocardiography ETT, Blood sample and 4D Flow MRI.

Group Type ACTIVE_COMPARATOR

4D Flow MRI

Intervention Type OTHER

Acquisitions of MR imagining with special contrast phase CMR sequences. There is no need for agent contrast injection. The CMR is performed at the time of inclusion.

Medical consultation with 12 leads ECG

Intervention Type OTHER

Collection of medical history, treatment, physical examination and realization of a 12 leads ECG.

Holter ECG

Intervention Type OTHER

48 hours ECG recording

Trans thoracic echocardiography

Intervention Type OTHER

Trans thoracic echocardiography with standard measures performes in the core lab.

Blood sample

Intervention Type BIOLOGICAL

Blood sample in a peripheral vein, send to medical laboratory to dosage of NT pro BNP and troponin serum level.

ESUS and non-paroxysmal AF patients with cardiac MRI

ESUS and non-paroxysmal AF patients (fulfilling the group 1 et 2 criteria) and who had had cardiac MRI, in a retrospective way. It corresponds to retrospective inclusion of patients which had MRI in the year before the beginning of the study.

Group Type EXPERIMENTAL

Standard MRI

Intervention Type OTHER

Acquisitions of MR imagining

Interventions

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4D Flow MRI

Acquisitions of MR imagining with special contrast phase CMR sequences. There is no need for agent contrast injection. The CMR is performed at the time of inclusion.

Intervention Type OTHER

Medical consultation with 12 leads ECG

Collection of medical history, treatment, physical examination and realization of a 12 leads ECG.

Intervention Type OTHER

Holter ECG

48 hours ECG recording

Intervention Type OTHER

Trans thoracic echocardiography

Trans thoracic echocardiography with standard measures performes in the core lab.

Intervention Type OTHER

Blood sample

Blood sample in a peripheral vein, send to medical laboratory to dosage of NT pro BNP and troponin serum level.

Intervention Type BIOLOGICAL

Standard MRI

Acquisitions of MR imagining

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

Groupe1:Ischemic embolic stroke of undetermined source (ESUS) according to TOAST criteria (N =10)

* Age ≥ 18 years old
* Non-gap ischemic stroke diagnosed on MRI or CT scan of the brain (gap stroke defined as a cerebral infarction ≤ 1.5 cm / ≤2.0 cm on diffusion sequences).
* No major cardio-embolic source (episode of atrial fibrillation or flutter \> 6min, intracardiac thrombus, LVEF \<30 percent recent myocardial infarction (\<4 weeks), mitral stenosis, valvular vegetation or infectious endocarditis).
* Absence of atherosclerosis causing stenosis ≥ 50 percent of the lumen of the intra or extra cranial arteries that vascularise the infarcted cerebral area.
* No other specific cause identified (arteritis, arterial dissection, migraine/vaso-spasm, toxic cause).
* Affiliation to a social security scheme
* Patient who signed the consent

Group 2: Non-paroxysmal AF (N=10)

* Age ≥ 18 years old
* Subject with documented non-paroxysmal AF
* Affiliation to a social security scheme
* Patient who signed the consent

Group 3: Healthy volunteers (N=10)


* Age ≥ 45 years old
* Patient with no documented cardiac or neuro-vascular history
* Affiliation to a social security scheme
* Patient who signed the consent
* Registration on the VRB file (Volontaires Recherches Biomédicales, https://vrb.sante.gouv.fr) or response to the published announcement

Criteria for inclusion :

* ECG in sinus rhythm
* Holter ECG: no AF
* Normal Trans thoracic echocardiography
* Patient with no neuro-vascular history

Group 4: Stroke-ESUS or non-paroxysmal AF with cardiac MRI (N=10)

* Age ≥ 18 years old
* Subject with a documented stroke-ESUS or documented non-paroxysmal FA
* Subject with cardiac MRI
* Affiliation to a social security scheme
* Subject having given its non-opposition

Exclusion Criteria

Groupe1: Ischemic embolic stroke of undetermined source (ESUS) according to TOAST criteria (N =10)

* Risk of pregnancy or pregnancy (proven on interrogation data or pregnancy test).
* Contraindication to MRI ferromagnetic material (in particular pacemaker, implantable defibrillator, cardiac valve prosthesis, cochlear implant, neuro-stimulator, implanted automated injection material, intraocular metallic foreign body, neurosurgical and vascular clips, claustrophobia)
* Less than 8 weeks after implantation of a stent
* Subject participating in another intervention research including a period of exclusion still in progress at the pre-inclusion stage.

Group 2: Non-paroxysmal AF (N=10)

* Risk of pregnancy or pregnancy (proven on interview data or pregnancy test).
* Contraindication to MRI ferromagnetic material (in particular pacemaker, implantable defibrillators, cardiac valve prosthesis, cochlear implant, neurostimulators, implanted automated injection equipment, intraocular metallic foreign body, neurosurgical and vascular clips, claustrophobia).
* Less than 8 weeks after implantation of a stent
* Subject participating in another intervention research including a period of exclusion still in progress at the pre-inclusion stage.

Group 4: Stroke-ESUS or non paroxysmal AF with cardiac MRI (N=10)

* History of neuro-vascular or cardiac pathology
* Risk of pregnancy or pregnancy (proven on interrogation data or pregnancy test).
* Contraindication to MRI (ferromagnetic material (in particular pacemaker, implantable defibrillator, cardiac valve prosthesis, cochlear implant, neuro-stimulator, implanted automated injection material, intraocular metallic foreign body, neurosurgical and vascular clips, claustrophobia)
* Subject participating in another intervention research including a period of exclusion still in progress at the pre-inclusion stage.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Hospices Civils de Lyon

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Philippe CHEVALIER, Pr

Role: PRINCIPAL_INVESTIGATOR

Chief of the Arrhythmia Unit at the Academic Hospital of Lyon

Locations

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Service d'urgences neuro-vasculaires, service de neurologie vasculaire Hôpital neurologique Pierre Wertheimer

Bron, , France

Site Status NOT_YET_RECRUITING

Service Imagerie médicale Hôpital neurologique Pierre Wertheimer

Bron, , France

Site Status NOT_YET_RECRUITING

Service rythmologie, Hôpital cardiologique Louis Pradel

Bron, , France

Site Status RECRUITING

Countries

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France

Central Contacts

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Philippe CHEVALIER, Pr

Role: CONTACT

4.72.35.70.27 ext. +33

Sihem BEN AOUICHA, PhD

Role: CONTACT

4 72 35 69 42 ext. +33

Facility Contacts

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Laura MECHTOUFF, MD

Role: primary

4.72.35.67.47 ext. +33

Philippe DOUEK, Pr

Role: primary

4.72.35.72.33 ext. +33

Philippe CHEVALIER, Pr

Role: primary

4.72.35.70.17 ext. +33

Sihem BEN AOUICHA, PhD

Role: backup

4.72.35.76.77 ext. +33

Other Identifiers

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69HCL20_0790

Identifier Type: -

Identifier Source: org_study_id

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