The Arrhythmogenic Potential of Midwall Septal Fibrosis in Dilated Cardiomyopathy

NCT ID: NCT05026112

Last Updated: 2022-03-31

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

Total Enrollment

120 participants

Study Classification

OBSERVATIONAL

Study Start Date

2021-10-01

Study Completion Date

2024-10-01

Brief Summary

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Midwall septal fibrosis (MSF) is a common structural abnormality in non-ischaemic dilated cardiomyopathy (DCM). Its presence is believed to increase the risk of malignant ventricular arrhythmias (VA), but the mechanism of arrhythmogenicity is not known. This is particularly relevant in DCM patients with MSF and mid-range left ventricular ejection fraction (LVEF) as they do not currently fulfil criteria for a primary prevention implantable cardioverter-defibrillator (ICD) insertion.

Access to the epicardium for electrical measurements of the heart can enhance the understanding of arrhythmogenicity in DCM, however direct epicardial access is invasive. Instead, the investigators will non-invasively combine high resolution 256-lead ECG imaging (ECGI) and latest generation cardiovascular magnetic resonance (CMR) to study the hearts of 60 DCM patients with and without MSF regardless of LVEF, and 60 matched healthy volunteers. The investigators recently invented the re-usable and CMR-safe SMART-ECGI vest technology for this purpose. Using supercomputers, the investigators will fuse the collected ECGI/CMR data and run electromechanical simulations of whole-heart activation to non-invasively measure each participant's personalised risk of malignant VA induction.

By panoramically mapping the DCM heart in a single beat, the investigators aim to elucidate how MSF perturbs the cardiac activation front and how this could lead to life-threatening VA. This has the potential to change the method by which cardiologists risk stratify patients with DCM.

Detailed Description

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Conditions

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Dilated Cardiomyopathy

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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DCM with MSF (MSF+)

Patients with dilated cardiomyopathy and midwall septal fibrosis identified in a previous cardiac MRI scan

ECG-Imaging

Intervention Type DIAGNOSTIC_TEST

ECG imaging acquisition

Cardiac MRI scan

Intervention Type DIAGNOSTIC_TEST

Cardiac MRI scan

DCM without MSF (MSF-)

Patients with dilated cardiomyopathy but without midwall septal fibrosis on previous cardiac MRI scan

ECG-Imaging

Intervention Type DIAGNOSTIC_TEST

ECG imaging acquisition

Cardiac MRI scan

Intervention Type DIAGNOSTIC_TEST

Cardiac MRI scan

Control - MSF+

Control healthy volunteers (HV) to the MSF+ cohort

ECG-Imaging

Intervention Type DIAGNOSTIC_TEST

ECG imaging acquisition

Cardiac MRI scan

Intervention Type DIAGNOSTIC_TEST

Cardiac MRI scan

Control - MSF-

Control healthy volunteers (HV) to the MSF- cohort

ECG-Imaging

Intervention Type DIAGNOSTIC_TEST

ECG imaging acquisition

Cardiac MRI scan

Intervention Type DIAGNOSTIC_TEST

Cardiac MRI scan

Interventions

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ECG-Imaging

ECG imaging acquisition

Intervention Type DIAGNOSTIC_TEST

Cardiac MRI scan

Cardiac MRI scan

Intervention Type DIAGNOSTIC_TEST

Eligibility Criteria

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Inclusion Criteria

* Adults with dilated cardiomyopathy
* With and without midwall septal fibrosis on previous CMR

Exclusion Criteria

* Needle-phobic patients that would preclude cannulation for contrast injection and blood taking
* anyone unwilling to consent
* anyone with a conventional contraindication for CMR
* anyone with any condition precluding full participation in the study such as DCM patients with infarct-pattern LGE, or subepicardial LGE or non-septal midwall fibrosis (participants with small volume right ventricular insertion point LGE will not be excluded).
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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University College, London

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Gabriella Captur, PhD

Role: PRINCIPAL_INVESTIGATOR

University College, London

Locations

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Royal Free Hospital NHS Trust (RFH)

London, , United Kingdom

Site Status RECRUITING

Countries

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United Kingdom

Central Contacts

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Fiona Chan, MBBS

Role: CONTACT

02076705702

Gabriella Captur, PhD

Role: CONTACT

02076705702

Facility Contacts

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Fiona Chan, MBBS

Role: primary

02076705702

Other Identifiers

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143656

Identifier Type: -

Identifier Source: org_study_id

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