Novel Echocardiographic and Invasive Haemodynamic Measurements in the Assessment of Patients Low Flow Low Gradient Aortic Stenosis Undergoing TAVI

NCT ID: NCT05196815

Last Updated: 2025-01-06

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

Clinical Phase

NA

Total Enrollment

7 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-07-01

Study Completion Date

2024-03-01

Brief Summary

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In this study the investigators will assess a variety of novel markers of heart strength (contractility) and assess whether they can give a clearer indication of how well patients with weak hearts respond to the TAVI procedure.

The investigators will perform a stress echocardiogram prior to each TAVI procedure and measure the global longitudinal strain (GLS) in the left ventricle (LV) heart muscle, a detailed marker of muscle strength.

The investigators will then proceed to the TAVI procedure and measure the contractility of the main pumping chamber in the heart before and after giving a very low dose of an adrenaline -like drug (dobutamine). The patient will already have received this short acting drug (at the same and higher doses) during their routine care planning stress echocardiogram.

Detailed Description

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In this study the investigators will assess a variety of novel markers of heart strength (contractility) and assess whether they can give a clearer indication of how well patients with weak hearts respond to the TAVI procedure.

The investigators will perform a stress echocardiogram prior to each TAVI procedure and measure the global longitudinal strain (GLS) in the left ventricle (LV) heart muscle, a detailed marker of muscle strength.

The investigators will then proceed to the TAVI procedure and measure the contractility of the main pumping chamber in the heart before and after giving a very low dose of an adrenaline -like drug (dobutamine). The patient will already have received this short acting drug (at the same and higher doses) during their routine care planning stress echocardiogram.

The investigators will also measure the pressure across the aortic valve, known as the trans-aortic gradient, using the pressure wire (PW) and a standard (multipurpose) heart catheter. The investigators will repeat the resting measures (i.e. without pacing or dobutamine) at the end of the procedure to measure the early change in left ventricular contractility and then repeat the echocardiogram immediately and after 3 months to assess the outcome of the TAVI procedure in terms of left ventricular function volume and function

Conditions

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Cardiovascular Abnormalities

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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The Royal Wolverhampton NHS Trust- New Cross Hospital

Group Type EXPERIMENTAL

Ultrasound

Intervention Type OTHER

Participants will have a routine ultrasound of the heart (echocardiogram) before the procedure. During this test we will take a few extra measurements, this will not add any significant time to the scan

Catheters

Intervention Type PROCEDURE

During the TAVI procedure 3 catheters (tubes) will be inserted into the blood vessels at the top of the participants legs as per normal standard care (there will be no extra skin punctures as part of the study).

Soft study wire

Intervention Type PROCEDURE

Participants will have a soft study wire inserted to measure the pressure in the left ventricle. This step is in addition to standard care.

X-ray

Intervention Type RADIATION

Participants will have chests x-ray when the soft study wire is inserted.

Dobutamine

Intervention Type DRUG

Participants will be given a low dose infusion of dobutamine, to make the heart pump quicker and more vigorously.. This will last for approximately 5 minutes

Interventions

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Ultrasound

Participants will have a routine ultrasound of the heart (echocardiogram) before the procedure. During this test we will take a few extra measurements, this will not add any significant time to the scan

Intervention Type OTHER

Catheters

During the TAVI procedure 3 catheters (tubes) will be inserted into the blood vessels at the top of the participants legs as per normal standard care (there will be no extra skin punctures as part of the study).

Intervention Type PROCEDURE

Soft study wire

Participants will have a soft study wire inserted to measure the pressure in the left ventricle. This step is in addition to standard care.

Intervention Type PROCEDURE

X-ray

Participants will have chests x-ray when the soft study wire is inserted.

Intervention Type RADIATION

Dobutamine

Participants will be given a low dose infusion of dobutamine, to make the heart pump quicker and more vigorously.. This will last for approximately 5 minutes

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

1. Patients presenting symptomatic AS listed for TAVI
2. Native aortic valve disease
3. Ejection fraction \</= 40%
4. Mean trans aortic gradient (echo) of \<35 mmHg
5. AVA \</= 1cm2
6. Able to give written informed consent prior to enrolment in the study
7. No contraindication to study procedures
8. CT scan confirmed severe AS
9. \*Able and willing to return to the implanting site for the follow-up visits\*

Exclusion Criteria

1. Unable to provide formal written consent
2. Known pseudo-severe AS prior to TAVI
3. Known allergy to agents required for stress echocardiography
4. Known hypersensitivity or contraindication to aspirin, heparin, clopidogrel, Nitinol, or sensitivity to contrast media, which cannot be adequately premedicated. \*
5. Any clinical contraindication to TAVI procedure

This pilot study will be restricted to English speaking subjects.
Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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The Royal Wolverhampton Hospitals NHS Trust

OTHER_GOV

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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James Cotton

Role: PRINCIPAL_INVESTIGATOR

The Royal Wolverhampton NHS Trust

Locations

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The Royal Wolverhampton NHS Trust

Wolverhampton, West Midlands, United Kingdom

Site Status

Countries

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United Kingdom

Other Identifiers

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2021CAR121

Identifier Type: -

Identifier Source: org_study_id

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