The Multicenter Stress Cardiac Magnetic Resonance Quantitative Perfusion Imaging in the United States Study

NCT ID: NCT06854458

Last Updated: 2025-10-28

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

RECRUITING

Clinical Phase

NA

Total Enrollment

1000 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-06-27

Study Completion Date

2029-03-31

Brief Summary

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This research aims to investigate whether symptoms of chest pain or shortness of breath among the study population are arising due to a heart problem, particularly any reduction of blood flow to the heart muscle from blockages in the coronary blood vessels or inflammation of the heart using cardiac magnetic resonance imaging that measures the amount of blood flow during a stress state meant to simulate vigorous exercise. At present, doctors use standard magnetic resonance imaging pictures of blood flow patterns to treat heart disease. The investigators want to study if detailed blood flow measurements, in addition to the standard blood flow pattern, could diagnose heart disease more accurately and allow more doctors to understand the severity of heart disease. Early research has demonstrated that detailed blood flow measurements may be more accurate in diagnosing heart disease in some patients, but doctors need more information to know how to use these measurements.

Detailed Description

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In this proposal of the Multicenter Stress Cardiac Magnetic Resonance Quantitative Perfusion Imaging in the United States (SPINS2) study, the investigators seek to assess the prognostic utility of myocardial blood flow and flow reserve by quantitative stress cardiac magnetic resonance imaging compared to patients with normal quantitative perfusion indices. The investigators hypothesize that patients with abnormal myocardial blood flow and flow reserve will have higher adverse cardiac events, incremental to demographic risks and qualitative perfusion, and they should be considered for invasive workup or early institution of goal-directed medical therapies. In addition, the investigators hypothesize that quantitative perfusion by cardiac magnetic resonance imaging will characterize the myocardial extent and severity of multivessel disease and the participants' risk of adverse cardiac outcomes.

Patients with chest pain syndromes and suspected ischemic heart disease who meet both inclusion and exclusion criteria will be prospectively recruited among 20 sites across the United States over the course of 1.5 years. Participants will receive standardized quantitative stress cardiac magnetic resonance imaging protocol with Gadavist (Bayer, Germany) 0.05 mmol/kg dose for each stress and rest perfusion imaging (total dose of 0.1 mmol/kg) as per Food and Drug Administration (FDA)-approved indication. All participants will receive vasodilator stress with regadenoson or adenosine depending on local site practice. A single (7-10 ml tube) whole blood sample will be collected from each patient for processing of blood biomarkers.

All participants will have demographics and imaging characteristics recorded at baseline visits. Follow-up will occur via email or telephone at 3 months, 12 months, and 24 months from baseline. At each follow-up visit, medications, treatment, and adverse events will be recorded. In addition, all available electronic patient records will be reviewed in detail to capture all follow-up data which will be entered into an outline database using clearly defined data definitions. Participants will be followed for a total of 2 years from baseline cardiac magnetic resonance imaging study.

Conditions

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Ischemic Heart Disease (IHD) Cardiac Magnetic Resonance Imaging Myocardial Blood Flow

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

DIAGNOSTIC

Blinding Strategy

NONE

Study Groups

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Standard Myocardial Blood Flow Evaluation

Qualitative stress cardiac magnetic resonance imaging only.

Group Type ACTIVE_COMPARATOR

Qualitative Myocardial Blood Flow Evaluation

Intervention Type DIAGNOSTIC_TEST

The perfusion sequence will not produce additional quantitative perfusion maps.

Gadavist

Intervention Type DRUG

Participants will receive Gadavist 0.05 mmol/kg dose for each stress and rest perfusion imaging (total dose of 0.1 mmol/kg).

Vasodilator

Intervention Type DRUG

All participants will receive vasodilator (regadenoson or adenosine depending on local site practice).

Blood draw for the laboratory assessment

Intervention Type DIAGNOSTIC_TEST

A single (7-10 ml tube) whole blood sample will be collected from each patient for processing of blood biomarkers.

New Myocardial Blood Flow Evaluation

Quantitative + Qualitative stress cardiac magnetic resonance imaging.

Group Type EXPERIMENTAL

Quantitative Myocardial Blood Flow Evaluation

Intervention Type DIAGNOSTIC_TEST

The perfusion sequence will produce on-the-fly additional quantitative perfusion maps with segmental myocardial blood flow values.

Gadavist

Intervention Type DRUG

Participants will receive Gadavist 0.05 mmol/kg dose for each stress and rest perfusion imaging (total dose of 0.1 mmol/kg).

Vasodilator

Intervention Type DRUG

All participants will receive vasodilator (regadenoson or adenosine depending on local site practice).

Blood draw for the laboratory assessment

Intervention Type DIAGNOSTIC_TEST

A single (7-10 ml tube) whole blood sample will be collected from each patient for processing of blood biomarkers.

Interventions

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Quantitative Myocardial Blood Flow Evaluation

The perfusion sequence will produce on-the-fly additional quantitative perfusion maps with segmental myocardial blood flow values.

Intervention Type DIAGNOSTIC_TEST

Qualitative Myocardial Blood Flow Evaluation

The perfusion sequence will not produce additional quantitative perfusion maps.

Intervention Type DIAGNOSTIC_TEST

Gadavist

Participants will receive Gadavist 0.05 mmol/kg dose for each stress and rest perfusion imaging (total dose of 0.1 mmol/kg).

Intervention Type DRUG

Vasodilator

All participants will receive vasodilator (regadenoson or adenosine depending on local site practice).

Intervention Type DRUG

Blood draw for the laboratory assessment

A single (7-10 ml tube) whole blood sample will be collected from each patient for processing of blood biomarkers.

Intervention Type DIAGNOSTIC_TEST

Other Intervention Names

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New Myocardial Blood Flow Evaluation Standard Myocardial Blood Flow Evaluation Gadobutrol stress vasodilator

Eligibility Criteria

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Inclusion Criteria

1. male or female at age 35-85 years,
2. presence of either of the following sign/symptom that led to a referral to stress cardiac magnetic resonance imaging:

1. chest pain or anginal equivalent, or
2. abnormal electrocardiogram with a suspicion of coronary artery disease
3. Intermediate or high risk of significant coronary disease based on at least 1 of the following conditions:

a) patient age \> 45 for male, 50 for female b) Diabetes, hypertension, or hypercholesterolemia: by either history or medical treatment c) family history of premature coronary disease: first degree relative at age \<= 55 male and \<=65 female d) history of smoking of \> 10 packed-years e) post-menopausal state \>5 years f) any chronic inflammatory conditions d) Body mass index \> 30 e) Any medical documentation of coronary or peripheral artery disease

Exclusion Criteria

1. Acute myocardial infarction within the past 30 days prior to cardiac magnetic resonance imaging
2. Confirmed diagnosis of any significant non-coronary cardiac conditions below:

1. any severe-grade valvular heart disease,
2. left ventricular ejection fraction \<40% from any known non-coronary causes,
3. infiltrative cardiomyopathy,
4. hypertrophic cardiomyopathy,
5. pericardial disease with significant constriction, or
3. active pregnancy,
4. any competing conditions leading to an expected survival of \< 2 years
5. contraindication to vasodilator (regadenoson or adenosine)
6. metallic device or object that poses an magnetic resonance imaging safety hazard
7. metallic device with a high likelihood of non-diagnostic cardiac magnetic resonance images
Minimum Eligible Age

35 Years

Maximum Eligible Age

85 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Brigham and Women's Hospital

OTHER

Sponsor Role lead

Responsible Party

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Raymond Y. Kwong, MD

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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University of California San Francisco

San Francisco, California, United States

Site Status RECRUITING

Brigham and Women's Hospital

Boston, Massachusetts, United States

Site Status RECRUITING

Beth Israel Deaconess Medical Center

Boston, Massachusetts, United States

Site Status RECRUITING

Virginia Commonwealth University

Richmond, Virginia, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Raymond Y Kwong, MD, MPH

Role: CONTACT

857-307-1960

Bobby Heydari, MD, MPH

Role: CONTACT

Facility Contacts

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Katie DeSutter

Role: primary

559-696-1926

Raymond Y Kwong, MD, MPH

Role: primary

857-307-1960

Connie Tsao, MD, MPH

Role: primary

(617) 667-8800

Caleb Bridgwater

Role: primary

804-628-8527

References

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Pepine CJ, Anderson RD, Sharaf BL, Reis SE, Smith KM, Handberg EM, Johnson BD, Sopko G, Bairey Merz CN. Coronary microvascular reactivity to adenosine predicts adverse outcome in women evaluated for suspected ischemia results from the National Heart, Lung and Blood Institute WISE (Women's Ischemia Syndrome Evaluation) study. J Am Coll Cardiol. 2010 Jun 22;55(25):2825-32. doi: 10.1016/j.jacc.2010.01.054.

Reference Type BACKGROUND
PMID: 20579539 (View on PubMed)

Patel MR, Peterson ED, Dai D, Brennan JM, Redberg RF, Anderson HV, Brindis RG, Douglas PS. Low diagnostic yield of elective coronary angiography. N Engl J Med. 2010 Mar 11;362(10):886-95. doi: 10.1056/NEJMoa0907272.

Reference Type BACKGROUND
PMID: 20220183 (View on PubMed)

Sammut EC, Villa ADM, Di Giovine G, Dancy L, Bosio F, Gibbs T, Jeyabraba S, Schwenke S, Williams SE, Marber M, Alfakih K, Ismail TF, Razavi R, Chiribiri A. Prognostic Value of Quantitative Stress Perfusion Cardiac Magnetic Resonance. JACC Cardiovasc Imaging. 2018 May;11(5):686-694. doi: 10.1016/j.jcmg.2017.07.022. Epub 2017 Nov 15.

Reference Type BACKGROUND
PMID: 29153572 (View on PubMed)

Kotecha T, Chacko L, Chehab O, O'Reilly N, Martinez-Naharro A, Lazari J, Knott KD, Brown J, Knight D, Muthurangu V, Hawkins P, Plein S, Moon JC, Xue H, Kellman P, Rakhit R, Patel N, Fontana M. Assessment of Multivessel Coronary Artery Disease Using Cardiovascular Magnetic Resonance Pixelwise Quantitative Perfusion Mapping. JACC Cardiovasc Imaging. 2020 Dec;13(12):2546-2557. doi: 10.1016/j.jcmg.2020.06.041. Epub 2020 Oct 1.

Reference Type BACKGROUND
PMID: 33011115 (View on PubMed)

Patel AR, Kramer CM. Role of Cardiac Magnetic Resonance in the Diagnosis and Prognosis of Nonischemic Cardiomyopathy. JACC Cardiovasc Imaging. 2017 Oct;10(10 Pt A):1180-1193. doi: 10.1016/j.jcmg.2017.08.005.

Reference Type BACKGROUND
PMID: 28982571 (View on PubMed)

Rozanski A, Gransar H, Hayes SW, Friedman JD, Hachamovitch R, Berman DS. Comparison of long-term mortality risk following normal exercise vs adenosine myocardial perfusion SPECT. J Nucl Cardiol. 2010 Dec;17(6):999-1008. doi: 10.1007/s12350-010-9300-9. Epub 2010 Nov 13.

Reference Type BACKGROUND
PMID: 21076898 (View on PubMed)

Arai AE, Schulz-Menger J, Shah DJ, Han Y, Bandettini WP, Abraham A, Woodard PK, Selvanayagam JB, Hamilton-Craig C, Tan RS, Carr J, Teo L, Kramer CM, Wintersperger BJ, Harisinghani MG, Flamm SD, Friedrich MG, Klem I, Raman SV, Haverstock D, Liu Z, Brueggenwerth G, Santiuste M, Berman DS, Pennell DJ. Stress Perfusion Cardiac Magnetic Resonance vs SPECT Imaging for Detection of Coronary Artery Disease. J Am Coll Cardiol. 2023 Nov 7;82(19):1828-1838. doi: 10.1016/j.jacc.2023.08.046.

Reference Type BACKGROUND
PMID: 37914512 (View on PubMed)

Nayfeh M, Ahmed AI, Saad JM, Alahdab F, Al-Mallah M. The Role of Cardiac PET in Diagnosis and Prognosis of Ischemic Heart Disease: Optimal Modality Across Different Patient Populations. Curr Atheroscler Rep. 2023 Jul;25(7):351-357. doi: 10.1007/s11883-023-01107-0. Epub 2023 May 10.

Reference Type BACKGROUND
PMID: 37162723 (View on PubMed)

Other Identifiers

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2024P003457

Identifier Type: -

Identifier Source: org_study_id

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