Dual MRI for Cardiopulmonary COVID-19 Long Haulers

Covid19 Clinical Trial

Official title:

Characterizing the Long-Term Cardiopulmonary Effects of COVID-19 With Hyperpolarized Xenon and Cardiac MRI

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT04828135
• Other study ID #: Pro00107681
• Status: Completed
• Phase: Phase 2
• Start date: May 26, 2021
• Est. completion date: April 20, 2023

Study information

• Verified date: May 2024
• Source: Duke University
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The next phase of the COVID-19 pandemic is likely to see a surge in an associated chronic cardiopulmonary disease that will challenge health systems. Recovered patients are presenting with persistent dyspnea at the Duke Pulmonary Post-COVID clinic. Evidence is now mounting that recovered patients have significant residual pulmonary disease, while myocardial injury has also been increasingly reported. To optimally care for these patients, Duke Pulmonary study team must comprehensively assess and monitor the changes in cardiopulmonary function and relate the changes to physiologic and quality of life outcomes. The study team will deploy cutting-edge MRI to fully characterize cardiopulmonary function in enrolled 30 subjects (accrual 23 subjects) at time point 60-120 days post recovery and 6-9 months later. Cardiac MRI will assess the myocardial status and right ventricular function, while hyperpolarized 129Xe MRI will provide a 3D assessment of pulmonary ventilation, interstitial barrier integrity, and pulmonary vascular hemodynamics. The overall objective outlined in this study is to demonstrate the feasibility and value of comprehensive longitudinal imaging characterization of cardiopulmonary structure and function in patients recovered from Covid-19.

Description:

The proposed research builds on the established sensitivity of Hyperpolarized 129Xe MRI to obstructive and pulmonary vascular lung disease, features expected to represented in the Covid-19 cohort. It further incorporates a new understanding of the possible role of myocardial injury in these recovered patients by combining cutting-edge pulmonary and cardiac MRI.

Although the initial presentation of patients with moderate to severe symptoms of COVID19 infections is dominated by respiratory symptoms, 10% go on to develop persistent post-infection symptoms which are thought to have an inflammatory etiology. Evidence suggests that pathologic activation of the inflammasome persists beyond the acute initial presentation that contributes to the persistent disabling symptoms characterized as "long-haul COVID". For this trial, subjects will be eligible for enrollment if subjects are outpatients with a history of a laboratory-confirmed diagnosis of COVID-19 infection, and after 60 days or longer. The study team will accrual 13 subjects who continue to have respiratory symptoms (i.e., cough, shortness of breath, dyspnea on exertion). An additional 10 subjects engaged in competitive sports and diagnosed with COVID-19 will also be enrolled. These subjects can be asymptomatic or mildly to moderately. Although rare, cardiac impairment has been documented in <2% of these individuals. The study team knowledge, XeMRI has not yet been studied in this specific patient subset.

Existing data highlight significant racial and ethnic disparities with historically underserved minority populations (i.e., Black, LatinX) suffering disproportionately higher infection rates and more severe illness compared to Whites. This is reflected by the population enrolled in the study team RedCAP database and biorepository. As such 30% of subjects enrolled will be required to be from underserved communities.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 18
• Est. completion date: April 20, 2023
• Est. primary completion date: April 20, 2023
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Diagnosis of post Coronavirus (COVID-19)

Inclusion Criteria:

1. Age = 18-year-old

2. Tested positive for SARS-CoV2

3. Willing and able to give informed consent and adhere to visit/protocol scheduled (consent must be given before any study procedures are performed)

Exclusion Criteria:

1. Prisoners

2. Pregnant, planning pregnancy, or lactating

3. Conditions that prohibit MRI scanning (metal in eye, claustrophobia, inability to lie supine).

4. Medical or psychological conditions which, in the opinion of the investigator, might create undue risk to the subject or interfere with the subject's ability to comply with the protocol requirements

Related Conditions & MeSH terms

• COVID-19
• Covid19

Intervention

Drug:
• Hyperpolarized 129Xenon gas
Each xenon dose will be limited to a volume less than 25% of subject lung capacity (TLC),

Locations

Country	Name	City	State
United States	Duke Asthma, Allergy, and Airway Center	Durham	North Carolina

Sponsors (1)

Lead Sponsor	Collaborator
Bastiaan Driehuys

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Red Blood Cell to Membrane (RBC:M) Ratio	To determine cardiopulmonary structure-function abnormalities that characterize early phase COVID-19 recovery.	1 year
Primary	Ventilation Defect Percent	To determine cardiopulmonary structure-function abnormalities that characterize early phase COVID-19 recovery.	1 year
Primary	High Membrane Percent	To determine cardiopulmonary structure-function abnormalities that characterize early phase COVID-19 recovery.	1 year
Primary	Red Blood Cell (RBC) Defect Percent	To determine cardiopulmonary structure-function abnormalities that characterize early phase COVID-19 recovery.	1 year
Primary	Red Blood Cell to Membrane (RBC:M) Ratio at 9 Months	To characterize the evolution of cardiopulmonary abnormalities over 9 months.	9 Months
Primary	Ventilation Defect Percent at 9 Months	To characterize the evolution of cardiopulmonary abnormalities over 9 months.	9 months
Primary	High Membrane Percent at 9 Months	To characterize the evolution of cardiopulmonary abnormalities over 9 months.	9 months
Primary	Red Blood Cell (RBC) Defect Percent at 9 Months	To characterize the evolution of cardiopulmonary abnormalities over 9 months.	9 months
Primary	Identify MRI Features That Predict Physiological Outcomes With DLCO (Diffusing Capacity of the Lungs for Carbon Monoxide)	DLCO is the extent to which oxygen passes from the air sacs of the lungs into the blood.	Baseline