Clinical Trials Logo

Clinical Trial Details — Status: Recruiting

Administrative data

NCT number NCT01378572
Other study ID # SDMC060911
Secondary ID
Status Recruiting
Phase N/A
First received June 21, 2011
Last updated June 21, 2011
Start date November 2009

Study information

Verified date June 2011
Source Catholic University of the Sacred Heart
Contact Pasquale Santangeli, MD
Phone 5127014689
Email pasquale.santangeli@gmail.com
Is FDA regulated No
Health authority Italy: Ethics Committee
Study type Observational

Clinical Trial Summary

With the present study the investigators intend to identify the morphologic and electrophysiologic substrate markers of increased arrhythmic risk in patients with dilated cardiomyopathy undergoing implantation of a defibrillator for the primary prevention of sudden cardiac death. Moreover, the investigators also aim to identify if there is any electrophysiological substrate modification at the time of the first arrhythmic event in these patients. To this aim, the investigators will prospectively correlate electroanatomic mapping and cardiac magnetic resonance findings with arrhythmic events, in order to identify substrate markers of increased arrhythmic risk in patients with dilated cardiomyopathy, who are therefore more likely to benefit from a defibrillator implantation. Furthermore, electroanatomic mapping will be repeated at the time of the first arrhythmic event and compared with that at baseline, in order to evaluate any electrophysiological substrate changes.


Description:

A correct identification of patients at high risk of sudden cardiac death is crucial for a rational clinical management, since the demonstrated effectiveness of implantable cardioverter-defibrillators on the reduction of sudden cardiac death. Basing on the results of multiple clinical trials, left ventricular systolic function, measured as ejection fraction, is currently the only recommended tool to identify patients at higher risk of sudden death that would benefit from a prophylactic defibrillator. However, the systematic implementation of current recommendations results in a substantial number of inappropriate defibrillator implantations, while failing to prevent the majority of sudden deaths occurring in the general population. Unfortunately, at present time we have no other way to identify patients at higher risk of sudden cardiac death, since other proposed risk markers have not been consistently demonstrated of incremental value. Recent data suggest that several substrate markers, either assessed morphologically with magnetic resonance imaging, or electrophysiologically with invasive mapping procedures, may be helpful to identify subgroup of patients at higher arrhythmic risk. However, previous studies have been largely conducted on few patients, most were retrospective or with short follow-up.

We will submit patients with dilated cardiomyopathy undergoing implant of an implantable cardioverter defibrillator to a morphologic and electrophysiologic substrate evaluation including cardiac magnetic resonance with gadolinium contrast-enhancement study, and electroanatomic mapping with bipolar electrogram voltage and morphological analysis. The electroanatomic mapping and cardiac magnetic resonance will be repeated at the time of the first arrhythmic event.

We expect to define the role of anatomical and electrophysiological substrate abnormalities in determining malignant ventricular arrhythmias in patients with dilated cardiomyopathy, thus allowing a better risk stratification and prevention of sudden death.


Recruitment information / eligibility

Status Recruiting
Enrollment 200
Est. completion date
Est. primary completion date
Accepts healthy volunteers No
Gender Both
Age group 18 Years and older
Eligibility Inclusion Criteria:

1. Males and females =18 year-old with full capacity.

2. A New York Heart Association (NYHA) class II or III chronic, stable congestive heart failure (CHF).

3. A left ventricular ejection fraction (LVEF) of no more than 35 percent.

Exclusion Criteria:

1. Age <18 years or diminished capacity.

2. Patients with LVEF = 35% or asymptomatic left ventricular dysfunction.

3. Patients with NYHA class IV CHF.

4. Patients with history of ventricular arrhythmias causing pre-syncope or syncope, cardiac arrest or a spontaneous episode of sustained ventricular tachycardia (VT) (=30 seconds at rates of >100 bpm), unless these occurred within 48 hours of a myocardial infarction.

5. Females who are pregnant or have childbearing potential and are not using reliable methods of contraception.

6. Patients with history of restrictive, infiltrative, or hypertrophic cardiomyopathy; arrhythmogenic cardiomyopathy; constrictive pericarditis; congenital heart disease; surgically correctable valvular disease; and/or inoperable obstructive valvular disease.

7. Patients with reversible nonischemic cardiomyopathy such as acute viral myocarditis, alcohol-induced cardiomyopathy, peripartum cardiomyopathy, Takotsubo cardiomyopathy.

8. Patients with mechanical or biologic prosthetic cardiac valves.

9. Patients with history of a major psychiatric disorder, active alcohol/drug abuse, or noncompliance.

10. Coronary artery bypass graft surgery or percutaneous coronary intervention (balloon and/or stent angioplasty) within the past 90 days prior to enrollment.

11. Myocardial infarction within the past 90 days prior to enrollment.

12. Angiographic evidence of coronary disease sufficient to be a candidate for coronary revascularization and likely to undergo coronary artery bypass graft surgery and/or percutaneous coronary intervention and likely to undergo such a procedure in the foreseeable future.

13. Presence of any disease, other than the patient's cardiac disease, associated with a reduced likelihood of survival for the duration of the study, including but not limited to cancer, uremia (blood urea nitrogen >70 mg/dl or creatinine >3.0 mg/dl), respiratory failure, hepatic failure, etc.

14. Contraindication to cardiac magnetic resonance evaluation

Study Design

Observational Model: Case Control, Time Perspective: Prospective


Related Conditions & MeSH terms


Locations

Country Name City State
Italy Centro Cardiologico Monzino Milan
Italy Policlinico "A. Gemelli" Rome
United States Texas Cardiac Arrhythmia Institute, St. David's Medical Center Austin Texas

Sponsors (5)

Lead Sponsor Collaborator
Catholic University of the Sacred Heart Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino, Milan, Italy, Dell'Angelo Hospital, Mestre-Venice, Italy, Policlinico Casilino ASL RMB, Rome, Italy, Texas Cardiac Arrhythmia Research Foundation

Countries where clinical trial is conducted

United States,  Italy, 

Outcome

Type Measure Description Time frame Safety issue
Primary Arrhythmic Event ICD shock on rapid sustained ventricular tachycardia or ventricular fibrillation or effective antitachycardia pacing. 2 years No
Primary Change in Arrhythmogenic Substrate Change in the arrhythmogenic substrate in patients who will experience an arrhythmic event compared to a matched control group who will remain free from arrhythmic event. 2 years No
Secondary Heart failure events Hospitalization for heart failure events 2 years No
Secondary Death All-cause mortality 2 years No
See also
  Status Clinical Trial Phase
Recruiting NCT05564689 - Absolute Coronary Flow in Patients With Heart Failure With Reduced Ejection Fraction and Left Bundle Branch Block With Cardiac Resynchronization Therapy
Recruiting NCT04982081 - Treating Congestive HF With hiPSC-CMs Through Endocardial Injection Phase 1
Not yet recruiting NCT04703751 - Evaluation of the CIRCULATE Catheter for Transcoronary Administration of Pharmacologic and Cell-based Agents N/A
Recruiting NCT01157299 - Hemodynamic Evaluation of Preload Responsiveness in Children by Using PiCCO N/A
Completed NCT00765518 - Use of Ixmyelocel-T (Formerly Cardiac Repair Cell [CRC] Treatment) in Patients With Heart Failure Due to Dilated Cardiomyopathy (IMPACT-DCM) Phase 2
Completed NCT02115581 - Coenzyme Q10 Supplementation in Children With Idiopathic Dilated Cardiomyopathy Phase 4
Recruiting NCT04246450 - Arrhythmic Risk Stratification in Nonischemic Dilated Cardiomyopathy N/A
Recruiting NCT05799833 - Low QRS Voltages in Young Healthy Individuals and Athletes
Recruiting NCT01914081 - Resveratrol: A Potential Anti- Remodeling Agent in Heart Failure, From Bench to Bedside Phase 3
Recruiting NCT03061994 - Metabolomic Study of All-age Cardiomyopathy N/A
Recruiting NCT02915718 - A Clinical Study of Immunoadsorption Therapy for Dilated Cardiomyopathy N/A
Completed NCT03893760 - Assessment of Right Ventricular Function in Advanced Heart Failure
Not yet recruiting NCT01219452 - Intramuscular Injection of Mesenchymal Stem Cell for Treatment of Children With Idiopathic Dilated Cardiomyopathy Phase 1/Phase 2
Recruiting NCT02175836 - Arrhythmia Prediction Trial N/A
Active, not recruiting NCT00962364 - Long-term Evaluation of Patients Receiving Bone Marrow-derived Cell Administration for Heart Disease
Recruiting NCT05026112 - The Arrhythmogenic Potential of Midwall Septal Fibrosis in Dilated Cardiomyopathy
Recruiting NCT05237323 - Micophenolate Mofetil Versus Azathioprine in Myocarditis Phase 3
Recruiting NCT04649034 - Intraventricular Stasis In Cardiovascular Disease
Suspended NCT03071653 - Left Cardiac Sympathetic Denervation for Cardiomyopathy Feasibility Pilot Study Phase 2
Completed NCT02619825 - Non-Invasive Evaluation of Myocardial Stiffness by Elastography in Pediatric Cardiology (Elasto-Pédiatrie) N/A