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Clinical Trial Details — Status: Recruiting

Administrative data

NCT number NCT06066970
Other study ID # ZKSJ0156
Secondary ID
Status Recruiting
Phase
First received
Last updated
Start date September 5, 2023
Est. completion date March 2025

Study information

Verified date September 2023
Source Jena University Hospital
Contact Ulrich Schneider, Dr.
Phone +49 3641
Email ulrich.schneider@med.uni-jena.de
Is FDA regulated No
Health authority
Study type Observational

Clinical Trial Summary

The aim of the study is to clarify whether the perioperative release of the cardiac biomarkers troponin I, troponin T and CK-MB consistently correlate with visualizable myocardial damage, and to what extent these biomarkers are comparable by means of their kinetics and dynamics. Due to the uncertainty regarding the validity of cardiac biomarkers in the diagnosis of myocardial infarction, the answer to these questions could have a considerable influence on internationally valid guidelines and definitions. International studies, especially in the field of coronary surgery and coronary artery disease treatment refer to these definitions, in particular, the adequate treatment of affected patients is directly dependent on them.


Description:

In the course of a myocardial infarction, the death of cardiomyocytes leads to the release of specific cardiac biomarkers (CK-MB, troponin I and T). Since there is a general risk of perioperative infarction in cardiac surgery, the standard monitoring includes appropriate diagnostics. These are based on clinical symptoms, ECG, imaging (echocardiography or coronary angiography) and, in particular, the elevation of these cardiac biomarkers. Recently, the latter have been regularly moved into the foreground as the sole indicators of perioperative myocardial infarction, and first definitions allow the diagnosis solely based on troponin or CK-MB elevation. However, biomarker elevations may not be accompanied by an image-morphologically detectable perfusion defect (myocardial infarction). Such phenomena have been described outside of cardiac surgery, for example, in marathon runners4, but also due to comorbidities such as renal insufficiency or neurological diseases. Even in patients undergoing cardiac surgery without coronary artery disease (e.g., isolated valve surgery), biomarker elevations up to the infarct-defining range are regularly observed. Whether in the latter case the perioperative routinely observed troponin or CK-MB elevation are indeed related to surgery-induced chronic perfusion disturbance has not yet been investigated. To date, there is no study that quantitatively correlates purely perioperatively induced ischemic damage with the release of cardiac biomarkers. In addition, the three most commonly used biomarkers for perioperative infarct diagnosis differ considerably in their temporal release and release dynamics. Moreover, a direct comparison of all three parameters has never been performed so far. Therefore, the aim of this study is to quantify and compare the release of troponin T, I and CK/CK-MB in the postoperative course in patients without relevant coronary artery disease undergoing elective isolated heart valve surgery. These findings will subsequently be correlated with classical diagnostics (clinic, ECG, echocardiography) and image morphological quantification of perioperatively induced myocardial damage by magnetic resonance imaging (LGE-cMRI).


Recruitment information / eligibility

Status Recruiting
Enrollment 100
Est. completion date March 2025
Est. primary completion date March 2025
Accepts healthy volunteers No
Gender All
Age group 18 Years and older
Eligibility Inclusion Criteria: - Indication for isolated aortic or mitral valve surgery - Written informed consent - Age = 18 years Exclusion Criteria: - Presence of coronary artery disease (excluded within the last 6 months) - Allergy to gadolinium - Cochlear implant - Deep brain stimulation - Individual factors excluding the performance of an MRI (e.g. claustrophobia of the patient) - Significantly reduced renal function (GFR < 30ml/min) - Perioperative complications that may lead to myocardial damage (discontinuation of the study for the patient and exclusion from the analysis after primary study inclusion) - Need for extension of surgery (additional procedures on other heart valves, aorta, myocardium, or similar; exclusion after primary study inclusion possible) - Pregnancy or lactation

Study Design


Locations

Country Name City State
Germany Universitätsklinikum Jena Jena

Sponsors (1)

Lead Sponsor Collaborator
Jena University Hospital

Country where clinical trial is conducted

Germany, 

Outcome

Type Measure Description Time frame Safety issue
Primary Correlation biomarker release and LGE cardiac MRI Correlation of the peak value of the respective biomarker with the amount of perioperatively induced myocardial damage quantified by cMRI. pre-surgery and 5 days post-surgery
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