The Right Ventricle in Chronic Pressure Overload: Identifying Novel Molecular Targets for Functional Imaging

Chronic Thromboembolic Pulmonary Hypertension Clinical Trial

— MVD  

Official title:

The Right Ventricle in Chronic Pressure Overload: Identifying Novel Molecular Targets for Functional Imaging

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03199131
• Other study ID #: 2015-A00149-40
• Status: Completed
• Phase: N/A
• Start date: February 20, 2017
• Est. completion date: October 20, 2018

Study information

• Verified date: January 2020
• Source: Centre Chirurgical Marie Lannelongue
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Chronically elevated pulmonary pressures do not immediately result in right ventricular failure. During the initial period of exposure, the RV adapts to the increased afterload by altering its metabolism and morphology so as to meet the increased work requirement. Several, interconnected adaptive mechanisms have been proposed, including myocyte hypertrophy, a switch in the primary fuel used for ATP generation, increased angiogenesis, and decreased production of mitochondrial reactive oxygen species. While adaptation is initially successful in many cases, it is temporary, and after an uncertain period of time, the ventricle begins to fail. This transition from a compensated to decompensated state is difficult to predict clinically, and patients with different etiologies of CPOS progress to overt RV failure over significantly different time periods. This variability hinders the implementation of treatments that are tailored to a specific disease stage.

Description:

Chronically elevated pulmonary pressures do not immediately result in right ventricular failure. During the initial period of exposure, the RV adapts to the increased afterload by altering its metabolism and morphology so as to meet the increased work requirement. Several, interconnected adaptive mechanisms have been proposed, including myocyte hypertrophy, a switch in the primary fuel used for ATP generation, increased angiogenesis, and decreased production of mitochondrial reactive oxygen species. While adaptation is initially successful in many cases, it is temporary, and after an uncertain period of time, the ventricle begins to fail. This transition from a compensated to decompensated state is difficult to predict clinically, and patients with different etiologies of CPOS progress to overt RV failure over significantly different time periods. This variability hinders the implementation of treatments that are tailored to a specific disease stage. As right heart failure is the primary outcome determinant in patients with pulmonary hypertension, understanding the major mediators of RV compensation, failure and recovery is essential to improving patient survival. Recently, there have been significant advances in the ability to assess RV function in vivo using functional imaging techniques, including positron emission tomography (PET) and cardiac MRI (CMR). CMR is an established and validated method of precisely defining cardiac structure and function, and new PET protocols have been developed that measure glucose utilization, oxygen consumption, apoptosis and angiogenesis. Importantly, the in vivo nature of PET and CMR allow for the non-invasive collection of detailed structural, metabolic and physiologic data on the performance of the RV5. When taken in combination with established echocardiographic evaluation, these new platforms allow in-depth analysis of cardiac structure and function without the need for invasive procedures. In order to maximize the potential of these techniques, however, a molecular imaging target needs to be identified so as to allow physicians to detect the transition from a compensated to decompensated state. Such a marker has not yet been reported

Recruitment information / eligibility

• Status: Completed
• Enrollment: 20
• Est. completion date: October 20, 2018
• Est. primary completion date: November 20, 2017
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

-Inclusion Criteria:

Chronic thromboembolic pulmonary hypertension group:

• Patients undergoing pulmonary endarterectomy at Marie Lannelongue Surgical Center for the treatment of chronic thromboembolic pulmonary hypertension.

Control group:

• Patients undergoing adult cardiac surgery without evidence of pulmonary hypertension on preoperative assessment

• Exclusion Criteria:

Chronic thromboembolic pulmonary hypertension group:

• Insufficient biopsy material,

• pre-operative therapy with bosentan or sildenafil

Control group:

• Insufficient biopsy sample,

• ischemic cardiomyopathy,

• miral or tricuspid valve disease,

• pre-operative pulmonary hypertension.

Related Conditions & MeSH terms

• Chronic Thromboembolic Pulmonary Hypertension
• Hypertension, Pulmonary

Intervention

Procedure:
• Right ventricular biopsies
a right ventricular biopsy will be taken intraoperatively during either pulmonary endarterectomy (experimental group) or open cardiac surgery (control group).

Locations

Country	Name	City	State
France	Centre Chirurgical Marie Lannelongue	Le Plessis-Robinson

Sponsors (1)

Lead Sponsor	Collaborator
Centre Chirurgical Marie Lannelongue

Country where clinical trial is conducted

France, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	relationship between the metabolic, morphologic and functional alterations in the right ventricle		to investigate the relationship between the metabolic, morphologic and functional alterations in the right ventricle before surgery,one and six months after surgery.
Secondary	validation in human subjects of metabolic signaling pathway alterations found in animal model		analyse gene and protein expression during surgery