Myocardial Infarction Clinical Trial
Official title:
Improving Risk Stratification of Patients for Implantable Cardioverter Defibrillators Through Electrophysiological Tests, Cardiac Magnetic Resonance Imaging, Autonomic Function Tests, RNA Analysis and Plasma Biomarkers.
Worldwide three million people a year die from sudden cardiac death (SCD). In most cases
there is no warning and the heart is stopped by a sudden arrhythmia. We know that some
people are at high risk of sudden cardiac death and can prevent their deaths with an
implantable cardioverter defibrillator (ICD) that is implanted in a minor operation.
However, most people who die from sudden cardiac death are not found to be at high risk by
our current risk markers and 40% of the people who have ICDs do not have therapy within the
first 4 years after implant. We need new and better ways of identifying people who are at
high risk of sudden cardiac death so that we can prevent their deaths with ICDs. Our
understanding of the electrical signals in the heart has increased considerably in recent
years; in no small part this is due to our Principal Investigator Professor Andre Ng's basic
science work. This study aims to take the understanding of action potential duration (APD)
restitution gained through our work and other studies in humans and in computer simulations
and translate it into a fresh way of assessing risk of sudden cardiac death.
This study will carefully examine electrical activity, using APD restitution, in the hearts
of patients who are having ICDs fitted because of their high risk of sudden cardiac death
and combine this with a detailed heart scan, assessment of autonomic nervous system and gene
expression data. We will then follow these patients up to see who benefits from their ICD.
This wide ranging information will give us as complete a picture as possible of the factors
that cause sudden cardiac death. We hope to use this to identify better predictors of sudden
cardiac death.
The study hypotheses are as follows:
Primary
1. Regional Restitution Instability Index (R2I2) will be significantly higher in patients
reaching the endpoint of ventricular endpoint / sudden cardiac death than in those not.
2. An R2I2 cut-off of 1.03 will partition patients into high and low risk groups.
Secondary
3. Peri-infarct zone mass in grams will be significantly higher in patients reaching the
endpoint of ventricular endpoint / sudden cardiac death than in those not.
n/a
Observational Model: Case Control, Time Perspective: Prospective
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