Stroke Clinical Trial
— ISBITAMIOfficial title:
A Prospective, Observational Study to Assess the Efficacy of New Quantitative Imaging Methods to Assess the Risk of Acute and Subacute Thromboembolic Complications of Myocardial Infarction
Verified date | February 2022 |
Source | Hospital General Universitario Gregorio Marañon |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Observational |
This project aims to assess the ability of cardiac imaging (cardiac MRI and Doppler-echocardiography) post-processing tools to predict a combined end-point of intraventricular thrombosis, silent brain infarcts, clinical stroke and peripheral arterial embolism in patients with first acute myocardial infarction and ventricular dysfunction.
Status | Completed |
Enrollment | 92 |
Est. completion date | January 1, 2022 |
Est. primary completion date | January 1, 2022 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years and older |
Eligibility | Inclusion Criteria: 1. First ST elevation AMI undergoing (or not) revascularization. 2. Sinus rhythm in the first 24 hours of the AMI. 3. Written informed consent. ( 4) Left ventricular ejection fraction < 45% measured by echocardiography in the first 24-72 hours after AMI symptoms onset. Exclusion Criteria: 1. Implantable defibrillation or stimulation devices not compatible with MRI. 2. Killip-IV class or other shock situations or marked peripheral hypoperfusion. 3. Aborted sudden death or other causes of possible acute brain damage attributed to cerebral hypoperfusion. 4. Hemodynamically significant valvular disease or prosthetic heart valves. 5. Claustrophobia that impedes MRI scanning. 6. Atrial fibrillation (AF) in the first 24 hours after AMI. 7. Carotid Artery Disease diagnosed with stenosis greater than 50%. 8. Full oral anticoagulation prior to admission or indication of anticoagulation. 9. Defined pro-thrombotic conditions. 10. History of previous stroke in the last 6 months. |
Country | Name | City | State |
---|---|---|---|
Spain | Hospital General Universitario Gregorio Maranon | Madrid |
Lead Sponsor | Collaborator |
---|---|
Hospital General Universitario Gregorio Marañon |
Spain,
Rossini L, Martinez-Legazpi P, Vu V, Fernández-Friera L, Pérez Del Villar C, Rodríguez-López S, Benito Y, Borja MG, Pastor-Escuredo D, Yotti R, Ledesma-Carbayo MJ, Kahn AM, Ibáñez B, Fernández-Avilés F, May-Newman K, Bermejo J, Del Álamo JC. A clinical method for mapping and quantifying blood stasis in the left ventricle. J Biomech. 2016 Jul 26;49(11):2152-2161. doi: 10.1016/j.jbiomech.2015.11.049. Epub 2015 Nov 30. — View Citation
Vermeer SE, Longstreth WT Jr, Koudstaal PJ. Silent brain infarcts: a systematic review. Lancet Neurol. 2007 Jul;6(7):611-9. Review. — View Citation
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Combined binary variable consisting of one of the following: ventricular thrombosis assessed by cardiac MRI, silent brain infarct detected by brain MRI, peripheral acute arterial embolism or ischemic stroke within the 6 months after a first STEMI | Individual outcome measurements as described in Secondary Outcome Measures Section | 6 months | |
Secondary | Left ventricle mural thrombosis assessed by cardiac MRI performed one week and 6 months after STEMI | Left ventricle mural thrombosis will be assessed by contrast cardiac MRI. Early after gadolinium contrast administration (3 min), two dimensional T1-weighted fast-field-echo sequences with an inversion-recovery prepulse will be used. A long inversion time (520 ms) will be used to identify intraventricular thrombus as a LV mass with low-signal intensity surrounded by high-signal intensity structures | 6 months | |
Secondary | Silent brain infarcts (SBI) within the 6 months following a first STEMI | SBIs diagnosis entails the presence of a focal lesion > 3 mm that meets one of the three following criteria: 1) high signal on DWI isotropic images and low signal on the map of apparent diffusion coefficient (ADC). DWI sequence allows to detecting ischemic lesions (4 hours) and assessing their chronology. (2) cavitary lesion hyperintense on T2, with no signal (or low) in the FLAIR sequence usually surrounded by a ring gliotic hyperintense, hypointense on T1). (3) hyperintense lesion on T2 / T1 hypointense with prior distribution defect known or new in a follow-up study. The studies will be interpreted by a neuroradiologist blinded to clinical and echocardiographic information. For the assessment of whether the brain infarct is clinically silent, a medical history and physical examination focused on neurological symptoms will be performed including for that purpose the National Institute of Health (USA) questionnaire | 6 months | |
Secondary | Peripheral acute arterial embolism (limb or visceral) within the 6 months following a first STEMI | Incidence of acute limb ischemia (characterized by pain, pallor, pulselessness, poikilothermia, paresthesias, paralysis) and/or acute visceral ischemia (renal or mesentheric acute isquemia) within the 6 months following a first STEMI, as confirmed by clinically-indicated imaging technique. | 6 months | |
Secondary | Ischemic stroke within the 6 months after STEMI | An episode of neurological dysfunction caused by focal cerebral, spinal, or retinal infarction within the 6 months following a first STEMI, confirmed by clinically-indicated imaging technique (CT or MRI). | 6 months | |
Secondary | High Intensity Transient Signals (HITs) detected by transcranial Doppler monitoring of both middle cerebral arteries during 30 minutes within the 24-72 hours after STEMI | 24-72 hours | ||
Secondary | Neuropsychiatric and cognitive impact of SBIs within the 6 months after STEMI assessed by Beck and Minimental questionnaire | 6 months |
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