Assessing the Efficacy of CARDIOgoniometry (CGM) to Determine Physiologically Significant Stenosis in Patients With Stable Coronary Artery Disease in Comparison to Fractional FLOW Reserve - CARDIOFLOW (CARDIOFLOW)

August 16, 2022 updated by: Hull University Teaching Hospitals NHS Trust

The CARDIOFLOW study compares the standard test, a pressure wire test called fractional flow reserve (FFR), with a new method that is based on taking a detailed "3D" ECG called Cardiogoniometry (CGM).

FFR is an angiographic technique which measures the physiological significance of a coronary stenosis and trial data has shown that basing management decisions on this data improves prognosis. However FFR studies are expensive and invasive, whereas CGM is painless and simply involves placing 4 sticky pads to the patient's chest / back and is similar to an ECG (heart tracing). The investigators want to see whether we can use this new method to find out whether treatment with coronary angioplasty would be of benefit. If so, then in the future, clinicians could use this method (CGM) rather than pressure wire assessment (FFR). This would have several advantages; in particular, it can be easily performed in the clinic and avoids the need to use an expensive pressure wire.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Completed

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

This study aims to test the hypothesis that cardiogoniometry (CGM) is helpful to identify physiologically significant coronary artery stenosis in comparison to fractional flow reserve (FFR).

Last year in the UK 202 098 patients underwent coronary angiography to determine whether they had significant coronary artery disease. However, it is well recognised that, even with orthogonal views, angiography is limited in terms of its ability to determine the functional importance of coronary lesions. In particular those lesions judged to be 50-70% stenosed may not necessarily cause ischaemia as this depends on factors such as the lesion length and, importantly, the size of the territory supplied by the vessel.

There have been several studies that have demonstrated the clinical utility of evaluating such lesions with FFR. The measurement of FFR is an index of the physiological significance of a coronary stenosis and is defined as the ratio of maximal blood flow in a stenotic artery to normal maximal flow. It is calculated by comparing the ratio of the aortic pressure and the pressure distal to the coronary stenosis during maximal hyperaemia. These pressures are measured by introducing a coronary pressure guide wire into the artery and hyperaemia is induced by giving an infusion of adenosine intravenously. An FFR ratio of <0.80 indicates that the coronary stenosis is causing significant ischaemia and would benefit from PCI. This has since been incorporated into ESC clinical guidelines on myocardial revascularisation.

However this is an invasive procedure and the pressure wires are relatively expensive compared to standard angioplasty wires. On the contrary, CGM is a cheap and non-invasive technique that can be easily applied. The aim of the proposed study is to assess whether CGM may be able to aid clinicians in identifying if a coronary stenosis is physiologically significant at inducing myocardial ischaemia in conjunction with standard coronary angiography.

CGM is form of 3D vector electrocardiography which can provide quantitative analysis of myocardial depolarisation and repolarisation. It has been shown to be more sensitive and specific than standard 12-lead ECG at diagnosing stable coronary artery disease. Furthermore, other work has showed CGM to be more sensitive than 12-lead ECG at detecting patients with ACS. More recently in 2012, further work found that CGM was more sensitive and specific than the 12 lead ECG at identifying abnormal myocardial perfusion scans (MPS). FFR validity was initially based on a comparison with MPS and therefore we hypothesise that CGM may be comparable to FFR.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Actual)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
30

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United Kingdom
    • East Yorkshire
      • Kingston upon Hull, East Yorkshire, United Kingdom, HU16 5JQ
        • Castle Hill Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Patients admitted with stable coronary artery disease for elective percutaneous coronary intervention (PCI)
  • Patients who have been consented to undergo coronary angiography +/- PCI as part of their routine care by their clinician.
  • Aged 18 or over.
  • The patient has been informed of the nature of the study and has provided full written informed consent.
  • FFR will be performed on study participants who demonstrate visible coronary stenosis on coronary angiography.

Exclusion Criteria:

  • Patients unable to give informed consent including those with communication difficulties due to poor English.
  • Patients with haemodynamic instability and / or cardiogenic shock (defined as a sustained blood pressure of <90mmHg +/- the need for inotropic support)
  • Patients with an acute coronary syndrome (as defined by the European Society of Cardiology)
  • Those unable to perform a good quality CGM: 1) Patients who are SOB at rest; 2) Patients with very frequent ectopic beats; 3) Patients in atrial fibrillation; 4) Patients with a heart rate >150 beats/min
  • Those patients unable to tolerate adenosine: 1) Patients with severe asthma, especially if taking oral theophylline; 2) Patients with second or third degree heart block (without a pacemaker in situ); 3) Patients with sick sinus syndrome; 4) Patients with Long QT syndrome; 5)Patients with severe hypotension (systolic pressure) <100mmHg); 6) Patients with decompensated heart failure.
  • Patients with previous coronary artery bypass graft surgery
  • Patients who are unable to receive treatment with heparin
  • Patients with a chronic total occlusion
  • Patients with extremely tortuous or calcified vessels that are unfavourable for assessment with FFR.
  • Patients with severe stenosis of the left main stem
  • Patients with significant renal impairment (defined as eGFR<30ml/min)
  • Females who are or could be pregnant

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Diagnostic
  • Allocation: Non-Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Triple

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Experimental: Cardiogoniometry (CGM)

Every patient involved in the study will undergo a series of CGM recordings whilst having their FFR procedure. These recordings will all be done whilst they are in the catheterisation laboratory and will be taking at the following points during the procedure.

  1. First baseline recording - taken when the patient first enters the catheterisation laboratory and is prepped for their procedure.
  2. Second baseline recording - taken when the FFR guide wire is in place in the coronary artery being assessed.
  3. Maximal hyperaemia recording - this will be taken when the patient is at maximal hyperaemia during their adenosine infusion for their FFR procedure.

The patients involvement will then be finished in the study and will be cared for as per clinical practice.

If the CGM records a result of anything less than 0, it will be regarded as a positive result.
Device: Cardiogoniometry (CGM)
Active Comparator: Fractional flow reserve (FFR)

Every patient involved in the study will undergo an FFR assessment of their coronary arteries. These recordings will all be done whilst they are in the catheterisation laboratory. They will have the following recordings:

  1. A baseline FFR will be recorded once the pressure wire has been advanced down the coronary artery being assessed.
  2. Maximal hyperaemia FFR will be recorded during adenosine infusion.

An FFR ratio of <0.80 will be regarded as a positive result.
Device: Fractional Flow Reserve (FFR)

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Sensitivity of CGM to detect physiologically important coronary stenosis.
Time Frame: Calculated within 30 days after participant recruitment is complete.
The sensitivity of CGM to detect physiologically important coronary stenosis will be calculated after all participants are recruited. The number of patients which had true positive results (that is CGM tested positive when they had significant coronary disease) will be divided by the total number of participants who were found to have physiologically important coronary stenosis and expressed as a percentage
Calculated within 30 days after participant recruitment is complete.
Specificity of CGM to detect physiologically important coronary stenosis
Time Frame: Calculated within 30 days after participant recruitment is complete.
The specificity of CGM to detect physiologically important coronary stenosis will be calculated after all participants are recruited. The number of patients which had true negative results (that is CGM tested negative when they did not have significant coronary disease) will be divided by the total number of participants who were found not to have physiologically important coronary stenosis and expressed as a percentage.
Calculated within 30 days after participant recruitment is complete.
Positive predictive value (PPV) of CGM to detect physiologically important coronary stenosis
Time Frame: Calculated within 30 days after participant recruitment is complete.
The PPV of CGM to detect physiologically important coronary stenosis will be calculated after all participants are recruited. The number of patients which had true positive results (that is CGM tested positive when they had significant coronary disease) will be divided by the total number of participants who had a positive CGM test and expressed as a percentage.
Calculated within 30 days after participant recruitment is complete.
Negative predictive value (NPV) of CGM to detect physiologically important coronary stenosis
Time Frame: Calculated within 30 days after participant recruitment is complete.
The NPV of CGM to detect physiologically important coronary stenosis will be calculated after all participants are recruited. The number of patients which had true negative CGM result (that is CGM tested negative when they didn't not have significant coronary disease) will be divided by the total number of participants who had a negative CGM result and expressed as a percentage.
Calculated within 30 days after participant recruitment is complete.

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Hull University Teaching Hospitals NHS Trust

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
September 1, 2015

Primary Completion (Actual)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
September 1, 2016

Study Completion (Actual)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
October 1, 2016

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
February 18, 2016

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
June 23, 2016

First Posted (Estimate)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
June 28, 2016

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
August 18, 2022

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
August 16, 2022

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
August 1, 2022

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • 15/YH/2071

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

Cookie Settings

We use cookies to ensure that we give you the best experience on our website. For more details carefully read our Privacy and Cookies Policy. ...>>>You can change your preferences or withdraw your consent at any time by deleting the cookies from your website or computer as described in the policy. Please accept it and choose your preferences by ticking the corresponding boxes in the "Manage Settings" section below. Please carefully read our Terms of Service before you proceed with using any part of this website.
«Manage Settings