Dilated Cardiomyopathy - Unknown Therapeutic Risk Reduction by Contempary Medication and Implantable Cardioverter-Defibrillators (DUTCH-ICD) (DUTCH-ICD)
Using Cardiovascular Magnetic Resonance Identified Fibrosis to Assess Sudden Cardiac Death Risk in Patients With Non-ischemic Dilated Cardiomyopathy and the Unknown Therapeutic Risk Reduction of Contemporary Heart Failure Medication and Implantable Cardioverter-Defibrillators
Research questions: The value of primary prevention implantable cardioverter-defibrillator implantation (ICD) therapy in patients with non-ischemic cardiomyopathy (NICM) is under debate. Improved risk stratification is needed to select patients at highest risk.
Hypotheses: 1. In NICM patients with CMR detected myocardial fibrosis, ICD implantation reduces all-cause mortality compared to guideline-directed medical therapy (GDMT) only. 2. Myocardial fibrosis assessed by cardiac MRI (CMR) can be used to stratify patients according to risk for sudden cardiac death.
Study design: 1. Patients with myocardial fibrosis: Randomized controlled trial (RCT). 2. Patients without myocardial fibrosis: Prospective registry.
Study population: Patients with non-ischemic cardiomyopathy with LVEF <35% after at least 3 months of guideline-directed medical therapy (GDMT).
Intervention: ICD implantation. Main study parameters/endpoints: primary endpoint: all-cause mortality. Secondary endpoints include: patient clinical status, quality of life, sudden cardiac death, ventricular arrhythmias, ICD complications and ICD therapy Nature and extent of the burden and risks associated with participation, benefit and group relatedness: All ICDs that are implanted in the study are standard devices that are used in daily clinical practice. Patients who are randomized to ICD implantation will be subjected to the risk of perioperative and long-term complications but will be partly protected against death from ventricular arrhythmias. Patients randomized to no ICD implantation will not be protected against the residual risk of sudden cardiac death but are not subjected to complications from ICD implantation and possible subsequent complications. The only additional burden for patients is completing quality-of-life questionnaires, all hospital visits are for routine follow-up.
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Study Type
Study Type
Enrollment (Estimated)
Enrollment
Phase
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
-
Groningen, Netherlands
- University Medical Center Groningen
-
Nijmegen, Netherlands
- Radboud University Medical Center
-
Contact:
- Cornelis P Allaart
-
-
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Non-ischemic cardiomyopathy
- Left ventricular late gadolinium enhancement on MRI, but not hinge-point fibrosis
- Left ventricular ejection fraction <35% on any modality
- Functional class NYHA I-III
- At least 3 months optimal medical treatment for heart failure
Exclusion Criteria:
- Indication for cardiac resynchronization therapy
- Functional class NYHA IV
- Typical ischemic scar tissue on CMR
- Amyloidosis, sarcoidosis, hypertrophic cardiomyopathy, complex congenital heart disease
- high-risk mutations causing DCM
- Patient on waiting list for heart transplantation
- Left ventricular assist device present
- Severe valve disease
- Secondary prevention indication for ICD
- Untreated cardiac ischemia
- High competing risk of death (>35% in 1 year according to HFmetascore)
- Active chemotherapy for cancer
- Severe renal failure with dialysis expected within 3 years
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
No Intervention: guideline directed medical therapy
|
|
|
Active Comparator: guideline directed medical therapy and ICD implantation
|
implantation of a non-resynchronisation ICD
|
What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Time Frame |
|---|---|
|
all-cause mortality
Time Frame: 36 months
|
36 months
|
Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
sudden cardiac death
Time Frame: 36 months
|
36 months
|
|
|
quality of life as measured by standardized questionnaires
Time Frame: 36 months
|
score on Kansas City Cardiomyopathy Questionnaire (KCCQ) and EQ-5D-5L questionnaire
|
36 months
|
|
ventricular arhythmias
Time Frame: 36 months
|
Number of participants with sustained ventricular arrhythmia or resuscitation from ventricular fibrillation
|
36 months
|
|
ICD-related complications
Time Frame: 36 months
|
Numboer of participantis experiencing cardiac tamponade, pneumothorax or hematothorax, hematoma or bleeding, lead displacement, infection, arm deep vein thrombosis
|
36 months
|
|
ICD therapy
Time Frame: 36 months
|
Number of patients experiencing appropriate ICD therapy (ATP or shock) or inappropriate ICD therapy
|
36 months
|
Collaborators and Investigators
Sponsor
Sponsor
Collaborators
Collaborators
Study record dates
Study Major Dates
Study Start (Estimated)
Study Start
Primary Completion (Estimated)
Primary Completion
Study Completion (Estimated)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
Other Study ID Numbers
- DUTCH-ICD
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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.
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