- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00955539
Viability and Cardiac Resynchronization Therapy
The Importance of Viability for Response to Cardiac Resynchronization Therapy
Study Overview
Status
Conditions
Detailed Description
Cardiac resynchronization therapy (CRT) is an established therapy for patients with severe heart failure, depressed left ventricular function and a wide QRS-complex. Large clinical trials have demonstrated unequivocal improvements in functional status, morbidity and mortality. However, 30 % of heart failure patients treated with a CRT-device do not benefit clinically. Several factors have been suggested to be important for the response to CRT such as mechanical dyssynchrony, presence of scar tissue in the myocardium, and device-optimization (among others). It is the purpose of this study to investigate the importance of these factors.
100 patients with ischemic cardiomyopathy, eligible to CRT according to current guidelines, will be included. Patients are randomised to two arms. One group will have atrioventricular (AV)-optimization after implantation, the other AV -and interventricular (VV)-optimization. After 4 months patients are crossed-over to the other arm. Preimplantation patients are MR-scanned and low-dose dobutamine stress-echocardiography is performed. Furthermore patients will be examined by echocardiography and evaluation of clinical status
- Mechanical dyssynchrony can predict response to CRT. b. Measures of mechanical dyssynchrony is related to myocardial viability and conduction.
- Individual optimization based on conduction times will increase benefit to CRT. b. The effect of adding VV-optimization is related to myocardial viability.
- > 30 % of non-viable tissue globally in the myocardium is predictive of lack of CRT- response. b. Non-viable tissue located in the area of the left ventricular lead is predictive of non-response.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Niels Risum, M.D.
- Phone Number: +45 39978473
- Email: nieris01@geh.regionh.dk
Study Contact Backup
- Name: Thomas Fritz Hansen, M.D.
- Phone Number: +45 39773977
- Email: THHAN@geh.regionh.dk
Study Locations
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-
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Hellerup, Denmark, 2900
- Recruiting
- Gentofte University Hospital
-
Contact:
- Niels Risum, M.D.
- Phone Number: +45 39978473
- Email: nieris01@geh.regionh.dk
-
Contact:
- Thomas Fritz Hansen, M.D.
- Phone Number: +45 39773977
- Email: THHAN@geh.regionh.dk
-
Principal Investigator:
- Niels Risum, M.D.
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Lund, Sweden, 221 85
- Recruiting
- University Hospital Lund
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Contact:
- Rasmus Borgquist, MD, PhD
- Phone Number: +46 70-4057350
- Email: rasmus.borgquist@med.lu.se
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Principal Investigator:
- Rasmus Borgquist, MD, PhD
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- LVEF</= 35%, QRS-duration>/= 120 ms, NYHA-class II- IV.
- Ischemic heart disease (> 50% stenosis in 1 or more major epicardial coronary artery or prior PCI or CABG.)
- Optimal treatment ( beta-blocker, ACE-1 or ARB and spironolactone)
Exclusion Criteria:
- Pregnancy
- Unstable angina pectoris
- Chronical atrial fibrillation
- Severe valvular disease
- Dementia or mental retardation
- Severe claustrophobia
- Acute myocardial infarction < 3 months
- Severe health condition threatening short-term survival
- Severe kidney insufficiency, GFR < 35 ml/min/1.73 m2
- Metal implants contraindicative of magnetic resonance scan
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Crossover Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: CRT group 1
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Patients are AV-optimized the first 4 months,then AV- and VV-optimized the next 4 months.
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Active Comparator: CRT group 2
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Patients are AV- and VV-optimized the first 4 months,then AV-optimized the next 4 months.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Responders:Echocardiographic:>/= 10% increase in Left ventricular ejection fraction (LVEF) or >/= 15 % reduction in left ventricular end-systolic volume (LVESV)
Time Frame: 4 and 8 months, ( follow up- 2 years)
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4 and 8 months, ( follow up- 2 years)
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Secondary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
LVESV, LVEDV, Cardiac output (CO), Minnesota Living with Heart Failure Questionnaire (MLHFQ) ProBNP Others: t-wave modulation all-cause mortality, cardiac death, hospitalization
Time Frame: 4 and 8 months (follow-up after 2 years)
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4 and 8 months (follow-up after 2 years)
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Clinical: >/= 25% increase in 6-min walk test or >/= 1 reduction in NYHA-class
Time Frame: 4 and 8 months (follow-up 2 years)
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4 and 8 months (follow-up 2 years)
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Collaborators and Investigators
Investigators
- Principal Investigator: Niels Risum, M.D., University Hospital Gentofte, Department of Cardiology
- Study Chair: Thomas Fritz Hansen, M.D., University Hospital Gentofte, Department of Cardiology
- Study Chair: Peter Søgaard, M.D., DMSc., Gentofte University Hospital, department of cardiology
- Study Chair: Rasmus Borgquist, MD, PhD, University Hospital Lund
- Study Chair: Niels E Bruun, MD, DMSc, Gentofte University Hospital, department of cardiology
Publications and helpful links
General Publications
- Bax JJ, Abraham T, Barold SS, Breithardt OA, Fung JW, Garrigue S, Gorcsan J 3rd, Hayes DL, Kass DA, Knuuti J, Leclercq C, Linde C, Mark DB, Monaghan MJ, Nihoyannopoulos P, Schalij MJ, Stellbrink C, Yu CM. Cardiac resynchronization therapy: Part 1--issues before device implantation. J Am Coll Cardiol. 2005 Dec 20;46(12):2153-67. doi: 10.1016/j.jacc.2005.09.019.
- Sogaard P, Egeblad H, Pedersen AK, Kim WY, Kristensen BO, Hansen PS, Mortensen PT. Sequential versus simultaneous biventricular resynchronization for severe heart failure: evaluation by tissue Doppler imaging. Circulation. 2002 Oct 15;106(16):2078-84. doi: 10.1161/01.cir.0000034512.90874.8e.
- Bleeker GB, Kaandorp TA, Lamb HJ, Boersma E, Steendijk P, de Roos A, van der Wall EE, Schalij MJ, Bax JJ. Effect of posterolateral scar tissue on clinical and echocardiographic improvement after cardiac resynchronization therapy. Circulation. 2006 Feb 21;113(7):969-76. doi: 10.1161/CIRCULATIONAHA.105.543678. Epub 2006 Feb 13.
- Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L, Tavazzi L; Cardiac Resynchronization-Heart Failure (CARE-HF) Study Investigators. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med. 2005 Apr 14;352(15):1539-49. doi: 10.1056/NEJMoa050496. Epub 2005 Mar 7.
Study record dates
Study Major Dates
Study Start
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- H-B-2009-057
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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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