- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02355418
The Role of Myocardial Fibrosis in Degenerative Mitral Regurgitation
A Prospective Observational Study Examining the Role of Myocardial Fibrosis in Outcome Following Mitral Valve Repair in Degenerative Mitral Regurgitation.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
The optimal management of chronic severe primary degenerative mitral regurgitation (MR) is to repair the valve, but timing of surgery remains controversial. Current guidelines suggest 'watchful waiting' until the onset of symptoms or left ventricular dysfunction but have been criticized for promoting 'rescue surgery'. Better predictors are required to optimize timing of surgery and patient outcomes.
Chronic volume overload is a stimulus for adverse adaptive left ventricular (LV) remodeling. Subclinical reduction in LV strain before mitral repair predicts a fall in LV ejection fraction following surgery and is thought to reflect myocardial fibrosis. The investigators' pilot cardiac magnetic resonance (CMR) data support this hypothesis. The aims of this study are:
- identify whether diffuse interstitial myocardial fibrosis impacts upon post-operative complications, symptomatic improvement and ventricular recovery following surgery,
- to show that diffuse fibrosis (assessed by T1 mapping CMR) is validated by histological assessment on myocardial biopsy,
- identify independent pre-operative imaging / biomarker / exercise predictors of post-operative clinical outcomes
The investigators will investigate and follow up patients with severe degenerative mitral regurgitation, who do meet a class 1 indication for mitral valve surgery using present AHA guidelines. Patients have the option of choosing either close monitoring or early surgical repair of their mitral valve (class 2a indication). The relationship between patient symptoms, CMR findings, blood and histological measures of fibrosis will be studied and correlated with patient outcomes.
Study Type
Enrollment (Actual)
Contacts and Locations
Study Locations
-
-
West Midlands
-
Birmingham, West Midlands, United Kingdom, B15 2TH
- University Hospital Birmingham
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Sampling Method
Study Population
Description
Inclusion Criteria:
(1) All patients with asymptomatic chronic, severe primary degenerative MR known to the Queen Elizabeth Hospital Birmingham (of note, the aetiology and severity of MR will be based on the echocardiography findings , interpreted according to the European Association of Echocardiography recommendations).
Exclusion Criteria:
- symptoms due to severe MR;
- LV endsystolic diameter >45mm at baseline;
- LV ejection fraction <60%;
- history of myocardial infarction, previous coronary artery bypass graft, or valve surgery;
- inherited or acquired cardiomyopathy;
- congenital heart disease; including common atrio-ventricular canal defects;
- more than mild coexisting aortic valve stenosis or regurgitation
- primary mitral regurgitation not due to degenerative disease, including rheumatic disease and infective endocarditis;
- uncontrolled atrial fibrillation (resting HR>100/min average on 24 hour Holter );
- unable to undergo CMR;
- unable to walk on treadmill or use supine bicycle.
Study Plan
How is the study designed?
Design Details
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
---|---|
Patients for early surgery
A prospective, cross sectional comparison of asymptomatic patients before and after mitral valve repair surgery for chronic severe primary degenerative mitral regurgitation.Once established, it is our intention to restudy subjects in 5 years to provide information on late outcome following surgery.
|
Standard mitral valve repair surgery
|
Patients against early surgery
In order to establish the natural history of diffuse fibrosis in mitral regurgitation, an additional cohort of patients with asymptomatic mitral regurgitation who do not wish to consider early repair will be followed.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Detection of diffuse interstitial fibrosis in patients with chronic severe degenerative mitral regurgitation and evaluation of its functional consequences.
Time Frame: 3 years
|
Using T1-mapping CMR and myocardial biopsy, the investigators can confirm the development of diffuse interstitial fibrosis in patients with chronic severe degenerative mitral regurgitation.
Using a range of clinical markers, the investigators will study the development of diffuse interstitial fibrosis and its relationship to left ventricular recovery following surgery, length of in-hospital stay, and patients' functional (exercise) and symptomatic (PROMS) status.
|
3 years
|
Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: Richard Steeds, University Hospital Birmingham
Publications and helpful links
General Publications
- Liu B, Neil DAH, Bhabra M, Patel R, Barker TA, Nikolaidis N, Billing JS, Hayer M, Baig S, Price AM, Vijapurapu R, Treibel TA, Edwards NC, Steeds RP. Reverse Myocardial Remodeling Following Valve Repair in Patients With Chronic Severe Primary Degenerative Mitral Regurgitation. JACC Cardiovasc Imaging. 2022 Feb;15(2):224-236. doi: 10.1016/j.jcmg.2021.07.007. Epub 2021 Aug 18.
- Liu B, Neil DAH, Premchand M, Bhabra M, Patel R, Barker T, Nikolaidis N, Billing JS, Treibel TA, Moon JC, Gonzalez A, Hodson J, Edwards NC, Steeds RP. Myocardial fibrosis in asymptomatic and symptomatic chronic severe primary mitral regurgitation and relationship to tissue characterisation and left ventricular function on cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2020 Dec 14;22(1):86. doi: 10.1186/s12968-020-00674-4.
- Liu B, Edwards NC, Neal DAH, Weston C, Nash G, Nikolaidis N, Barker T, Patel R, Bhabra M, Steeds RP. A prospective study examining the role of myocardial Fibrosis in outcome following mitral valve repair IN DEgenerative mitral Regurgitation: rationale and design of the mitral FINDER study. BMC Cardiovasc Disord. 2017 Nov 22;17(1):282. doi: 10.1186/s12872-017-0715-y.
Study record dates
Study Major Dates
Study Start (ACTUAL)
Primary Completion (ACTUAL)
Study Completion (ACTUAL)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ESTIMATE)
Study Record Updates
Last Update Posted (ACTUAL)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- not yet available (not yet available)
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.
Clinical Trials on Mitral Regurgitation
-
Abbott Medical DevicesCompletedFunctional Mitral Regurgitation | Degenerrative Mitral RegurgitationRussian Federation
-
Ancora Heart, Inc.CompletedMitral Regurgitation | Mitral Valve Regurgitation | Functional Mitral RegurgitationAustria, Lithuania, Germany
-
Heinrich-Heine University, DuesseldorfCompletedMitral Regurgitation | Functional Mitral Regurgitation | Degenerative Mitral Valve RegurgitationGermany
-
Mitre Medical Corp.BSWRI Cardiac Imaging Core Lab (CICL)Not yet recruitingIschemic Mitral Regurgitation | Functional Mitral RegurgitationUnited States
-
Abbott Medical DevicesCompletedMitral Valve Regurgitation | Mitral Valve Incompetence | Mitral Insufficiency | Functional Mitral Regurgitation | Mitral Stenosis With InsufficiencyJapan
-
Hospital Clinic of BarcelonaAbbottUnknownMITRAL REGURGITATIONSpain
-
Boston Scientific CorporationActive, not recruitingCardiovascular Diseases | Mitral Regurgitation Functional | Mitral Valve DiseaseUnited States, Australia
-
Edwards LifesciencesRecruitingMitral Regurgitation | Mitral Insufficiency | Functional Mitral Regurgitation | Degenerative Mitral Valve DiseaseUnited States, Canada, Switzerland, Germany
-
Abbott Medical DevicesActive, not recruitingHeart Failure | Mitral Regurgitation | Mitral Valve Regurgitation | Treatment of Functional Mitral Regurgitation in Symptomatic Heart Failure SubjectsUnited States, Canada
-
Mardil MedicalRecruitingFunctional Mitral RegurgitationCanada, Hungary, France, Germany, Netherlands, Panama, Poland
Clinical Trials on Mitral valve repair
-
Michele De BonisCompletedMitral Valve RegurgitationItaly
-
Michele De BonisCompletedDegenerative Mitral Valve DiseaseItaly
-
Hangzhou Valgen Medtech Co., LtdNot yet recruitingMitral Valve Insufficiency
-
Southern Illinois UniversityWithdrawnMyocardial Infarction | Mitral RegurgitationUnited States
-
Hong LiuUnknownPulmonary Arterial Hypertension | Mitral InsufficiencyChina
-
Second Affiliated Hospital, School of Medicine,...Recruiting
-
Icahn School of Medicine at Mount SinaiNational Heart, Lung, and Blood Institute (NHLBI); Canadian Institutes of Health... and other collaboratorsCompletedCoronary Artery Disease | Mitral Valve InsufficiencyUnited States, Canada
-
Meshalkin Research Institute of Pathology of CirculationCompletedHypertrophic Obstructive CardiomyopathyRussian Federation
-
Beijing Anzhen HospitalRecruitingOutcomes of Mitral Valve Surgery in Patients Affected by Rheumatic Heart DiseaseChina
-
UMC UtrechtMaastricht University Medical Center; Academisch Medisch Centrum - Universiteit... and other collaboratorsRecruitingMitral RegurgitationNetherlands