- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03217240
Integrated Computational modelIng of Right Heart Mechanics and Blood Flow Dynamics in Congenital Heart Disease
Integrated Computational modelIing of Right Heart Mechanics and Blood Flow Dynamics in Congenital Heart Disease ("INITIATE")
Advances in paediatric cardiology and cardiac surgery have enabled the survival of most patients born with congenital heart disease (CHD) into adulthood. Many CHD patients have undergone palliative or reparative surgery earlier in life. As patients survive into adulthood, they may need intervention or surgery for residual haemodynamic lesions. This is because they are at risk of arrhythmias secondary to structure heart disease and are susceptible to acquired heart disease. In these patients, pre-operative and post-operative evaluation of right ventricular (RV) structure (shape and volume) and function is an essential component of clinical management.
Advances have been made in cardiac imaging so that accurate assessment of the right heart chamber in terms of its structure, function and physiology is possible. However, this technology has as yet never been applied in an effort to comprehensively assess RV structure, function and physiology. Cardiac Magnetic Resonance (CMR) will be used in this comprehensive assessment of structure and function. Thus, this research will allow development of a comprehensive integrated biomedical engineering (BME) R&D platform for in-depth study and clinical diagnosis of the RV structure-function relationship and physiology and its association with biomarker, and exercise capacity in CHD.
Study Overview
Status
Conditions
Detailed Description
The incidence of Congenital Heart Disease (CHD) in live new-borns is estimated to vary from 4.1/1000 to 12.3/1000. The improvement in survival of CHD patients has led to burgeoning numbers of grown-up CHD.The majority of these CHD patients face a lifetime of problems including RV dilation, ventricular arrhythmias, and sudden cardiac death.Considering inflation to visit costs and added image technology for diagnosis, the cost of each patient is expected to increase .In contrast to adult patients with acquired heart disease, abnormalities of the RV are ubiquitous in children and adults with CHD.
Currently, clinical evaluation includes ECG and pulse oximetry alongside clinical examination. Investigation of RV anatomy and physiology is evolving from a reliance on invasive studies (right heart catheterization or RHC) to non-invasive imaging techniques such as echocardiography, nuclear scintigraphy, computed tomography, and CMR .2D echocardiography is largely operator dependent and suffers from poor inter-study reproducibility.The complex geometry of the RV makes it difficult to accurately quantify remodelling before and after intervention. Nuclear scintigraphy and computed tomography (CT) are constrained by the need for ionizing radiation as well as the poor temporal resolution of the technique.Importantly, existing CMR analytics fail to exploit the full potential of the rich CMR image dataset, and do not yield information on regional RV remodelling, muscle stiffness and blood flow characterization.
Due to the challenges mentioned above, other than RV volumes and ejection fraction, other changes in RV shape and haemodynamics have yet to be considered in the official guidelines used to define eligibility for surgery and to quantify risk of operation. It is plausible that incorporation of additional variables that more comprehensively characterizes fine alterations in RV structure, function and haemodynamics in large risk-stratification models, such as the EuroSCORE and the Society of Thoracic Surgeons' Risk Calculator, may enhance risk stratification and prognostication.
Incorporating novel exploratory RV functional indices (e.g. curvedness, area strain) and computational methods (e.g. CFD, FSI simulations), and then correlating these with clinical and cardiopulmonary exercise test outcomes will allow investigators to have established an unprecedentedly sizeable and rich clinical imaging database that serves both as a touchstone for clinical reference, as well as a repository for future exploratory research.
Investigators tend to develop a comprehensive (BME) Research and Development platform for in-depth study of RV mechanics, blood flow and function in Congenital Heart Disease.
Study Type
Enrollment (Anticipated)
Contacts and Locations
Study Contact
- Name: Zhong Liang
- Phone Number: 2237 67042237
- Email: zhong.liang@nhcs.com.sg
Study Contact Backup
- Name: Nurkhairunisah Abdul Rahim
- Phone Number: 2263 67042263
- Email: nurkhairunisah.abdul.rahim@nhcs.com.sg
Study Locations
-
-
-
Singapore, Singapore, 119074
- Not yet recruiting
- National University Hospital
-
Contact:
- Dr Chai Ping
- Phone Number: 2165 67722165
- Email: ping_chai@nuhs.edu.sg
-
Sub-Investigator:
- Dr Chai Ping
-
Singapore, Singapore, 229899
- Not yet recruiting
- KK Women's and Children's Hospital
-
Contact:
- Dr Tan Teng Hong
- Phone Number: 1049 63941049
- Email: tan.teng.hong@singhealth.com.sg
-
Sub-Investigator:
- Dr Tan Teng Hong
-
Singapore, Singapore, 169609
- Recruiting
- National Heart Centre
-
Contact:
- Nurkhairunisah Binte Abdul Rahim
- Phone Number: 2263 67042263
- Email: nurkhairunisah.abdul.rahim@nhcs.com.sg
-
Contact:
- Yin Siang Liaw
- Phone Number: 2274 67042274
- Email: liaw.yin.siang@nhcs.com.sg
-
Principal Investigator:
- Dr Zhong Liang
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Sampling Method
Study Population
Study will recruit 200 patients and 200 Healthy volunteers from across 3 sites at the following institutions:
- National Heart Centre
- National University Hospital
KK Women's and Children's Hospital
200 Congenital Heart Disease Patients 200 Healthy Volunteer
Description
Inclusion Criteria:
For patients with repaired tetralogy of Fallot
- Survivors of TOF repair more than one year after repair
- Aged: 12-80
For patients with pulmonary hypertension
- Signed informed consent prior to initiation of any study mandated procedure
- Age between 12 - 80 years
- Patient with clinically suspected or known primary PH belonging to one of the following subgroups of the Updated Dana Point Clinical Classification Group 1 (at least 1 of the following a)Idiopathic (IPAH), or b)Heritable (HPAH), or c)Drug or toxin induced, or d)Associated (APAH) with one of the following: i.Connective tissue disease ii.Congenital heart disease
For Healthy volunteers
- Aged :12-80
- Asymptomatic and ambulant
- Resting blood pressure <140/90 mmHg
Exclusion Criteria:
- Non-cardiac illness with a life expectancy of less than 2 years
- Previous heart, kidney, liver or lung transplantation
Contraindication to MRI examination
- Cardiac pacemaker
- Brain aneurysm or clips
- Electronic implants or prosthesis
- Eye metal foreign body injury
- Severe claustrophobia
- Severe renal impairment, glomerular filtration rate <30ml/min/1.73m2
- Pregnancy
Additional exclusion criteria for healthy volunteers:
- History of any major medical problems, any cardiovascular disease (such as hypertension or diabetes) or significant renal or lung disease (eg.COPD, Asthma, Pneumonia,Pulmonary embolism,Pulmonary edema,Respiratory tract infection,Bronchiolitis)
- Concurrently taking any medications for cardiovascular disease (including hypertension)
- Heavy smoking (over 5 sticks per day or who has quit smoking in less than 12 months and had smoked over 5 sticks per day)
Study Plan
How is the study designed?
Design Details
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
---|---|
Congenital Heart Disease
Tetralogy of Fallot Repair/Pulmonary Hypertension Cardiac Magnetic Resonance - MRI Cardiopulmonary Exercise Test Blood Sampling for all participants
|
All participants will have to undergo CMR which uses interaction of the magnetic properties of body tissues with strong magnetic fields to create images.
Participants will be asked to lie on a narrow bed placed inside of a large magnet for about 1 hour.
Several sets of images are needed.
Participants are required to stay very still and follow the instruction of the MRI technologist who operates the machine from a room next door.
Participants will be asked to undergo a cardiopulmonary exercise test (CPET).
Participants will need to wear a mask.
Several electrodes will be placed on the chest to record heart activity during exercise.
Participants will need to pedal for at least 8-12 minutes.
Pedalling will be instructed to report any symptoms such as chest discomfort, shortness of breath, leg fatigue or dizziness.
A small probe will be placed on participant's finger during the test to measure the oxygen content in the blood.
Immediately after exercising, participants will rest for 5-10 minutes while the blood pressure and electrocardiogram are monitored.
The results will be read by a cardiologist.
Serum samples will be obtained before CMR.
The sample will be stored at -80 degree until assay.
Investigators will perform various tests related to participants heart function
|
Healthy Volunteer
Cardiac Magnetic Resonance - MRI Cardiopulmonary Exercise Test Blood Sampling for all participants
|
All participants will have to undergo CMR which uses interaction of the magnetic properties of body tissues with strong magnetic fields to create images.
Participants will be asked to lie on a narrow bed placed inside of a large magnet for about 1 hour.
Several sets of images are needed.
Participants are required to stay very still and follow the instruction of the MRI technologist who operates the machine from a room next door.
Participants will be asked to undergo a cardiopulmonary exercise test (CPET).
Participants will need to wear a mask.
Several electrodes will be placed on the chest to record heart activity during exercise.
Participants will need to pedal for at least 8-12 minutes.
Pedalling will be instructed to report any symptoms such as chest discomfort, shortness of breath, leg fatigue or dizziness.
A small probe will be placed on participant's finger during the test to measure the oxygen content in the blood.
Immediately after exercising, participants will rest for 5-10 minutes while the blood pressure and electrocardiogram are monitored.
The results will be read by a cardiologist.
Serum samples will be obtained before CMR.
The sample will be stored at -80 degree until assay.
Investigators will perform various tests related to participants heart function
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Develop a comprehensive (BME) RnD platform for in-depth study of RV mechanics, blood flow and function in Congenital Heart Disease
Time Frame: 3 years
|
This research will give an in-depth understanding of RV structure-function relationship, mechanics and haemodynamics.
This is the foundation for rationale and physiologically-sound clinical decision-making in CHD monitoring and management.
In addition, computational modelling of RV blood flow would be the best tool to optimize an individual solution to RV surgery and may ultimately improve surgical planning.
This proposal is a pioneering study that can influence the research field and current management in preoperative, intraoperative, and post-operative interventions in CHD patients.
|
3 years
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Dr Zhong Liang, Researcher
Publications and helpful links
General Publications
- Geva T, Sandweiss BM, Gauvreau K, Lock JE, Powell AJ. Factors associated with impaired clinical status in long-term survivors of tetralogy of Fallot repair evaluated by magnetic resonance imaging. J Am Coll Cardiol. 2004 Mar 17;43(6):1068-74. doi: 10.1016/j.jacc.2003.10.045.
- Min JK, Leipsic J, Pencina MJ, Berman DS, Koo BK, van Mieghem C, Erglis A, Lin FY, Dunning AM, Apruzzese P, Budoff MJ, Cole JH, Jaffer FA, Leon MB, Malpeso J, Mancini GB, Park SJ, Schwartz RS, Shaw LJ, Mauri L. Diagnostic accuracy of fractional flow reserve from anatomic CT angiography. JAMA. 2012 Sep 26;308(12):1237-45. doi: 10.1001/2012.jama.11274.
- Koo BK, Erglis A, Doh JH, Daniels DV, Jegere S, Kim HS, Dunning A, DeFrance T, Lansky A, Leipsic J, Min JK. Diagnosis of ischemia-causing coronary stenoses by noninvasive fractional flow reserve computed from coronary computed tomographic angiograms. Results from the prospective multicenter DISCOVER-FLOW (Diagnosis of Ischemia-Causing Stenoses Obtained Via Noninvasive Fractional Flow Reserve) study. J Am Coll Cardiol. 2011 Nov 1;58(19):1989-97. doi: 10.1016/j.jacc.2011.06.066.
- Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Baron-Esquivias G, Baumgartner H, Borger MA, Carrel TP, De Bonis M, Evangelista A, Falk V, Lung B, Lancellotti P, Pierard L, Price S, Schafers HJ, Schuler G, Stepinska J, Swedberg K, Takkenberg J, Von Oppell UO, Windecker S, Zamorano JL, Zembala M; ESC Committee for Practice Guidelines (CPG); Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC); European Association for Cardio-Thoracic Surgery (EACTS). Guidelines on the management of valvular heart disease (version 2012): the Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur J Cardiothorac Surg. 2012 Oct;42(4):S1-44. doi: 10.1093/ejcts/ezs455. Epub 2012 Aug 25. No abstract available.
- Brenner DJ, Hall EJ. Computed tomography--an increasing source of radiation exposure. N Engl J Med. 2007 Nov 29;357(22):2277-84. doi: 10.1056/NEJMra072149. No abstract available.
- Douglas PS, Pontone G, Hlatky MA, Patel MR, Norgaard BL, Byrne RA, Curzen N, Purcell I, Gutberlet M, Rioufol G, Hink U, Schuchlenz HW, Feuchtner G, Gilard M, Andreini D, Jensen JM, Hadamitzky M, Chiswell K, Cyr D, Wilk A, Wang F, Rogers C, De Bruyne B; PLATFORM Investigators. Clinical outcomes of fractional flow reserve by computed tomographic angiography-guided diagnostic strategies vs. usual care in patients with suspected coronary artery disease: the prospective longitudinal trial of FFR(CT): outcome and resource impacts study. Eur Heart J. 2015 Dec 14;36(47):3359-67. doi: 10.1093/eurheartj/ehv444. Epub 2015 Sep 1.
- Egidy Assenza G, Cassater D, Landzberg M, Geva T, Schreier J, Graham D, Volpe M, Barker N, Economy K, Valente AM. The effects of pregnancy on right ventricular remodeling in women with repaired tetralogy of Fallot. Int J Cardiol. 2013 Oct 3;168(3):1847-52. doi: 10.1016/j.ijcard.2012.12.071. Epub 2013 Jan 28.
- Warnes CA. Adult congenital heart disease importance of the right ventricle. J Am Coll Cardiol. 2009 Nov 17;54(21):1903-10. doi: 10.1016/j.jacc.2009.06.048.
- Kilner PJ, Geva T, Kaemmerer H, Trindade PT, Schwitter J, Webb GD. Recommendations for cardiovascular magnetic resonance in adults with congenital heart disease from the respective working groups of the European Society of Cardiology. Eur Heart J. 2010 Apr;31(7):794-805. doi: 10.1093/eurheartj/ehp586. Epub 2010 Jan 11.
- Zhao X, Hu L, Leng S, Tan RS, Chai P, Bryant JA, Teo LLS, Fortier MV, Yeo TJ, Ouyang RZ, Allen JC, Hughes M, Garg P, Zhang S, van der Geest RJ, Yip JW, Tan TH, Tan JL, Zhong Y, Zhong L. Ventricular flow analysis and its association with exertional capacity in repaired tetralogy of Fallot: 4D flow cardiovascular magnetic resonance study. J Cardiovasc Magn Reson. 2022 Jan 3;24(1):4. doi: 10.1186/s12968-021-00832-2.
- Leng S, Tan RS, Guo J, Chai P, Zhang G, Teo L, Ruan W, Yeo TJ, Zhao X, Allen JC, Tan JL, Yip JW, Chen Y, Zhong L. Cardiovascular magnetic resonance-assessed fast global longitudinal strain parameters add diagnostic and prognostic insights in right ventricular volume and pressure loading disease conditions. J Cardiovasc Magn Reson. 2021 Apr 1;23(1):38. doi: 10.1186/s12968-021-00724-5.
Helpful Links
- Clinical outcomes of fractional flow reserve.
- Diagnostic accuracy of fractional flow reserve from anatomic CT angiography
- Diagnosis of ischemia-causing coronary stenoses by noninvasive fractional flow reserve computed from coronary computed tomographic angiograms.
- Guidelines on the management of valvular heart disease (version 2012): the Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS).
- The effects of pregnancy on right ventricular remodeling in women with repaired tetralogy of Fallot
- Factors associated with impaired clinical status in long-term survivors of tetralogy of Fallot repair evaluated by magnetic resonance imaging
- Adult congenital heart disease importance of the right ventricle
- Recommendations for cardiovascular magnetic resonance in adults with congenital heart disease from the respective working groups of the European Society of Cardiology
- Computed tomography--an increasing source of radiation exposure
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
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
- NHeartCentreS
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.
Clinical Trials on Pulmonary Hypertension
-
Sheffield Teaching Hospitals NHS Foundation TrustUniversity of SheffieldCompletedIdiopathic Pulmonary Arterial Hypertension | Chronic Thromboembolic Pulmonary HypertensionUnited Kingdom
-
Centre Chirurgical Marie LannelongueUnknownChronic Thrombo-embolic Pulmonary Hypertension and Pulmonary Arterial HypertensionFrance
-
Heidelberg UniversityMerck Sharp & Dohme LLCRecruitingChronic Thromboembolic Pulmonary Hypertension | Primary Pulmonary Arterial HypertensionGermany
-
University of South FloridaWithdrawnPulmonary Arterial Hypertension | Familial Primary Pulmonary Hypertension | Idiopathic Pulmonary Arterial Hypertension | Primary Pulmonary HypertensionUnited States
-
BayerCompletedPrimary HypertensionChina
-
University of Kansas Medical CenterRecruitingPulmonary Arterial Hypertension | Pulmonary Hypertension | Chronic Thromboembolic Pulmonary Hypertension | Pulmonary Hypertension Due to Left Heart Disease | Pulmonary Hypertension, Primary, 4 | Pulmonary Hypertension, Primary, 2 | Pulmonary Hypertension, Primary, 3 | Pulmonary Hypertension, Primary and other conditionsUnited States
-
Vanderbilt University Medical CenterJohns Hopkins UniversityCompletedPulmonary Arterial Hypertension | Idiopathic Pulmonary Arterial Hypertension | Associated Pulmonary Arterial Hypertension | Heritable Pulmonary Arterial HypertensionUnited States
-
Papworth Hospital NHS Foundation TrustMerck Sharp & Dohme LLCCompleted
-
University of ZurichCompletedPulmonary Hypertension | Pulmonary Artery Hypertension | Chronic Thromboembolic Pulmonary HypertensionSwitzerland
-
National Taiwan University HospitalUnknownPulmonary HypertensionTaiwan
Clinical Trials on Cardiac Magnetic Resonance - MRI
-
University of FloridaOcala Royal DamesActive, not recruitingBreast CancerUnited States
-
RWTH Aachen UniversityHeidelberg UniversityCompletedAcute Myocardial InfarctionGermany
-
Alejandro Rodriguez Oviedo , MDTerminatedMyocardial Ischemia | Pneumonia, PneumococcalSpain
-
University Medical Center GroningenCompleted
-
Hospices Civils de LyonRecruiting
-
Centre Hospitalier Universitaire, AmiensCompletedHypertrophic Cardiomyopathy | Obstruction | EchocardiographyFrance
-
Cardiovascular Research Institute DublinActive, not recruitingCovid19 | Cardiomyopathies | SARS-CoV InfectionIreland
-
University of Maryland, BaltimoreTerminatedBreast Cancer | Mesothelioma | Thoracic Cancer | Thymic Cancer | Lung Cancer (Non-Small Cell)United States
-
Hari NarayanRecruitingHeart Failure | Cardiotoxicity | Pediatric CancerUnited States
-
Joshua KanterActive, not recruitingAortic Stenosis | Atrial Septal Defect | Aortic Coarctation | Patent Ductus Arteriosus | Cardiomyopathy | Post Heart Transplant Catheter ProcedureUnited States