- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04627987
Mechanisms of Excess Risk in Aortic Stenosis (MASTER)
Mechanisms of Excess Risk in Aortic STEnosis After Aortic Valve Replacement
Aortic stenosis (AS) is caused by narrowing of one of the main heart valves. Replacing the valve is the only treatment to prevent the heart from failing or death. The timing of replacement is currently often too late - half of patients are left with permanent scarring and a quarter die within 3.5 years.
Studies are underway to see if earlier replacement makes a difference. But for those with scarring of the heart, there is currently no tailored treatment. I want to change this by understanding why and how patients with scar are dying and what the investigators can do to prevent this.
In this study, the investigators will use a heart scan (MRI) to detect scarring before valve replacement. After replacement, patients will receive a tiny monitor (paper clip size), which the investigators inject underneath the skin. This monitor continuously checks the heartbeat and can detect increased body fluid due to heart failure. The investigators will monitor patients for an average of 3 years to see if scarring is linked to abnormal heart rhythms and heart failure.
Once the investigators know how and why, the investigators can target patients with available medications and design studies using specialised treatments, eg defibrillator implantation, to protect patients with scar from dying.
Study Overview
Status
Conditions
Detailed Description
Valvular heart disease (VHD) affects around 1.5 million people above the age of 65 across the UK and is set to nearly double by 2050. Aortic Stenosis (AS) is the most common VHD in the UK, affecting 3% of those over 75 with more than 11,000 people requiring aortic valve replacement (AVR) in the UK each year (>100,000 world-wide). Current guidelines recommend AVR to improve survival and symptom status when AS symptoms emerge or there is a reduction in left ventricle (LV) function (1), but years of excessive haemodynamic load result in an "AS cardiomyopathy" with LV hypertrophy, remodelling, diffuse and focal scar. The investigators, and others, have shown that these changes lead to an excess in morbidity and mortality, but the mechanisms of increased risk is unclear.
Patients undergoing aortic valve replacement for severe aortic stenosis have a shorter life expectancy compared with the general population (2). Years of excessive haemodynamic load result in an "AS cardiomyopathy" with LV hypertrophy, remodelling, diffuse and focal scar. The investigators and others have shown that these changes to the heart muscle are associated with poor outcome. But the mechanism of how heart muscle damage leads to excess mortality is poorly understood.
The proposed study will enhance our understanding of the residual risk after AVR and reveal the modes and substrate of mortality. Heart failure and heart rhythm disturbances (arrhythmias) are likely downstream effects of heart muscle damage, but without understanding the mode of death (heart failure, arrhythmia or other), the investigators are unable to target therapeutic strategies to improve outcomes.
Study Type
Enrollment (Anticipated)
Contacts and Locations
Study Contact
- Name: Thomas A Treibel, MBBS PhD
- Phone Number: 020 3416 5000
- Email: thomas.treibel.12@ucl.ac.uk
Study Locations
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London, United Kingdom, EC1A 7BE
- Recruiting
- Barts Heart Centre
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Contact:
- Thomas Treibel, MBBS PhD
- Phone Number: 020 3416 5000
- Email: thomas.treibel.12@ucl.ac.uk
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Principal Investigator:
- Thomas A Treibel, MBBS PhD
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Sampling Method
Study Population
Description
Inclusion Criteria:
- Patients with symptomatic severe aortic stenosis referred for surgical or transcatheter AVR (one out of: effective orifice area [EOA] <1.0 cm2 , indexed EOA of 0.6cm/m2, peak velocity >4.0 m/s or mean gradient >40mmHg).
Exclusion Criteria:
- More than moderate valve disease other than AS
- Diagnosis of dilated or hypertrophic cardiomyopathy, pregnancy/breast feeding
- eGFR <30ml/min, CMR incompatible devices
- Inability to complete the protocol
- Other conditions that would prevent participation in the study.
- Adenosine perfusion will not be performed in patients with AV block, severe asthma/COPD or LVEF<40%.
Study Plan
How is the study designed?
Design Details
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
---|---|
Main study
Patients with severe, symptomatic aortic stenosis will be recruited and followed up with primary outcome of heart failure death and hospitalisation (n=192).
Of these, 170 will have an implantable cardiac monitor placed to detect presence and burden of non-sustained VT.
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Cardiac MRI scan pre- and post- aortic valve replacement to assess degree of left ventricular remodelling, fibrosis and myocardial blood flow.
Blood tests looking evidence of cardiac structural remodelling and function.
Determine post-AVR arrhythmia burden
Validated assessment of functional capacity - distance walked over 6 minute time frame.
Ultrasound assessment of heart structure and function.
Standard of care in valve surgery pathway.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Heart failure death or hospitalisation for heart failure.
Time Frame: 5 years after aortic valve replacement
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5 years after aortic valve replacement
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Burden of non-sustained VT
Time Frame: 2.5 years after aortic valve replacement.
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As assessed on implantable cardiac monitor (approximate battery life 2.5 years)
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2.5 years after aortic valve replacement.
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
All-cause mortality (all-cause and cardiovascular via NHS spine/death registration)
Time Frame: 5 years after aortic valve replacement
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5 years after aortic valve replacement
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change in functional capacity (6-minute walk test)
Time Frame: At 6 weeks and 12 months after aortic valve replacement.
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At 6 weeks and 12 months after aortic valve replacement.
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Heart failure symptoms
Time Frame: At 6 weeks and 12 months post aortic valve surgery
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New York Heart Association (NYHA) functional classification (NYHA 1 least symptomatic, 4 most symptomatic)
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At 6 weeks and 12 months post aortic valve surgery
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Heart failure symptoms
Time Frame: At 6 weeks and 12 months post aortic valve surgery
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World Health Organisation Disability Assessment Schedule 2.0 (Higher score indicates greater disability)
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At 6 weeks and 12 months post aortic valve surgery
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Burden of other serious arrhythmias requiring change in management
Time Frame: 2.5 years after aortic valve replacement
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Participants with complete heart block, Mobitz 2 AV block, new onset atrial fibrillation
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2.5 years after aortic valve replacement
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Collaborators and Investigators
Sponsor
Collaborators
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
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 125312
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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