- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05965258
Phenotypic Classification of FMR With CMR
Improving Phenotypic Classification and Prediction of Treatment Outcomes in Patients With Non-ischemic Cardiomyopathy and Functional Mitral Regurgitation
The goal of the current research is to develop personalized risk prediction for functional mitral regurgitation (FMR) patients through explainable unsupervised phenomapping enriched with advanced cardiac magnetic resonance (CMR) imaging biomarkers, and to determine the CMR predictors of reverse remodeling following modern therapies for FMR.
The prospective study entails aiming to recruit 360 adult patients (ages >18 years) with EF 10-50% and FMR RF> 20%, who are clinically referred for CMR evaluation. Patients who enroll in our study will be referred for optimization of mGDMT and will undergo follow-up CMR studies at 6months. NICM patients who are fully medically optimized with significant FMR at the time of the baseline CMR and are referred for Mitraclip treatment will undergo follow-up CMR 6 months from Mitraclip intervention. NICM patients referred for mGDMT optimization, but have persistent or progressive FMR at the time of 6 month follow-up CMR and referred for Mitraclip therapy, will undergo a 2nd follow-up CMR 6 months from Mitraclip therapy.
Study Overview
Status
Intervention / Treatment
Detailed Description
Functional mitral regurgitation (FMR) portends a bleak prognosis and is a common consequence of ischemic and non-ischemic cardiomyopathy (ICM, NICM), where adverse annular and left ventricular (LV) remodeling and/or infarction alters mitral valve (MV) function.
Prior studies demonstrate significant increases in mortality risk as severity of FMR increases; mortality rates range from 15-40% at 1 year. Furthermore, as the prevalence of heart failure (HF) is rising, FMR is projected to double from over 2 million patients in 2000 to over 4 million patients in the United States by 2030. Defining FMR severity, optimal timing of intervention, and most appropriate method for intervention remain controversial. Recently, MITRA-FR and COAPT trials demonstrated contrasting survival benefit with percutaneous MV repair, demonstrating the importance and need for more optimal selection criteria. Currently, the patient selection criteria for Mitraclip therapy are solely based on MV anatomy and controversial echocardiographic criteria for FMR severity. Cardiac magnetic resonance (CMR) provides an exciting opportunity to address numerous unmet needs regarding characterizing FMR and the need for more optimal selection criteria for improving outcomes. Superior accuracy and reproducibility for quantification of LV size and function, and gold standard tissue characterization, positions CMR as the ideal imaging modality for comprehensively characterizing FMR and the underlying myopathic processes that significantly impact response to FMR therapies. The goal of the current research is to develop personalized risk prediction for FMR patients through explainable unsupervised phenomapping enriched with advanced CMR imaging biomarkers, and to determine the CMR predictors of reverse remodeling following modern therapies for FMR.
The proposed research will leverage a large retrospective single center NICM CMR database. Our CMR NICM database currently features 458 NICM patients, who underwent CMR on a single CMR vendor platform from 2008-2017, who have been extensively curated with contoured data for standard CMR measures. An additional 802 NICM patients have been identified from our 2018-2021 CMR database with EF<50% with the same inclusion/exclusion criteria, which will be extensively curated to enable phenomapping discovery. An external 400 NICM patient cohort will be used as an external validation cohort.
The prospective study entails aiming to recruit 360 adult patients (ages >18 years) with EF 10-50% and FMR RF> 20%, who are clinically referred for CMR evaluation. Patients who enroll in our study will be referred for optimization of mGDMT with Heart Failure Pharmacist Clinic and followed every 2 weeks until optimized. All will return and undergo follow-up CMR studies at 6months. NICM patients who are fully medically optimized with significant FMR at the time of the baseline CMR and are referred for Mitraclip treatment will undergo follow-up CMR 6 months from Mitraclip intervention. NICM patients referred for mGDMT optimization, but have persistent or progressive FMR at the time of 6 month follow-up CMR and referred for Mitraclip therapy, will undergo a 2nd follow-up CMR 6 months from Mitraclip therapy. CMR will be done on dedicated cardiac research MRI scanner.
Study Type
Enrollment (Estimated)
Contacts and Locations
Study Contact
- Name: Deborah Kwon, MD
- Phone Number: 216-444-8526
- Email: kwond@ccf.org
Study Locations
-
-
Ohio
-
Cleveland, Ohio, United States, 44195
- Recruiting
- Cleveland Clinic
-
Sub-Investigator:
- Wilson Tang, MD
-
Contact:
- Deborah Kwon, MD
- Phone Number: 216-444-8526
- Email: kwond@ccf.org
-
Sub-Investigator:
- Samir Kapadia, MD
-
Sub-Investigator:
- David Chen, PhD
-
Sub-Investigator:
- Xiaofeng Wang, PhD
-
Sub-Investigator:
- Marc Gillinov, MD
-
Sub-Investigator:
- Christopher Nguyen, PhD
-
Sub-Investigator:
- Nancy Obuchowski, PhD
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Sampling Method
Study Population
Description
Inclusion Criteria:
1 CMR LVEF <50% 2.FMR Fraction>20%, with adequate image quality and no evidence of severe obstructive CAD
Exclusion Criteria:
- >moderate aortic regurgitation/stenosis,
- <18 years of age,
- acute myocarditis,
- eGFR<15
- HCM
- cardiac amyloidosis/sarcoidosis
- prior mitral valve intervention
- myocardial infarction within 8 weeks of CMR
- ischemic infarct pattern on CMR
Study Plan
How is the study designed?
Design Details
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
---|---|
Optimize mGDMT
NICM patients referred for mGDMT optimization
|
Cardiac magnetic resonance (CMR) at 6 months.
If referred to MitraClip, CMR will be performed at 6 months from the procedure.
|
MitraClip and mGDMT
NICM patients who are fully medically optimized with significant FMR at the time of the baseline CMR and are referred for Mitraclip treatment
|
Cardiac magnetic resonance (CMR) at 6 months.
If referred to MitraClip, CMR will be performed at 6 months from the procedure.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Composite of cardiac mortality, heart transplant, or LVAD implantation.
Time Frame: Up to 36 months
|
Occurrence of cardiac mortality and/or heart transplant and/or LVAD implantation
|
Up to 36 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in FMR
Time Frame: 6 months
|
a change of >5 units/percentage points compared to baseline
|
6 months
|
Change in NT-proBNP
Time Frame: 6 months
|
30% change in NT-proBNP or decrease to level < 1000 compared to baseline
|
6 months
|
Change in KCQL score
Time Frame: 6 months
|
5 point change in KCQL score compared to baseline
|
6 months
|
Change in 6-minute walk test
Time Frame: 6 months
|
25 meter change in 6-minute walk test compared to baseline
|
6 months
|
Recurrent heart failure hospitalization
Time Frame: up to 1 year
|
Occurrence of heart failure related hospitalization
|
up to 1 year
|
Arrhythmias
Time Frame: up to 1 year
|
Occurrence of arrhythmia
|
up to 1 year
|
MI
Time Frame: up to 1 year
|
Occurrence of myocardial infarction
|
up to 1 year
|
Stroke
Time Frame: up to 1 year
|
Occurrence of stroke
|
up to 1 year
|
Heart transplant
Time Frame: up to 1 year
|
Occurrence of heart transplant
|
up to 1 year
|
LVAD implantation
Time Frame: up to 1 year
|
Occurrence of implant of left ventricular assisted device (LVAD)
|
up to 1 year
|
Mortality
Time Frame: up to 1 year
|
Occurrence of mortality
|
up to 1 year
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Deborah Kwon, MD, The Cleveland Clinic
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
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
- 23-702
- 1R01HL170090-01 (U.S. NIH Grant/Contract)
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 Functional 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
-
Cardiac Dimensions Pty LtdTerminatedAtrial Fibrillation | Functional Mitral Regurgitation | Atrial Functional Mitral RegurgitationAustralia, Greece
-
Mitre Medical Corp.BSWRI Cardiac Imaging Core Lab (CICL)Not yet recruitingIschemic Mitral Regurgitation | Functional Mitral RegurgitationUnited States
-
Mardil MedicalRecruitingFunctional Mitral RegurgitationCanada, Hungary, France, Germany, Netherlands, Panama, Poland
-
Shanghai Shenqi Medical Technology Co., LtdActive, not recruitingFunctional Mitral RegurgitationChina
-
Jenscare ScientificEnrolling by invitationFunctional Mitral RegurgitationChina
-
Asklepios proresearchAbbottWithdrawn
-
Barts & The London NHS TrustRecruitingAtrial Fibrillation | Functional Mitral Regurgitation | Functional Tricuspid RegurgitationUnited Kingdom
Clinical Trials on Cardiac magnetic resonance (CMR)
-
RenJi HospitalNingbo Hangzhou Bay Hospital; Shanghai Jiading Central HospitalCompleted
-
Ottawa Hospital Research InstituteOttawa Heart Institute Research CorporationCompleted
-
German Heart InstituteCompletedHeart Failure, DiastolicGermany
-
University of FloridaOcala Royal DamesActive, not recruitingBreast CancerUnited States
-
Johann Wolfgang Goethe University HospitalKerckhoff KlinikCompletedHeart Failure | Chronic Kidney Diseases | Cardiomyopathies | Hypertrophy, Left VentricularGermany
-
Medical University of South CarolinaRecruitingCardiomyopathy, Myocarditis, Ischemic Heart DiseaseUnited States
-
Society for Cardiovascular Magnetic ResonanceBayer; Siemens HealthcareUnknownMyocardial IschemiaUnited States
-
Beth Israel Deaconess Medical CenterDana-Farber Cancer Institute; American Heart AssociationRecruiting
-
The University of Hong KongNot yet recruiting
-
Universitätsmedizin MannheimCompletedCardiac DiseasesGermany