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Subclinical Myocardial Dysfunction in Children With Wilson's Disease
Assessment of Subtle Myocardial Dysfunction in Children With Wilson's Disease: A Case-Control Study
Wilson's disease (WD) is one of the most common metabolic liver diseases in older children. The most frequent clinical presentation is liver disease. However, Wilson's disease (WD) is a multisystem disorder. It is concluded that four modes of cardiac manifestations in Wilson's disease (WD) include arrhythmias, cardiomyopathy, cardiac death, and autonomic dysfunction. Such possible cardiac involvement should be added to the clinical picture of Wilson's disease (WD) involving the hepatic and central nervous system(CNS).
The data on cardiac manifestations in children is very limited and only few adult studies are available.
In this study, the investigators aim to unveil subclinical cardiac dysfunction in children with Wilson's disease with apparently normal cardiac functions by conventional assessment.
Studie Overzicht
Toestand
Conditie
Gedetailleerde beschrijving
Studietype
Inschrijving (Geschat)
Contacten en locaties
Studie Locaties
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Cairo, Egypte
- Faculty of medicine AinShams U
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Giza, Egypte
- National Hepatology and Tropical Research Institute (NHTMRI)
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Deelname Criteria
Geschiktheidscriteria
Leeftijden die in aanmerking komen voor studie
- Kind
- Volwassen
Accepteert gezonde vrijwilligers
Bemonsteringsmethode
Studie Bevolking
They will be divided in to 2 groups: - Group 1: Patients confirmed Wilson's disease. - Group 2: Controls.
- Patients group: Patient diagnosed as WD patients, following up in Pediatric Hepatology Clinic in NHTMRI.
According to Criteria of diagnosis based on Leipzig scoring system (11,12): Typical clinical symptoms and signs, as: Kayser-Fleischer rings, neurological symptoms, serum ceruloplasmin, Coombs-negative hemolytic anemia. Other tests: Liver biopsy, 24hr urinary Cu, gene analysis.
Beschrijving
Inclusion Criteria
- Confirmed diagnosis of Wilson's disease based on Leipzig scoring criteria (including clinical signs, Kayser-Fleischer rings, low ceruloplasmin, or genetic analysis).
- Age between 4 years and 18 years.
- Written informed consent obtained from parents or legal guardians.
Exclusion Criteria
- Children with clinical evidence of overt heart failure or known congenital heart disease.
- Children suffering from fulminant hepatitis.
- Known co-existing primary liver diseases other than Wilson's disease.
- Presence of syndromic disorders or major congenital anomalies.
Studie plan
Hoe is de studie opgezet?
Ontwerpdetails
Cohorten en interventies
Groep / Cohort |
Interventie / Behandeling |
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Group 1 (Cases)
Children aged 4-18 years with confirmed Wilson's disease recruited from the Pediatric Hepatology Clinic at the National Hepatology and Tropical Medicine Research Institute (NHTMRI).
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a safe, painless test that uses sound waves to create moving pictures of your heart's structure and pumping function.
Andere namen:
a quick, painless test that records the electrical signals in the heart.
Andere namen:
a protein made by our heart, examined by peripheral blood sample.
Andere namen:
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Group 2 (Controls)
Age- and sex-matched control children without chronic liver or cardiac illness recruited from the outpatient clinic.
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a safe, painless test that uses sound waves to create moving pictures of your heart's structure and pumping function.
Andere namen:
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Wat meet het onderzoek?
Primaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
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Left Ventricular Peak Longitudinal Strain (LV-PLS)
Tijdsspanne: Baseline (Day 1 , at single cross-sectional evaluation).
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Left Ventricular Peak Longitudinal Strain (LV-PLS) assessed by Speckle Tracking Echocardiography (STE) to evaluate subclinical LV systolic dysfunction.
Expressed as a negative percentage (%), where a less negative percentage indicates impaired function.
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Baseline (Day 1 , at single cross-sectional evaluation).
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Secundaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
|---|---|---|
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Serum Pro-Brain Natriuretic Peptide (Pro-BNP) Level
Tijdsspanne: Baseline (Day 1 , at single cross-sectional evaluation).
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Quantitative measurement of serum Pro-BNP assessed via ELISA (pg/mL) as a circulating biomarker of cardiac wall stress.
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Baseline (Day 1 , at single cross-sectional evaluation).
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Tissue Doppler LV Filling Pressure (E/e' Ratio)
Tijdsspanne: Baseline (Day 1 , at single cross-sectional evaluation).
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Ratio of early mitral inflow velocity (E) measured by conventional Doppler to early diastolic mitral annular velocity (e') measured by tissue Doppler imaging to evaluate LV diastolic function.
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Baseline (Day 1 , at single cross-sectional evaluation).
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Serum Ceruloplasmin Level Correlation
Tijdsspanne: Baseline (Day 1,at time of cardiac evaluation or within 6 months preceding cardiac evaluation).
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Serum ceruloplasmin levels (mg/dL) measured within 6 months of cardiac evaluation to correlate hepatic copper transport marker levels with cardiac function parameters.
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Baseline (Day 1,at time of cardiac evaluation or within 6 months preceding cardiac evaluation).
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Frequency of Electrocardiographic (ECG) Abnormalities
Tijdsspanne: Baseline (Day 1 , at single cross-sectional evaluation).
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Presence or absence of cardiac electrical abnormalities, including conduction delays, ST-T wave changes, and arrhythmias recorded on standard 12-lead ECG.
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Baseline (Day 1 , at single cross-sectional evaluation).
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Medewerkers en onderzoekers
Sponsor
Onderzoekers
- Hoofdonderzoeker: Hebatullah I Fawzy, Msc Student, Faculty of medicine AinShams U,National Hepatology and Tropical Research Institute (NHTMRI)
- Studie stoel: Eman M ElSayed (Assistant Professor of Pediatrics), AssProfessor, Faculty of medicine AinShams U
- Studie directeur: Mona AH Khafagy (Lecturer of Pediatrics), Lecturer, Faculty of medicine AinShams U
- Studie directeur: Sara M Osman (Teaching Fellow of Pediatrics), PedFellow, National Hepatology and Tropical Research Institute (NHTMRI)
Publicaties en nuttige links
Algemene publicaties
- Wiernicka A, Dadalski M, Janczyk W, Kaminska D, Naorniakowska M, Husing-Kabar A, Schmidt H, Socha P. Early Onset of Wilson Disease: Diagnostic Challenges. J Pediatr Gastroenterol Nutr. 2017 Nov;65(5):555-560. doi: 10.1097/MPG.0000000000001700.
- European Association for the Study of the Liver. EASL-ERN Clinical Practice Guidelines on Wilson's disease. J Hepatol. 2025 Feb 22:S0168-8278(24)02706-5. doi: 10.1016/j.jhep.2024.11.007. Online ahead of print.
- European Association for Study of Liver. EASL Clinical Practice Guidelines: Wilson's disease. J Hepatol. 2012 Mar;56(3):671-85. doi: 10.1016/j.jhep.2011.11.007.
- https://ebm.one/en/chapter-table/scoring-system-developed-8th-international-meeting-wilson-disease-leipzig-2001
- https://doi.org/10.4236/wjcd.2019.93018
- Romuk E, Jachec W, Zbrojkiewicz E, Mroczek A, Niedziela J, Gasior M, Rozentryt P, Wojciechowska C. Ceruloplasmin, NT-proBNP, and Clinical Data as Risk Factors of Death or Heart Transplantation in a 1-Year Follow-Up of Heart Failure Patients. J Clin Med. 2020 Jan 3;9(1):137. doi: 10.3390/jcm9010137.
- Salatzki J, Mohr I, Heins J, Cerci MH, Ochs A, Paul O, Riffel J, Andre F, Hirschberg K, Muller-Hennessen M, Giannitsis E, Friedrich MG, Merle U, Weiss KH, Katus HA, Ochs M. The impact of Wilson disease on myocardial tissue and function: a cardiovascular magnetic resonance study. J Cardiovasc Magn Reson. 2021 Jun 24;23(1):84. doi: 10.1186/s12968-021-00760-1.
- Chevalier K, Benyounes N, Obadia MA, Van Der Vynckt C, Morvan E, Tibi T, Poujois A. Cardiac involvement in Wilson disease: Review of the literature and description of three cases of sudden death. J Inherit Metab Dis. 2021 Sep;44(5):1099-1112. doi: 10.1002/jimd.12418. Epub 2021 Aug 2.
- Quick S, Reuner U, Weidauer M, Hempel C, Heidrich FM, Mues C, Sveric KM, Ibrahim K, Reichmann H, Linke A, Speiser U. Cardiac and autonomic function in patients with Wilson's disease. Orphanet J Rare Dis. 2019 Jan 28;14(1):22. doi: 10.1186/s13023-019-1007-7.
- https://doi.org/10.21608/cupsj.2021.71046.1018
- Sanchez-Monteagudo A, Ripolles E, Berenguer M, Espinos C. Wilson's Disease: Facing the Challenge of Diagnosing a Rare Disease. Biomedicines. 2021 Aug 28;9(9):1100. doi: 10.3390/biomedicines9091100.
- Ovchinnikova EV, Garbuz MM, Ovchinnikova AA, Kumeiko VV. Epidemiology of Wilson's Disease and Pathogenic Variants of the ATP7B Gene Leading to Diversified Protein Disfunctions. Int J Mol Sci. 2024 Feb 18;25(4):2402. doi: 10.3390/ijms25042402.
- https://doi.org/10.1038/s41598-024-59377-w
- Dang J, Chevalier K, Letavernier E, Tissandier C, Mouawad S, Debray D, Obadia M, Poujois A. Kidney involvement in Wilson's disease: a review of the literature. Clin Kidney J. 2024 Mar 9;17(4):sfae058. doi: 10.1093/ckj/sfae058. eCollection 2024 Apr.
Studie record data
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Studie start (Werkelijk)
Primaire voltooiing (Geschat)
Studie voltooiing (Geschat)
Studieregistratiedata
Eerst ingediend
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Meer informatie
Termen gerelateerd aan deze studie
Trefwoorden
Aanvullende relevante MeSH-voorwaarden
- Hersenziekten
- Ziekten van het centrale zenuwstelsel
- Ziekten van het zenuwstelsel
- Hart-en vaatziekten
- Hartziekten
- Metabolisme, aangeboren fouten
- Genetische ziekten, aangeboren
- Metabole ziekten
- Ziekten van het spijsverteringsstelsel
- Neurodegeneratieve ziekten
- Lever Ziekten
- Bewegingsstoornissen
- Heredodegeneratieve aandoeningen, zenuwstelsel
- Ventriculaire disfunctie
- Basale ganglia-ziekten
- Hersenziekten, metabolisch, aangeboren
- Hersenziekten, Metabool
- Metaalmetabolisme, aangeboren fouten
- Aangeboren, erfelijke en neonatale ziekten en afwijkingen
- Voedings- en stofwisselingsziekten
- Ventriculaire disfunctie, links
- Hepatolenticulaire degeneratie
- Diagnostische technieken en procedures
- Diagnose
- Diagnostische beeldvorming
- Diagnostische technieken, cardiovasculair
- Hartfunctietests
- Elektrodiagnose
- Cardiale beeldvormingstechnieken
- Ultrasonografie
- Elektrocardiografie
- Echocardiografie
Andere studie-ID-nummers
- Wilson's disease and Heart
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