Brief Title
A Comparison of Advanced Imaging Techniques in Aortic Stenosis
Official Title
A Comparative Study of Advanced Imaging Techniques in Predicting the Clinical Outcome in Aortic Stenosis
Brief Summary
In patients with aortic stenosis the valve through which blood is pumped out of the main heart chamber is narrowed. This results in heart muscle working harder to open the valve so blood can circulate around the body. The muscle adapts to the increased pressure load to maintain efficiency. This can cause long-term muscle damage. To predict when this deterioration will require a valve replacement is difficult and untimely operation exposes patients to unnecessary risk. We aim to compare all validated techniques looking at different aspects of heart muscle strain in these patients. These will be a blood sample measuring a specific hormone (BNP) and enzyme (Troponin), a nuclear scan to assess nerve activation, an MRI identifying scarring and an exercise echocardiogram that measures heart muscle response and pressure changes across the valve. Tests will be performed at recruitment and either after one year or after valve replacement, which ever comes first. In comparing these different imaging techniques we aim to identify patients who will benefit from an early operation, those whose muscle is likely to recover back to normal and which patients it is safe to wait longer for the surgery, avoiding unnecessary risk. The results of the study will benefit patients as it will help doctors more accurately assess the timing of valve surgery and improve their prediction of long term heart muscle recovery. It may also increase convenience in clinical management by reducing unnecessary tests and hospital trips. This would translate into cost savings for the NHS.
Study Type
Observational
Primary Outcome
Need for aortic valve replacement
Secondary Outcome
Improvement in measured indices post aortic valve replacement
Condition
Aortic Stenosis
Intervention
Cardiac I123-MIBG Scintigraphy
Study Arms / Comparison Groups
A - Symptomatic severe AS
Description: Patients with symptomatic severe aortic stenosis (AS) as per ESC guidelines, requiring aortic valve replacement.
Publications
* Includes publications given by the data provider as well as publications identified by National Clinical Trials Identifier (NCT ID) in Medline.
Recruitment Information
Recruitment Status
Radiation
Estimated Enrollment
0
Start Date
January 2013
Completion Date
January 2016
Primary Completion Date
January 2015
Eligibility Criteria
Inclusion Criteria: (Group A) - Asymptomatic patients with moderate to severe Aortic Stenosis - Ejection fraction greater than 50% - Not yet being considered for valve surgery (Group B) - Severe Aortic Stenosis (as per ESC guidelines) - Listed for immediate aortic valve replacement Exclusion Criteria: (Group A and B) - Inability to provide informed consent - Concurrent primary valve lesions greater than mild (as defined by ESC criteria) - Previous myocardial infarction (regional wall motion abnormality on resting echo) - Cardiomyopathy - Congenital heart disease - Previous cardiac surgery - Renal failure (CKD stage 3, eGFR >30ml/min/1.73m2) - Pregnancy, risk of pregnancy, breast feeding
Gender
All
Ages
18 Years - N/A
Accepts Healthy Volunteers
No
Contacts
Andrew Kelion, MRCP DM, ,
Location Countries
United Kingdom
Location Countries
United Kingdom
Administrative Informations
NCT ID
NCT01775215
Organization ID
12/LO/1846
Responsible Party
Sponsor
Study Sponsor
Royal Brompton & Harefield NHS Foundation Trust
Study Sponsor
Andrew Kelion, MRCP DM, Principal Investigator, Royal Brompton and Harefield NHS Foundation Trust
Verification Date
November 2014