Left Ventricular Structural Predictors of Sudden Cardiac Death
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Purpose
Sudden cardiac death (SCD) poses a significant health care challenge with high annual incidence and low survival rates. Implantable cardioverter defibrillators (ICDs) prevent SCD in patients with poor heart function. However, the critical survival benefit afforded by the devices is accompanied by short and long-term complications and a high economic burden. Moreover, in using current practice guidelines of reduced heart function, specifically left ventricular ejection fraction (LVEF)≤35%, as the main determining factor for patient selection, only a minority of patients actually benefit from ICD therapy (<25% in 5 years). There is an essential need for more robust diagnostic approaches to SCD risk stratification.
This project examines the hypothesis that structural abnormalities of the heart itself, above and beyond global LV dysfunction, are important predictors of SCD risk since they indicate the presence of the abnormal tissue substrate required for the abnormal electrical circuits and heart rhythms that actually lead to SCD. Information about the heart's structure will be obtained from cardiac magnetic resonance imaging and used in combination with a number of other clinical risk factors to see if certain characteristics can better predict patients at risk for SCD.
| Condition |
|---|
|
Ischemic Cardiomyopathy Nonischemic Cardiomyopathy |
| Study Type: | Observational |
| Study Design: | Observational Model: Cohort Time Perspective: Prospective |
| Official Title: | Left Ventricular Structural Predictors of Sudden Cardiac Death [Substudy of: Functional Energetics and Imaging for Phenotypic Characterization of Patients at Risk for Sudden Cardiac Death, See Also NCT000181233] |
- Composite SCD outcomes [ Time Frame: Every 6 months for 5 years ] [ Designated as safety issue: No ]The first occurrence of an adjudicated appropriate ICD firing for ventricular tachycardia/ventricular fibrillation or cardiac death not treated by the ICD.
- Composite cardiac outcomes [ Time Frame: Every 6 months for 5 years ] [ Designated as safety issue: No ]The first occurrence of an adjudicated appropriate ICD firing for ventricular tachycardia/ventricular fibrillation, hospitalization for heart failure or cardiac death.
| Estimated Enrollment: | 400 |
| Study Start Date: | October 2003 |
| Estimated Study Completion Date: | June 2015 |
| Estimated Primary Completion Date: | June 2014 (Final data collection date for primary outcome measure) |
Sudden cardiac death (SCD) poses a significant health care challenge with high annual incidence and low survival rates. Implantable cardioverter defibrillators (ICDs) prevent SCD in patients with left ventricular (LV) systolic dysfunction. However, the critical survival benefit afforded by the devices is accompanied by short and long-term complications and a high economic burden. Moreover, in using current practice guidelines of LV ejection fraction (LVEF)≤35% as the main determining factor for patient selection, only a minority of patients actually benefit from ICD therapy (<25% in 5 years). There is an essential need for more robust diagnostic approaches to SCD risk stratification.
This project examines the hypothesis that LV structural abnormalities above and beyond global LV dysfunction are important predictors of SCD risk since they indicate the presence of abnormal pathophysiologic substrate required for the ventricular arrhythmogenicity leading to SCD. This premise is supported by pre-clinical models and limited patient cohort studies examining the contribution of individual LV structural indices. However, there has been no prospective study of primary prevention ICD candidates in sufficiently large numbers to investigate the incremental value of a comprehensive assessment of LV structure on SCD risk over and above that of LVEF and readily available demographic and clinical variables.
LV structure can be quantified in detail using cardiac magnetic resonance imaging with late gadolinium enhancement (CMR-LGE). Specifically, accurate assessment of global LV function, volumes, mass, geometry, and infarct/scar characteristics are feasible and obtainable clinically in a single examination. We aim to examine whether or not any of these CMR indices or combination of indices are better able to discriminate between patients with high versus low susceptibility to SCD within the broader population of reduced LVEF patients. If the results of these studies demonstrate that LV structure is an important prognostic risk factor, it may be then be possible to more specifically focus ICD therapy to those who are most likely to benefit and avoid unnecessary device implantations.
Eligibility| Ages Eligible for Study: | 21 Years to 80 Years |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
| Sampling Method: | Non-Probability Sample |
Patients with LV ejection fraction (LVEF) ≤35% of ischemic or nonischemic etiology (as measured by a clinical echocardiogram, ventriculogram, or radionuclide study) referred clinically for ICD insertion for primary prevention purposes (i.e. no prior history of sustained ventricular arrhythmias)
Inclusion Criteria:
- LVEF≤35%, referred clinically for ICD insertion for primary prevention purposes (i.e. no prior history of sustained ventricular arrhythmias)
- Between the ages of 21 and 80 years old
- Permission of the patient's clinical attending physician
Exclusion Criteria:
- Patients who refuse or are unable to give consent.
- Individuals with contraindications to MRI (i.e. implanted metallic objects such as pre-existing cardiac pacemakers, cerebral clips or indwelling metallic projectiles)
- Minors.
- Pregnant women.
- NYHA Class IV heart failure.
- Chronic renal insufficiency with creatinine clearance<60 ml/min; acute renal insufficiency of any severity
- Claustrophobia
- Prior adverse reaction to gadolinium-based contrast
Contacts and Locations| Contact: Jeannette Walker, RN | 410-502-7310 | jhoefli1@jhmi.edu |
| United States, Delaware | |
| Christiana Care Health Services | Not yet recruiting |
| Newark, Delaware, United States, 19718 | |
| United States, Maryland | |
| Johns Hopkins Medical Institutions | Recruiting |
| Baltimore, Maryland, United States, 21287 | |
| Principal Investigator: Katherine Wu, MD | |
| Principal Investigator: | Katherine Wu, MD | Johns Hopkins Medical Institutions |
| Study Director: | Robert G Weiss, MD | Johns Hopkins Medical Institutions |
More Information
Publications:
| Responsible Party: | Katherine C. Wu, Associate Professor of Medicine, Johns Hopkins University |
| ClinicalTrials.gov Identifier: | NCT01076660 History of Changes |
| Other Study ID Numbers: | Reynolds03073103 |
| Study First Received: | February 25, 2010 |
| Last Updated: | February 19, 2013 |
| Health Authority: | United States: Institutional Review Board |
Keywords provided by Johns Hopkins University:
|
Ischemic cardiomyopathy Nonischemic cardiomyopathy Implantable cardioverter defibrillator |
Sudden Cardiac Death Ventricular tachycardia Ventricular fibrillation |
Additional relevant MeSH terms:
|
Death Ischemia Death, Sudden, Cardiac Cardiomyopathies Pathologic Processes |
Heart Arrest Heart Diseases Cardiovascular Diseases Death, Sudden |
ClinicalTrials.gov processed this record on May 23, 2013