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Identification of Parameters in rapId-proGression Subgroup Patients With Moderate Aortic Stenosis (ENIGMAS)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01575249
Recruitment Status : Unknown
Verified April 2012 by MISCHIE Nicolae Alexandru, Carol Davila University of Medicine and Pharmacy.
Recruitment status was:  Not yet recruiting
First Posted : April 11, 2012
Last Update Posted : April 11, 2012
Information provided by (Responsible Party):
MISCHIE Nicolae Alexandru, Carol Davila University of Medicine and Pharmacy

Brief Summary:
The investigators aim to identify all clinical, biological, echo and imagistic parameters that predispose to increased progression rates in a prospective observational trial which will include ONLY patients with moderate AS, with the complete cardiological investigational tools provided in 2012. Once those parameters are found, medical and interventional treatment could be implemented to decrease the mortality rates.

Condition or disease
Aortic Stenosis

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Study Type : Observational
Estimated Enrollment : 200 participants
Observational Model: Case-Control
Time Perspective: Prospective
Official Title: Prospective Study Focused on idEntification of cliNical, Biological and Imagistic Parameters in rapId-proGression Subgroup Patients With Moderate Aortic Stenosis
Study Start Date : July 2012
Estimated Primary Completion Date : January 2016
Estimated Study Completion Date : June 2016

Resource links provided by the National Library of Medicine

Asymptomatic group
one hundred patients with a negative exercise stress echo for symptoms/ECG/wall motion abnormalities (WMA), negative spirometry test for pulmonary disease, without known CAD or other valvular diseases, in sinus rhythm and with a LVEF>55%
Symptomatic group
one hundred patients with symptomatic AS (negative pulmonary tests but positive stress echo or prior CAD or other valvular diseases and a LVEF>55%

Primary Outcome Measures :
  1. occurrence of major adverse cardiac events (MACE) defined by the followings: death, aortic valve replacement (AVR) and myocardial infarction (MI). [ Time Frame: 3 years ]

Secondary Outcome Measures :
  1. TIME TO SYMPTOMS (angina, dyspnea, syncope) at stress echocardiography [ Time Frame: 3 years ]
  2. TIME TO ALTERED HEMODYNAMIC PARAMETERS at stress (strain decrease, EF decrease, ventricular arrhythmia, decrease in SBP, stress gradients suggestive of severe AS) [ Time Frame: 3 years ]
  3. differentiate outcomes of patients with mean gradients between 40 and 50 mmHg (grey zone of AS) [ Time Frame: 6 years ]

Biospecimen Retention:   Samples Without DNA
standard blood count, c-reactive protein, urea, creatinin, hepatic standard biology, serum calcium, cholesterol and tryglicerides.

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Ages Eligible for Study:   50 Years to 90 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Probability Sample
Study Population
The enrollment will be done by echo screening of the population (of the 3rd Arrondissement in Bucharest, Romania) with age >50 years until target patients reached and also by screening out-patients arriving at "Bagdasar-Arseni" Emergency Hospital (Bucharest) with other cardiovascular diseases other than specified in the exclusion criteria.

Inclusion Criteria:

  • age 21 years;
  • native aortic valve leaflet thickening with reduced systolic opening on two-dimensional echocardiography and an aortic jet velocity at rest between 2.8 and 3.1 m/s or a valve area calculated by the continuity equation of 1.7 to 1.5 cm2, evaluated at a heart rate between 60 and 90/ minute and at a systolic arterial pressure of 120-140mmHg at baseline;
  • LVEF > 55% (calculated by modified Simpson formula).

Exclusion Criteria:

  • positive stress test (symptoms including dyspnoea, angina, syncope, ECG pathological changes, WMA);
  • positive pulmonary disease (spirometry);
  • heart failure;
  • LVEF < 55%;
  • moderate/severe aortic or mitral regurgitation or mitral stenosis, subvalvular or supravalvular AS, dynamic subaortic obstruction;
  • CAD (history of MI or coronary artery stenosis on coronary angiography);
  • active endocarditis;
  • rhythm other than sinus rhythm;
  • severe uncontrolled risk factors for CAD:

    • uncontrolled DM,
    • uncontrolled hypertension (SBP > 180mmHg),
    • refuse to discontinue smoking,
    • persistent hypercholesterolemia under treatment (total cholesterol > 240mg/dl);
  • glomerular filtration rate < 30% or patient requiring dialysis;
  • patient refusal; survival expectancy < 2 years;
  • inability to perform physical exercise;
  • suboptimal echo window;
  • different types of echo machines.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01575249

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"Bagdasar-Arseni" Emergency Hospital
Bucharest, Romania, 041915
Contact: ALEXANDRU N MISCHIE, MD    0040723708050   
Principal Investigator: ALEXANDRU N MISCHIE, MD         
Principal Investigator: CRINA SINESCU, MD FESC FACC         
Sponsors and Collaborators
Carol Davila University of Medicine and Pharmacy
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Additional Information:
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Responsible Party: MISCHIE Nicolae Alexandru, CARDIOLOGIST, ASSISTANT PROFESSOR, Carol Davila University of Medicine and Pharmacy Identifier: NCT01575249    
Other Study ID Numbers: The ENIGMAS trial
First Posted: April 11, 2012    Key Record Dates
Last Update Posted: April 11, 2012
Last Verified: April 2012
Keywords provided by MISCHIE Nicolae Alexandru, Carol Davila University of Medicine and Pharmacy:
moderate aortic stenosis
Additional relevant MeSH terms:
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Aortic Valve Stenosis
Constriction, Pathologic
Disease Progression
Pathological Conditions, Anatomical
Disease Attributes
Pathologic Processes
Heart Valve Diseases
Heart Diseases
Cardiovascular Diseases
Ventricular Outflow Obstruction