Correlation Study of Imaging Data Acquired During CABG With Data Acquired in the Cath Lab (PERSEUS)
|ClinicalTrials.gov Identifier: NCT02138305|
Recruitment Status : Completed
First Posted : May 14, 2014
Last Update Posted : August 28, 2019
Visual assessment of a coronary artery narrowing (called stenosis) seen on angiography is conventionally used to infer how likely the stenosis will limit blood flow (called ischemia) under conditions of increased demand (e.g exercise). This is based on animal work and data from humans with simple single vessel disease with no co-existing conditions. These data have been extrapolated to more complex patients/ complex disease but clearly over-simplifies the situation in the majority of patients cardiologists treat.
Pivotal work by DeBruyne, Pils and colleagues in the 90's convincingly showed that pressure derived measurements, called FFR, from the coronary artery during a cardiac catheterization, more accurately identify stenoses that would cause ischemia compared to visual assessment alone. A strategy of FFR guided coronary stenting with drug eluting stents significantly improved outcomes and reduced costs compared to visual assessment alone (FAME trial). Deferring treatment based on FFR has been shown to be safe (DEFER Trial). FFR has excellent sensitivity and specificity. A FFR of <=0.80 was used as this identified ischemia causing lesions 90% of the time. Therefore, the concept of FFR guided percutaneous revascularisation and treatment deferral has a robust evidence base to support it.
Coronary bypass grafting (CABG) is traditionally based solely on a visual assessment of angiography images. SPY® Infrared Fluorescence Angiography (NIRF, FDA approved 2005) is used by some cardiac surgeons to assess the patency of bypass grafts in real-time in the operating room, as a surrogate for immediate traditional coronary angiography. Dr. Ferguson observed that regional myocardial perfusion (RMP) image data was also captured in these video sequences.
- In patients who are likely CABG candidates, target vessel epicardial coronary arteries (TVECAs) with FFR > 0.80 will not demonstrate an increase in RMP despite an anatomically patent bypass conduit during SPY® imaging.
- In TVECAs with an increase in RMP during SPY® imaging, cardiac catheter laboratory measures of coronary physiology from that TVECA, namely one or a combination of FFR, CFR, HSR and HMR, will correlate with the SPY® data on myocardial perfusion, and suggest a potential mechanism for this physiologic response to TVECA grafting.
|Condition or disease||Intervention/treatment||Phase|
|Coronary Artery Disease||Device: ComboMap XT Guidewire Procedure: 'SPY' NIRF During CABG||Not Applicable|
|Study Type :||Interventional (Clinical Trial)|
|Actual Enrollment :||1 participants|
|Intervention Model:||Single Group Assignment|
|Intervention Model Description:||Controlled prospective observational study|
|Masking:||None (Open Label)|
|Official Title:||Collaborative Pilot Study to Determine the Correlation Between Intra-Operative Observations Using SPY® Near Infra-Red Imaging and Cardiac Catheterization Laboratory Physiological Assessment of Lesion Severity (PERSEUS Pilot Study)|
|Study Start Date :||December 2014|
|Actual Primary Completion Date :||March 30, 2018|
|Actual Study Completion Date :||March 30, 2019|
Patients referred for CABG
Device: ComboMap XT Guidewire
Intracoronary pressure and flow measurements
Procedure: 'SPY' NIRF During CABG
FDA approved use of injection of indocyanine green for the purposes of performing pre and post coronary grafting graft patency and perfusion assessment with the SPY near infra red fluorescence system
- Correlation Analysis [ Time Frame: 18 months ]Correlation between anatomy, functional anatomy, FFR, SPY® RMP change, and the presence or absence of imaged competitive flow
- Correlation Analysis [ Time Frame: 18 months ]Correlation analysis between anatomy, functional anatomy, FFR, CFR, HMR and SPY® perfusion data for each TVECA and perfusion territory.
- Instantaneous Wave Free Ratio (iFR) [ Time Frame: 18 months ]Offline analysis of de-identified encrypted data for each TVECA interrogated with ComboMap XT wire by Dr Justin Davies's research group, Imperial College, London for iFR determination. Correlation analysis between iFR and presence or absence of imaged competitive flow and intra-operative RMP data on SPY® NIRF
- Wave Intensity Analysis (WIA) [ Time Frame: 18 months ]Offline wave wave intensity analysis (WIA) of de-identified encrypted data for each TVECA interrogated with ComboMap XT wire by Dr Justin Davies's research group, Imperial College, London. Correlation analysis between WIA data and presence or absence of imaged competitive flow and intra-operative RMP data on SPY® NIRF
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02138305
|United States, North Carolina|
|East Carolina Heart Institute at Vidant Medical Center|
|Greenville, North Carolina, United States, 27834|
|Principal Investigator:||Ashesh N Buch, MBChB, MD||East Carolina University|
|Principal Investigator:||T. Bruce Ferguson, MD||East Carolina University|