Use of Cardiac MRI in Early Stages of STEMI to Predict Left Ventricular Function Recovery and ICD Implantation (STEMI-MR)
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|ClinicalTrials.gov Identifier: NCT03743935|
Recruitment Status : Recruiting
First Posted : November 16, 2018
Last Update Posted : May 15, 2019
Patients presenting with STEMI and late revascularization can suffer from severe left ventricular dysfunction. Midterm and longterm mortality can be determined by the risk of fatal ventricular arrythmias. For this specific population, ESC guidelines currently recommend a waiting period of up to 40 days after a STEMI with severe left ventricular dysfunction before considering ICD implantation for primary prevention of sudden death.This delay is allocated to judge left ventricular recovery.
This study aims to see whether early cardiac MRI with specific sequences can help predict which patients will most probably not recover their left ventricular function and benefit from earlier ICD implantation.
|Condition or disease||Intervention/treatment||Phase|
|Acute STEMI Severe Left Ventricular Systolic Dysfunction (Disorder)||Other: Gadolinium-enhanced cardiac MRI||Not Applicable|
ST segment elevation myocardial infarction represent 120 000 annual cases in France. Although its mortality has been drastically reduced by primary percutaneous coronary angioplasty (PCI), its midterm and longterm outcome in patients presenting initially with severe left ventricular (LV) dysfunction depends on the risks of heart failure and sudden death by malignant ventricular arrhythmias.
Many clinical studies such as MADIT I and II, MUSTT and DINAMIT have participated in defining which patients should benefit from ICD implantation. These studies were based on evaluation of the LV ejection fraction (LVEF) and of the risk of arrhythmia (by electrophysiology or holter recordings).
However, ESC Guidelines recommend a mandatory waiting period of 40 days post-PCI to reevaluate LVEF before confirming the need for ICD implantation (LVEF < 35%). Therefore, patients are at risk of sudden cardiac death (SCD). during this period.
The investigators sought to determine whether specific cardiac MRI sequences could help predict which patients would eventually recover from their LV dysfunction and therefore reduce the risk of SCD by implanting ICD earlier than recommended.
Patients presenting at our Cardiac ICU with STEMI and severe LV dysfunction (LVEF < 35%), not indicated to coronary artery bypass surgery (CABG) and free from initial cardiac arrest or severe ventricular arrhythmias, will be included. They will undergo a gadolinium-enhanced cardiac MRI during the 1st days of hospitalization with specific sequences to determine myocardial zones at risk of non-recovery.
Initial assessment will also include thorough clinical examination with NYHA class, trans-thoracic echocardiography and blood works to evaluate renal function, inflammation, signs of heart failyre (BNP and troponin). Patients will be equipped with Lifevests for 6 weeks and followed-up with the same criteria.
Ratio of final ICD implantation will then be compared to the MRI criterion to determine whether LV recovery could have been predicted.
|Study Type :||Interventional (Clinical Trial)|
|Estimated Enrollment :||30 participants|
|Intervention Model:||Single Group Assignment|
|Masking:||None (Open Label)|
|Official Title:||Primary Prevention ICD Implantation in STEMI With Severe Left Ventricular Dysfunction : Input of Early Cardiac MRI in Order to Predict Left Ventricular Recovery|
|Actual Study Start Date :||January 7, 2019|
|Estimated Primary Completion Date :||May 1, 2020|
|Estimated Study Completion Date :||August 1, 2020|
Experimental: Early cardiac MRI post-STEMI
Early stages post-STEMI (within the first 5 days)
Other: Gadolinium-enhanced cardiac MRI
Gadolinium-enhanced cardiac MRI during the 1st days post-STEMI with specific sequences including extra-cellular volume measurement
- Mesure of zones of delayed myocardial transmural enhancement and no-reflow [ Time Frame: 40 days ]Defining the area at risk with Cardiac MRI
- Mesure of ejection fraction and regional wall motion and thickening [ Time Frame: 40 days ]Defining the area at risk with Cardiac MRI
- Mesure of extracellular volume [ Time Frame: 40 days ]Defining the area at risk with Cardiac MRI
- Number of CVD events [ Time Frame: 40 days ]Occurrence of major adverse cardiac events
- Number of admission to the hospital for heart failure event [ Time Frame: 40 days ]Occurrence of heart failure events
- Number of ischemic cardiovascular events [ Time Frame: 40 days ]Occurrence of major adverse cardiac events
- Number of cardiac death [ Time Frame: 40 days ]Occurrence of major adverse cardiac events
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03743935
|Contact: Jean-Luc PASQUIE, MD-PhD||0467336187 ext email@example.com|
|Contact: Julie Roux, MDfirstname.lastname@example.org|
|University Hospital of Montpellier||Recruiting|
|Montpellier, France, 34090|
|Contact: Sonia Soltani, Engineer email@example.com|