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82 active trials for Ischemic Heart Disease

Evaluating Myocardial Ischemia in Chest Pain Using Exercise CMR

Ischemic Heart Disease (IHD) is a condition of recurring chest pain or discomfort that occurs when a part of the heart is not receiving sufficient blood flow. It is a major public health concern internationally and in Singapore, the leading cause of death from cardiovascular disease. Cardiovascular magnetic resonance (CMR) has the ability to assess heart structures, scarring or lack of blood supply to the heart muscle with great accuracy and without any radiation involved. A CMR-compatible cycle ergometer can offer a safe and low cost stress equipment to assess heart function and motion abnormalities, and restrictions of the blood supply to the heart tissues due to partial or complete blockages of the blood vessels. This study aims to develop an exercise-CMR stress protocol by testing its feasibility and robustness in assessing changes in cardiac volumes and function due to physical exertion in healthy individuals and to assess the accuracy of the multiparametric stress-CMR as a diagnostic tool for ischemic-causing coronary artery disease (CAD) with coronary fractional flow reserve (FFR) as a reference. to measure the overall economic impact of ischaemic heart disease by estimating the direct and indirect medical costs for each participant. The current sample costs will be extrapolated to estimate the annual costs of treating and managing ischaemic heart disease in the local population. to evaluate the effects of coronary microvascular dysfunction on coronary flow and regulation, physiological response and cardiac sympathetic signaling in patients with chest pain.

Start: May 2017
ISCHEMIA-CTO Trial - Revascularisation or Optimal Medical Therapy of CTO

Study design Prospective randomized open labeled multicenter study Hypotheses In asymptomatic patients with ? 10% of myocardial ischemia: PCI (Percutaneous Coronary Intervention) with latest generation of drug eluting stents is superior to optimal medical therapy in terms of relative reduction in MACCE (Major Adverse Cardiovascular and Cerebrovascular events). In symptomatic patients with ? 5% of myocardial ischemia: PCI with latest generation of drug eluting stents is superior to optimal medical therapy (OMT) in terms of improved life quality measured as an increase of SAQ (Self Assessment Questionnaire) score of 8 points after 6 months. Inclusion Criteria CTO in native coronary artery Myocardial ischemia in a territory supplied by CTO assessed by nuclear imaging. Age ?18 yrs. Able to provide written Informed consent and willing to comply with the specified follow-up contacts Target artery ? 2.5 mm Prior to randomization all patients undergo 3 months of OMT. Subsequently the population will be divided into: Cohort A: Asymptomatic (CCS < 2 and SAQ QoL > 60) patients with myocardial ischemia (? 10% of LV) in a territory supplied by CTO Cohort B: Symptomatic patients (CCS class ? 2 and/or SAQ QoL score ? 60 after treating non CTO lesions and after OMT) with Myocardial ischemia (5% of LV) in a territory supplied a CTO Cohort C: patients enrolled but not randomized in cohort A or B Exclusion criteria (for both cohort A and B) NSTEMI or STEMI within 1 month Coronary anatomy not suitable for CTO-procedure Coronary artery disease involving the left main/three-vessel disease with indication for CABG following heart team conference Life expectancy < 2 years Severe chronic pulmonary disease (FEV1 < 30 % of predicted value) Contraindication to dual anti-platelet therapy Pregnancy eGFR < 30 mL/min/1.73 m2 In multi-vessel disease: if it is deemed unsafe to treat the non-CTO lesion first. Severe valvular heart disease Primary endpoint Cohort A: Composite endpoint of MACCE (all-cause mortality, stroke, any myocardial infarction, clinically driven revascularization*), hospitalization for heart failure or incidence of malignant arrhythmias. *CCS class ? 2 and/or QoL score < 60. Same criteria used as for allocation to Cohort B Cohort B: SAQ Quality of Life Assessment after 6 months. Number of patients 1,560 (1200 in cohort A/360 in cohort B Follow up time Cohort A: 5 years Cohort B: 6 months

Start: November 2018