Technical Development of Cardiovascular Magnetic Resonance Imaging

NCT00064896 | Completed Phase 1

• 2 other identifiers: 03025003-H-0250
• Study Type: interventional
• Target: 37
• Locations: 1 country
• Sites: 1

Brief Summary

The goal of this study is to develop advances in cardiovascular diagnostic and treatment methods using magnetic resonance imaging (MRI), a test that uses a strong magnetic field and radio waves to show anatomic detail. For the scan, the patient lies on a table in a cylinder containing a magnetic field. He or she can communicate with a staff member at all times during the procedure. Patients 18 years of age or older who require 1) catheterization of the leg arteries for diagnosis or treatment of blocked arteries, or 2) heart catheterization for diagnosis or treatment of coronary artery disease or other heart problems may be eligible for this study. Participants will undergo one of the following procedures: Blood Flow Measurement Using Standard Techniques and MRI For patients with blockage in a leg artery, blood flow will be measured before and after successful catheter-based treatment (angioplasty or stenting) using standard venous occlusion plethysmography and a newer MRI technique. (Patients whose treatment is not successful will not undergo follow-up blood flow measurements in this study.) For venous occlusion plethysmography, a large pressure cuff is placed around the upper or lower legs. Thin elastic bands called a strain gauge are placed around the calves to measure blood blow to the legs. The pressure cuffs are inflated for 5 minutes, preventing blood from flowing to the legs, and are then deflated, allowing the blood to rush to the legs. A smaller cuff is inflated to a low pressure, and the strain gauge measures this maximum blood flow to the legs for 1 or 2 more minutes. For the new MRI technique, blood flow is measured while the patient is in the MRI scanner. Flow is first measured with the patient at rest. Then, the large pressure cuff is inflated for 5 minutes. The cuff is deflated and additional images are taken. Before the cuff is deflated, a dye called gadolinium contrast is injected into an arm vein to brighten the images. Patients may undergo six to eight cuff inflations on four to six different days. Fusion of X-Ray and MRI Images of Peripheral Arteries For patients with blockage in a leg artery Participants will undergo catheterization and MRI of the legs. Special plastic beads are taped to the leg(s) to help compare the MRI and x-ray pictures. For the catheterization procedure, x-rays of the blood vessels are taken to guide placement of the catheters. Contrast dye is injected to brighten the images of the blood vessels. These injections work well in normal and partly blocked arteries, but not in arteries that are completely blocked. For this study, patients first have an MRI scan of their legs. During the scan, gadolinium contrast dye is injected into an arm vein. Then, during the catheterization procedure, a computer aligns the MRI pictures with the x-ray pictures to see if the combined images allow the doctor to better see where to place the catheters. Fusion of X-ray and MRI Images of the Heart For patients undergoing heart catheterization will undergo MRI and heart catheterization. Special plastic beads are taped to the chest to help compare the MRI and x-ray pictures. Patients first have an MRI scan of their heart. During the scan, gadolinium contrast dye is injected into an arm vein. Then, during the catheterization procedure, a computer aligns the MRI pictures with the x-ray pictures to see if the combined images allow the doctor to learn more about the pattern of heart disease. Heart rhythm, blood pressure, heart function, and breathing will be monitored during all the MRIs.

Conditions

Peripheral Artery Disease

Keywords

Blood Flow; Revascularization; Image Fusion; Fluoroscopy; MRI; Chronic Total Occlusion of Arteries; Claudication; Safety; Atherosclerosis; Cardiovascular Disease

Outcome Measures

Primary Outcomes (1)

• To develop, test, and provide adjunctive information to the operator derived from MRI during the management of patients being considered for, or undergoing, invasive procedures.

Secondary Outcomes (1)

• This protocol aims to develop and test novel MRI techniques in patients being treated for cardiovascular disease.

Interventions

MRI PROCEDURE

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Subjects with known or suspected cardiovascular disease will be eligible for participation in this protocol. The subject is eligible under the following conditions:
• Subject's age is greater than 18 years of age.
• Expected to undergo, or having undergone, a clinically-indicated diagnostic or therapeutic catheterization procedure or MRI angiogram procedure.
• Known or suspected peripheral artery occlusion.

You may not qualify if:

• Subjects with absolute contraindications to MRI scanning will be excluded. These contraindications include subjects with the following devices:
• Implanted cardiac pacemaker or defibrillator
• Central nervous system aneurysm clips
• Implanted neural stimulator
• Cochlear implant
• Ocular foreign body (e.g. metal shavings)
• Insulin pump
• Metal shrapnel or bullet.
• Pregnant women (Subjects who are uncertain as to whether they are pregnant will be required to have a screening urine or blood pregnancy test) or Lactating Women.
• Subjects with hemoglobinopathies
• Subjects with renal disease (eGFR\[R\] less than 30 mL/min/1.73m(2))
• Glomerular filtration rate will be estimated using the MDRD 2005 revised study formula:
• eGFR (mL/min/1.73m (2)) equal 175 x (standardized Scr) (-1.154) x (age) (-0.203) x 0.742 (if the subject is female) or x 1.212 (if the subject is black)
• However, if the eGFR less than 30 mL/min/1.73m(2) and gadolinium contrast exposure is thought likely to reduce the overall risk of the medically necessary interventional procedure in Specific Aim number 2, then with informed consent and the concurrence of the attending physician, the patient may be enrolled in the study. This would be documented in the medical record, and the IRB would be notified.
• Active deep vein thrombosis of the lower extremity based on clinical findings.

Sponsors & Collaborators

• National Heart, Lung, and Blood Institute (NHLBI): lead

Study Sites (1)

National Institutes of Health Clinical Center, 9000 Rockville Pike

Bethesda, Maryland, 20892, United States

Location

Related Publications (1)

• Murphy KP, Szopinski KT, Cohan RH, Mermillod B, Ellis JH. Occurrence of adverse reactions to gadolinium-based contrast material and management of patients at increased risk: a survey of the American Society of Neuroradiology Fellowship Directors. Acad Radiol. 1999 Nov;6(11):656-64. doi: 10.1016/S1076-6332(99)80114-7.

  PMID: 10894068 BACKGROUND

MeSH Terms

Conditions

Peripheral Arterial Disease; Intermittent Claudication; Atherosclerosis; Cardiovascular Diseases

Condition Hierarchy (Ancestors)

Arteriosclerosis; Arterial Occlusive Diseases; Vascular Diseases; Peripheral Vascular Diseases; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Study Officials

• Robert J Lederman, M.D.

  National Heart, Lung, and Blood Institute (NHLBI)

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: phase 1
• Purpose: TREATMENT
• Sponsor Type: NIH

Study Record Dates

• First Submitted: July 14, 2003
• First Posted: July 15, 2003
• Study Start: July 14, 2003
• Primary Completion: October 26, 2017
• Study Completion: October 26, 2017
• Last Updated: October 30, 2017

Record last verified: 2017-10-26

Locations

US (1)