Speckle Tracking Imaging and Realtime 3 Dimensional Echocardiograhy to Study LV Function and Remodeling After Acute Myocardial Infarction (AMI)

The recruitment status of this study is unknown because the information has not been verified recently.
Verified January 2011 by National Taiwan University Hospital.
Recruitment status was  Recruiting
Sponsor:
Information provided by:
National Taiwan University Hospital
ClinicalTrials.gov Identifier:
NCT00745680
First received: August 31, 2008
Last updated: January 20, 2011
Last verified: January 2011
  Purpose

Left ventricular (LV) remodeling after acute myocardial infarction (AMI) has been well described in previous studies. However, there is a paucity of data on the incidence of and risk factors for LV remodeling in modern clinical practice that incorporates widespread use of acute reperfusion strategies and almost systematic use of "antiremodeling" medications, such as angiotensin-converting enzyme inhibitors and beta blockers. The recent improvements in AMI management do not abolish LV remodeling, which remains a relatively frequent event after an initial anterior wall AMI. As a leading cause of heart failure, postinfarction LV remodeling represents an important target for therapeutic interventions. Within the ventricular mass, size, shape, connections and orientation in a three-dimensional space of every single constituent determine its functional behavior. The complex architecture of the ventricular mass creates multiple inhomogeneities of electrical and mechanical loads at the cellular and the microscopic tissue level, that cause cardiac function to be 'stochastic in nature'. The myocardial infarction will altered the ventricular shape and functional inhomogeneities carrying the morphodynamic advantages such as impaired suction for diastole after diminishing recoil relaxation with decreased twisting strain in systole. The alteration in contractile mechanics interacts with the intraventricular fluid dynamic filed that influence the regional myocardial shearing stress. Altered LV transmural wall strains have been proposed to cause infarct extension and may have an important role in propagating LV remodeling.


Condition
Congestive Heart Failure
Mitral Regurgitation

Study Type: Observational
Study Design: Observational Model: Case-Only
Time Perspective: Prospective
Official Title: Morphodynamic Study of Left Ventricular Remodeling With Possible Mechanisms for Pharmacologic Therapy: Assessment by Real-time 3-dimensional Echocardiography and 2-dimensional Speck Tracking Imaging.

Resource links provided by NLM:


Further study details as provided by National Taiwan University Hospital:

Estimated Enrollment: 200
Study Start Date: October 2007
Estimated Study Completion Date: October 2011
Groups/Cohorts
A
A: AMI patient

Detailed Description:

We are currently witnessing the advent of new diagnostic tools and therapies for heart diseases, but,without serious scientific consensus on fundamental questions about normal and diseased heart structure and function. During the last decade, three successive, international, multidisciplinary symposia were organized in order to setup fundamental research principles, which would allow us to make a significant step forward in understanding heart structure and function. (Kocica MJ et al., 2006) Helical ventricular myocardial band (HVMB, Figure 2-1) of Torrent-Guasp is the revolutionary new concept in understanding global, three-dimensional, functional architecture of the ventricular myocardium. This concept defines the principal, cumulative vectors, integrating the tissue architecture (i.e. form) and net forces developed (i.e. function) within the ventricular mass. Helical ventricular myocardial band of Torrent-Guasp may also, hopefully, allow overcoming some difficulties encountered in contemporary efforts to create a comprehensive mathematical model of the heart.

Within the ventricular mass, size, shape, connections and orientation in a three-dimensional space of every single constituent determine its functional behavior. This kind of spatial dependence allows the ventricular myocardial mass to be considered as the source of interdependent vectorial forces (i.e.

electrical and mechanical), being generated on different length and time scales. The ultimate net result of these vectorial forces is to translate uniaxial sarcomere shortening into efficient three-dimensional deformation of the ventricular cavity. The complex architecture of the ventricular mass creates multiple inhomogeneities of electrical and mechanical loads at the cellular and the microscopic tissue level, that cause cardiac function to be 'stochastic in nature'. However, at macroscopic (i.e. organ) level, these stochastic events become average and appear consistent with a continuous medium. This dialectic coexistence of complexity and simplicity, discreetness and continuity suggests the existence of certain rule-based assignment, which 'may be applied equally well to all the ventricular myocardial fibers', enabling the ventricular myocardial mass to assemble abundant, dynamic, stochastic vectorial forces and produce apparently smooth, averaged, continuous, global response.

  Eligibility

Ages Eligible for Study:   20 Years to 90 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population

Patients after AMI

Criteria

Inclusion Criteria:

  • Structurally normal mitral and aortic valve;
  • Technically adequate color flow Doppler image;
  • Technically adequate real-time 3D echocardiographic image of the LV chamber and the mitral apparatus (annulus and leaflets) to allow analysis of 3D geometry;
  • Normal sinus rhythm.

Exclusion Criteria:

  • Recurrent MI or coronary reintervention during the follow up period;
  • Clinical or echocardiographic evidence of other cardiac diseases, such as organic valvular, pericardial, congenital, or infiltrative heart disease;
  • Right ventricular alterations resulting in abnormal position or movement of the septum.
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00745680

Contacts
Contact: Lung-Chun Lin, PhD. anniejou@ms28.hinet.net

Locations
Taiwan
NTUH Recruiting
Taipei, Taiwan
Contact: Fun-Yu Lin, PhD    23123456 ext 5433      
Sponsors and Collaborators
National Taiwan University Hospital
Investigators
Study Director: Lung-chun Lin, Ph D National Taiwan University Hospital
  More Information

No publications provided

Responsible Party: Lung-Chun Lin, National Taiwan University Hospital
ClinicalTrials.gov Identifier: NCT00745680     History of Changes
Other Study ID Numbers: 200701057R
Study First Received: August 31, 2008
Last Updated: January 20, 2011
Health Authority: Taiwan: Department of Health

Keywords provided by National Taiwan University Hospital:
Left ventricular remodeling, acute myocardial infarction

Additional relevant MeSH terms:
Heart Failure
Mitral Valve Insufficiency
Myocardial Infarction
Ventricular Remodeling
Heart Diseases
Cardiovascular Diseases
Heart Valve Diseases
Myocardial Ischemia
Vascular Diseases
Pathological Conditions, Anatomical

ClinicalTrials.gov processed this record on April 17, 2014