Measurement of Matrix Metalloproteinase Activation Post Myocardial Infarction

The recruitment status of this study is unknown because the information has not been verified recently.
Verified January 2010 by Yale University.
Recruitment status was  Recruiting
Sponsor:
Information provided by:
Yale University
ClinicalTrials.gov Identifier:
NCT00576121
First received: December 15, 2007
Last updated: January 13, 2010
Last verified: January 2010
  Purpose

This study is designed to look at the measurement and prediction of changes in the heart following a heart attack.


Condition
Acute Myocardial Infarction

Study Type: Observational
Study Design: Observational Model: Case Control
Time Perspective: Prospective
Official Title: Measurement of Matrix Metalloproteinase Activation Post Myocardial Infarction

Resource links provided by NLM:


Further study details as provided by Yale University:

Primary Outcome Measures:
  • To predict left ventricular remodeling after myocardial infarction using serum matrix metalloproteinase measurement with Tl201 SPECT/CT hybrid imaging and MRI. [ Time Frame: 1 day ] [ Designated as safety issue: No ]

Estimated Enrollment: 30
Study Start Date: July 2008
Estimated Study Completion Date: August 2012
Estimated Primary Completion Date: August 2011 (Final data collection date for primary outcome measure)
Groups/Cohorts
1
Left ventricular ejection fraction (LVEF) patients will be compared at two time-points, 2-5 days and 4 weeks after acute MI.
2
End-diastolic volume (LVEDV) patients will be compared at two time-points, 2-5 days and 4 weeks after acute MI.
3
End-systolic volume (LVESV) patients will be compared at two time-points, 2-5 days and 4 weeks after acute MI.

  Hide Detailed Description

Detailed Description:

Patients who are admitted to Yale New Haven Hospital with first acute myocardial infarction within the onset of 12 hours of symptoms will be eligible for this study and referred by their physician for this study. Subjects will be screened with medical interview and physical exam for eligibility. Clinical data will be obtained for demographic purposes including: EKG upon admission, serum cardiac markers, basic metabolic panel, cardiac catheterization report and recent echocardiography report. All standard medications will be allowed which include diuretics, ACE/Ang-II inhibitors, nitrates/hydralazine, digoxin, low dose aspirin, beta-blockers, calcium channel antagonists, anticoagulants and anti-arrhythmic agents.

A 10cc blood sample will be drawn from a peripheral vein at 3 days post myocardial infarction into chilled EDTA tubes, plasma decanted and placed at -70 degrees C until MMP/TIMP assays are performed. These samples will be sent to collaborators at the Medical University of South Carolina for high sensitivity plasma assays developed at MUSC for MMP-1, -13, -8, -2, -9 and TIMP-1, -2, -4. [1] These assays will be performed in Core C and detailed description of specificity of these measurements is described. In addition, indices of collagen synthesis and degradation, through the use of telopeptide measurements will be measured in these plasma samples.

Nitroglycerin resting Tl-201 myocardial perfusion imaging will be performed between 2-5 days after myocardial infarction. Subjects will have a peripheral intravenous line placed and will be injected with 2.5-3.5mCi of Tl-201. The Tl-201 given will be a slightly lower dosage than the standard clinical protocol of Yale New Haven Hospital nuclear cardiology lab because of improved reconstruction algorithms with CT will allow lower doses of radioactive isotopes. Resting myocardial perfusion images will be acquired 5 minutes post-injection on a multislice helical SPECT/CT (GE Infinia Hawkeye) followed by a CT scan. A redistribution image will be performed 4 hours after thallium administration. Each SPECT scan will take approximately 25 minutes. Perfusion defect size will be quantified using the Yale C-Q method previously described [2].

Transthoracic echocardiography will be performed at 2-5 days post-MI and 28 days after MI in standard apical and parasternal views using a commercial ultrasound system either Phillips 7500 or IE33 ultrasound imaging system with an S3 transducer. The transducer will be placed on the apical and/or parasternal location on the chest and ECG-gated images will be obtained during a breath hold. Each acquisition will be performed in zoom mode at 40 Hz, over the entire LV in 4 cardiac cycles with 40 frames per cardiac cycle. Image data will be captured in digital form and will be backed up on DVDs. NOTE: No patient HIPPA data will be saved on the DVD. Left ventricular ejection fraction (LVEF), end-diastolic volume (LVEDV), and end-systolic volume (LVESV) will be measured. The echocardiograms will be used to determine LV mass, LV cavity size and regional thickening. Patients will undergo MRI with gadolinium contrast in the GE Signa 1.5 tesla magnetic resonance image scanner located in the Yale-New Haven Hospital MRI Center, using standard ECG-gated cine gradient echo, and echo-planar, phase contrast and MR tagged imaging sequences.

Electrocardiographic monitoring will be maintained during the magnetic resonance imaging. MRI scans will occur between 2-5 days post-MI.

The first acquisitions to be performed will be combined cine-gradient echo/cine phase velocity approach that will obtain both the magnitude images required for our segmentation and shape-based tracking as well as contrast data for finding midwall myocardial velocities in a single image acquisition. This sequence will yield adjacent 5 mm thick axial images with in plane resolution of approximately 1.6mm x 1.6mm. We will acquire 16-20 cardiac phase per location. Patients will receive 0.1 mmol/kg of standard gadolinium contrast in a peripheral IV. The acquisition will apply inversion recovery preparatory pulse to null normal myocardium, followed by a segmented k-space gradient echo acquisition. We anticipate that all of the proposed magnetic resonance imaging for each subject will be completed within 2 hours. The technologist or doctor operating the scanner will be able to see the subject. The operator will maintain contact by voice with the subjects.

None of the aforementioned procedures are considered experimental and individually, may or may not be part of the subjects' standard of care post myocardial infarction. During each part of the step of image acquisition, there will be a physician present. All data will be transferred via network to the image processing laboratory for analysis and will not include any projected personal information.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Sampling Method:   Probability Sample
Study Population

Patients will be recruited by a physician referral into the study. Patients will be referred to the study by the cardiologist in the cardiac catheterization lab at Yale New Haven Hospital. Patient recruitment will be limited to patients who are English speakers. Informed consent will be obtained by Dr. Albert Sinusas, MD.

Criteria

Inclusion Criteria:

  • Diagnosis of acute myocardial infarction characterized by (1) greater than 30 minutes of chest pain; (2) ST elevation in 2 contiguous leads greater than 2mV; and (3) elevated serum markers greater than three times the normal value.
  • Males or females 18 years of age or older.
  • Adequate intravenous access in one arm.
  • Willing to comply with the requirements of the protocol.
  • Provided written informed consent to participate in the study.

Exclusion Criteria:

  • History of significant co-morbidity requiring hospitalization separate from acute myocardial infarction (i.e. metastatic cancer).
  • History of/current structural heart disease.
  • Arrhythmia
  • History of previous myocardial infarction
  • History of coronary revascularization
  • Cardiogenic shock
  • Hypotension
  • Renal failure (creatinine >2mg/dl) or hyperkalemia (serum potassium > 5.5mg/dl)
  • History of allergic reaction to gadolinium
  • Contraindication to undergo MR imaging (pacemaker, metallic implants, etc)
  • History of claustrophobia
  • Pregnant or breast-feeding, or (if pre-menopausal), not practicing acceptable method of birth control.
  • History of any other conditions, which in the judgment of the investigator, are likely to hinder or confuse study conduct or to pose a safety concern to the patient.
  • Resting HR >110
  • Chronic tetracycline or doxycycline use
  • Ongoing/active rheumatic disease requiring significant anti-inflammatory agents, steroids or immunosuppression
  • Not capable of informed consent
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00576121

Contacts
Contact: Carol Akirav, MSc 203-785-2429 carol.akirav@yale.edu
Contact: Albert J Sinusas, MD 203-785-3155 albert.sinusas@yale.edu

Locations
United States, Connecticut
Yale New Haven Hospital Recruiting
New Haven, Connecticut, United States, 06520
Contact: Carol Akirav, MSc    203-785-2429    carol.akirav@yale.edu   
Contact: Albert J Sinusas, MD    203-785-3155    albert.sinusas@yale.edu   
Sub-Investigator: Hamid Mojibian, MD         
Sub-Investigator: Daniel Cornfeld, MD         
Sub-Investigator: Gabriel Vorobiof, MD         
Sub-Investigator: Robert McNamara, MD         
Sub-Investigator: Farid Jadbabaie, MD         
Sponsors and Collaborators
Yale University
Investigators
Principal Investigator: Albert J Sinusas, MD Yale University
  More Information

Publications:

Responsible Party: Dr. Albert Sinusas, Yale University
ClinicalTrials.gov Identifier: NCT00576121     History of Changes
Other Study ID Numbers: 0610001945
Study First Received: December 15, 2007
Last Updated: January 13, 2010
Health Authority: United States: Institutional Review Board

Additional relevant MeSH terms:
Infarction
Myocardial Infarction
Cardiovascular Diseases
Heart Diseases
Ischemia
Myocardial Ischemia
Necrosis
Pathologic Processes
Vascular Diseases

ClinicalTrials.gov processed this record on October 22, 2014