Detection of Acute Graft Rejection in Heart Transplant Patients by Estimation of T2 (DRAGET)
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| ClinicalTrials.gov Identifier: NCT02261870 |
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Recruitment Status :
Completed
First Posted : October 10, 2014
Last Update Posted : May 12, 2020
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The investigators propose a simple and non-invasive method to monitor heart transplant patients with MRI. Its diagnostic and prognostic values have already been assessed in two monocentric studies. Other monocentric studies based on related methods have confirmed the investigators findings. These studies are insufficient to allow a large diffusion of the technique. Only a large multi-centric study will change medical practices. In addition, this project will spread the new method at a national level and will allow an assessment of its practical usefulness in centres not familiar with MRI T2 quantification.
Furthermore, MRI seems to detect rejections at earlier stage than biopsy. A confirmation of this observation could lead to a modification of diagnostic criteria of cardiac graft rejection. The ultimate aim of the DRAGET project is to replace a strategy based solely on biopsy with one based on a first-line MRI (with biopsy only when needed) for a more efficient and earlier detection of rejection. This would constitute a major advance in patients security and comfort as well as an economic improvement.
| Condition or disease | Intervention/treatment | Phase |
|---|---|---|
| Acute Graft Rejection Heart Transplantation | Device: MRI T2 quantification | Not Applicable |
| Study Type : | Interventional (Clinical Trial) |
| Actual Enrollment : | 116 participants |
| Allocation: | N/A |
| Intervention Model: | Single Group Assignment |
| Masking: | None (Open Label) |
| Primary Purpose: | Diagnostic |
| Official Title: | "Detection of Acute Rejection in Heart Transplant Patients by Mean of T2 Quantification With MRI" Open Transversal Clinical Trial With Repeated Measures |
| Actual Study Start Date : | February 18, 2015 |
| Actual Primary Completion Date : | February 27, 2020 |
| Actual Study Completion Date : | February 27, 2020 |
| Arm | Intervention/treatment |
|---|---|
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Experimental: ALL_patients
MRI T2 quantification : heart transplant patients will have 4-6 MRI exams for T2 quantification during their first year after transplantation.
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Device: MRI T2 quantification
MRI acquisitions will be performed according to the already described method based on conventional Fast Spin Echo sequences and with an additional calibration pad positioned on the patient thorax (dedicated pad made by the Nancy CIC-IT with stable and adapted T2). MRI will be performed if possible before the biopsy and otherwise the radiologist will be kept blinded of the biopsy results. |
- Sensitivity and specificity of myocardial T2 assessed with MRI for the diagnosis of histological heart graft rejection (with 95% confidence interval). [ Time Frame: 3 years after first inclusion ]endpoint = sensitivity and specificity acute rejection means presence of damaged myocytes in endomyocardial biopsy (former grade 2, grade 2R and grade 3R)
- Incidence of histological or clinical rejection within months of a couple MRI/biopsy with normal biopsy (grade<2R). [ Time Frame: 3 years after first inclusion ]endpoint = number of rejections For this purpose, rejection will be defined as: a) acute rejection documented by presence of damaged myocytes in endomyocardial biopsy (former grade 2, grade 2R and grade 3R), or b) marked decrease in left ventricle ejection fraction (>10%), reversible after subsequent increase in immunosuppressive treatment.
- Complications with MRI and with biopsies. [ Time Frame: 3 years after first inclusion ]endpoint = Number of adverse events due to both exams
- Magnitude of better tolerability of MRI over biopsies for the patient. [ Time Frame: 3 years after first inclusion ]endpoint = Physical and psychological distress assessed by questionnaire using Likert scales. This questionnaire will be completed by the patients.
- Inter-observer reproducibility of T2 quantification with MRI and of pathological grading of the biopsies. [ Time Frame: 3 years after first inclusion ]endpoint = 95% interobserver limit of agreement for T2 quantification and Cohen's Kappa coefficient for histological grading.
- Level of confidence, at the end of the study, of the expert-physicians of each centre concerning the use of T2 quantification as an alternative to routine biopsies. [ Time Frame: 3 years after first inclusion ]endpoint = Confidence assessed by questionnaire using Likert scales. This questionnaire will be completed by study investigators at the end of the study.
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| Ages Eligible for Study: | 18 Years and older (Adult, Older Adult) |
| Sexes Eligible for Study: | All |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Heart transplant patient
- Able to realize 4 couples Biopsy/MRI within 12 months after the transplant
- Mandatory enrolment in a social security plan
- Patient having signed an informed consent.
Exclusion Criteria:
- Contraindication to MRI: pacemaker, ferromagnetic foreign body, etc
- Impossibility to undergo MRI: claustrophobia, morbid obesity, hospitalisation in intensive care unit, arrhythmia
- Pregnancy
- Patients under a measure of legal protection
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02261870
| France | |
| Hospices Civils de Lyon | |
| Bron, France, 69677 | |
| CHU Grenoble | |
| La Tronche, France, 38700 | |
| CHRU Nancy Brabois | |
| Nancy, France | |
| CHU de Nantes | |
| Nantes, France, 44093 | |
| Hôpital Européen Georges Pompidou | |
| Paris, France, 75015 | |
| Groupe Hospitalier Pitié-Salpêtrière | |
| Paris, France, 75651 | |
| CHU Bordeaux | |
| Pessac, France, 33604 | |
| CHU de Rennes | |
| Rennes, France, 35033 | |
| Hopitaux Universitaires de Strasbourg | |
| Strasbourg, France | |
| CHU de Tours | |
| Tours, France, 37044 | |
| Principal Investigator: | Laurent Bonnemains, MD, PhD | INSERM, IADI U47, Nancy, France |
| Responsible Party: | Central Hospital, Nancy, France |
| ClinicalTrials.gov Identifier: | NCT02261870 |
| Other Study ID Numbers: |
2014-A00848-39 CIC1433 ( Other Identifier: 12-109_DRAGET ) |
| First Posted: | October 10, 2014 Key Record Dates |
| Last Update Posted: | May 12, 2020 |
| Last Verified: | May 2020 |
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MRI, T2 quantification |