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Clinical Trial of Manganese-Enhanced MRI (MEMRI) to Assess Peri-Infarct Injury

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ClinicalTrials.gov Identifier: NCT02933034
Recruitment Status : Completed
First Posted : October 14, 2016
Results First Posted : February 17, 2020
Last Update Posted : February 17, 2020
Sponsor:
Collaborator:
General Electric
Information provided by (Responsible Party):
Phillip C. Yang, MD, Stanford University

Brief Summary:
The purpose of this study is to evaluate the safety and tolerance of a new intravenous diagnostic agent, SeeMore or EVP 1001-1, in patients with Cardiovascular Disease (MEMRI scan). The initial phase of this study, NCT01989195 enrolling a total of 6 patients, has been closed. This second phase adds 10 patients in a safety cohort and 60 additional patients for a total of 70 patients.

Condition or disease Intervention/treatment Phase
ISCHEMIC CARDIOMYOPATHY Drug: Manganese-enhanced MRI contrast reagent Drug: Gadolinium-enhanced MRI contrast reagent Phase 1 Phase 2

Detailed Description:

This is an open-label, baseline-controlled study to be conducted. Adult male or nonpregnant female patients who have been referred for evaluation of dilated cardiomyopathy, ischemic cardiomyopathy, non-ischemic cardiomyopathy, atrial arrhythmia and also patients who have received stem cell therapy related to both ischemic and dilated cardiomyopathy (under different trials) will be recruited. An initial cohort study of 6 patients to conduct safety evaluation was conducted before proceeding with 60 additional patients. In the initial cohort, a patient was dosed based on the Phase 1 and 2 clinical trial data evaluation completed by Eagle Vision Pharmaceutical, Inc. Subjects were excluded if they had received an investigational device within 30 days prior to administration of EVP1001-1; had a history of drug abuse or alcoholism; were taking a digitalis preparation; had a history of torsades; had New York Heart Association (NYHA) Grade IV heart failure; had abnormal liver function tests or a history of liver disease; had uncontrolled hypertension; had abnormal calcium, potassium or hemoglobin values at baseline; if they develop a cardiac arrhythmia prior to or during either of the exercise tests-- EVP1001-1 was not administered. The same parameters will apply to the new group of subjects.

Prior to entry into this study, all subjects will sign an Informed Consent and will undergo a physical examination including medical history, details regarding their cardiac history, prescription and over-the-counter drug questionnaire, vital signs, electrocardiogram (ECG), evaluation of the major organ systems, hematology, serum chemistries, and urinalysis. In addition, female subjects will undergo a serum pregnancy test.

Starting 30 minutes before the cardiac MRI scan (CMR), the subjects will take a 16 mg tablet of ondansetron by mouth. CMR imaging will subsequently take place and then EVP1001-1 will then be administered approximately 15 minutes into the scan for contrast enhanced images. EVP1001-1 will be administered intravenously over approximately one minute. The subjects will each receive 0.28 mL/kg of EVP 1001-1. All subjects will be monitored closely from before ondansetron administration until their discharge from the imaging center. Following MEMRI, delayed-enhanced MRI (DEMRI scan) is performed using 0.2 mmol/kg.

We will compare the two different contrast enhanced images (EVP1001-1 vs gadolinium (GD)) in determining the non-viable (infarct core), peri-infarct, and total infarct size of myocardial tissue.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 33 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Diagnostic
Official Title: Clinical Trial of Manganese-Enhanced MRI (MEMRI) to Assess Peri-Infarct Injury
Actual Study Start Date : April 2015
Actual Primary Completion Date : February 3, 2019
Actual Study Completion Date : February 3, 2019

Resource links provided by the National Library of Medicine

Drug Information available for: Manganese

Arm Intervention/treatment
Experimental: Coronary Disease
Participant receive 2 cardiac MRI procedures: MEMRI and DEMRI.
Drug: Manganese-enhanced MRI contrast reagent
MRI using manganese-enhanced MRI contrast reagent (manganese 0.28 mL/kg).
Other Name: EVP 1001-1

Drug: Gadolinium-enhanced MRI contrast reagent
MRI using gadolinium-enhanced MRI contrast reagent (gadolinium 0.2 mmol/kg).
Other Name: GD-DTPA




Primary Outcome Measures :
  1. Infarct Size of MEMRI Versus DEMRI Scans [ Time Frame: Day of MEMRI and DEMRI scans (up to 3 hours per scan, performed on the same day or up to 7 days apart) ]
    MEMRI is an assessment of non-viable myocardial tissue and evaluates core infarct size. DEMRI is an assessment of fibrotic tissue and evaluates the total infarct size. The difference between these two measurements evaluates the size of peri-infarct region consisting of mixed components of injured but viable cardiomyocytes and fibrosis.


Secondary Outcome Measures :
  1. Systolic Blood Pressure [ Time Frame: Before, during, and after MEMRI scan (up to 3 hours) ]
    Systolic blood pressure during MEMRI scan as a measure of manganese contrast reagent safety. Normal reference range: 90-120 mmHg.

  2. Diastolic Blood Pressure [ Time Frame: Before,during, and after MEMRI scan (up to 3 hours) ]
    Diastolic blood pressure during MEMRI scan as a measure of manganese contrast reagent safety. Normal reference range: 60-80 mmHg.

  3. Heart Rate [ Time Frame: Before,during, and after MEMRI scan (up to 3 hours) ]
    Heart rate during MEMRI scan as a measure of manganese contrast reagent safety. Normal reference range: 60 and 100 beats per minute.

  4. QT Interval [ Time Frame: Before and after MEMRI scan (up to 3 hours) ]
    QT interval during MEMRI scan as a measure of manganese contrast reagent safety. QT is a measurement of heart function that is dependent on heart rate, so QTc is mainly used for diagnosis rather than QT. Normal reference range was considered to be 360-450 milliseconds for this study.

  5. Corrected QT (QTc) [ Time Frame: Before and after MEMRI scan (up to 3 hours) ]
    Corrected QT (QTc) interval during MEMRI scan as a measure of manganese contrast reagent safety. QTc is a measurement of heart function and is mainly used for diagnosis rather than QT, because QT is dependent on heart rate. Normal reference range was considered to be 360-450 milliseconds for this study.

  6. Alanine Aminotransferase (ALT) [ Time Frame: Before and after MEMRI scan (up to 3 hours) ]
    ALT levels during MEMRI scan as a measure of manganese contrast reagent safety. ALT is a measurement of liver function. Normal reference range was considered to be <60 U/L for this study.

  7. Aspartate Aminotransferase (AST) [ Time Frame: Before and after MEMRI scan (up to 3 hours) ]
    AST levels during MEMRI scan as a measure of manganese contrast reagent safety. AST is a measurement of liver function. Normal reference range was considered to be <40 U/L for this study.

  8. Alkaline Phosphatase (ALP) [ Time Frame: Before and after MEMRI scan (up to 3 hours) ]
    ALP levels during MEMRI scan as a measure of manganese contrast reagent safety. ALP is a measurement of liver function. Normal reference range was considered to be <40-130 U/L for this study.

  9. Total Bilirubin [ Time Frame: Before and after MEMRI scan (up to 3 hours) ]
    Total bilirubin levels during MEMRI scan as a measure of manganese contrast reagent safety. Total bilirubin is a measurement of liver function. Normal reference range was considered to be <1.4 mg/dL for this study.

  10. Creatinine [ Time Frame: Before and after MEMRI scan (up to 3 hours) ]
    Creatinine levels during MEMRI scan as a measure of manganese contrast reagent safety. Creatinine is a measurement of kidney function. Normal reference range was considered to be 0.50-1.20 mg/dL for this study.

  11. Estimated Glomerular Filtration Rate (eGFR) [ Time Frame: Before and after MEMRI scan (up to 3 hours) ]
    eGFR levels during MEMRI scan as a measure of manganese contrast reagent safety. eGFR is a measurement of kidney function. Normal reference range was considered to be >60 ml/min/1.73m^2 for this study.



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 70 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

All subjects to be entered must:

  • be at least 18 years of age.
  • if female, be nonpregnant as evidenced by a serum pregnancy test and using a medically-approved method of birth control, or post-menopausal or surgically sterile
  • provide written informed consent after having received oral and written information about the study
  • be in stable health based on medical history, examination and tests

Exclusion Criteria:

have a positive pregnancy test (females)

  • received an investigational drug or device within 30 days prior to administration of SeeMore
  • have known hypersensitivity to ondansetron or other selective serotonin 5HT3 receptor blockers
  • have a history of drug abuse or alcoholism
  • are taking a digitalis preparation or calcium channel blocker
  • have a history of torsades or prolonged QT/QTc interval
  • have NYHA Grade IV heart failure
  • have abnormal liver function tests or a history of liver disease
  • have uncontrolled hypertension (Systolic Blood Pressure > 140 or Diastolic BP > 90 consistently at baseline)
  • have abnormal baseline potassium or calcium values or hemoglobin less than 10 g/dl
  • are noncompliant or otherwise unlikely to perform as required by the protocol
  • have pretest likelihood of CAD for which the requisite number of subjects have been entered
  • develop an arrhythmia prior to or during either of the exercise tests; SeeMore should not be administered.

Information from the National Library of Medicine

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): NCT02933034


Locations
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United States, California
Stanford University School of Medicine
Stanford, California, United States, 94305
Sponsors and Collaborators
Stanford University
General Electric
Investigators
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Principal Investigator: Phillip C Yang, MD Stanford University
  Study Documents (Full-Text)

Documents provided by Phillip C. Yang, MD, Stanford University:
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Responsible Party: Phillip C. Yang, MD, Associate Professor, Stanford University
ClinicalTrials.gov Identifier: NCT02933034    
Other Study ID Numbers: 28508
First Posted: October 14, 2016    Key Record Dates
Results First Posted: February 17, 2020
Last Update Posted: February 17, 2020
Last Verified: February 2020
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Phillip C. Yang, MD, Stanford University:
ISCHEMIC OR CORONARY HEART DISEASE
MYOCARDIAL INFARCTION
MAGNETIC RESONANCE IMAGING
DELAYED GADOLINIUM ENHANCEMENT MRI
MANGANESE-ENHANCED MRI
INFARCT VOLUME/SIZE
ALL CAUSE MORTALITY
VENTRICULAR ARRHYTHMIAS
Additional relevant MeSH terms:
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Cardiomyopathies
Infarction
Ischemia
Pathologic Processes
Heart Diseases
Cardiovascular Diseases
Necrosis
Manganese
Trace Elements
Micronutrients
Nutrients
Growth Substances
Physiological Effects of Drugs