Arterial Properties of Thoracic Aorta Disease (ao_diss)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01068691
Recruitment Status : Unknown
Verified February 2010 by University Hospital, Grenoble.
Recruitment status was:  Recruiting
First Posted : February 15, 2010
Last Update Posted : February 15, 2010
Information provided by:
University Hospital, Grenoble

Brief Summary:

A dissecting or intramural haematoma of the thoracic aorta (AH) is a haemorrhage that dissects the aortic wall. An entry point is detected at an intimal tear, ulcer or plaque rupture via imaging in almost 50% of cases. AH occurs in older patients than those with AD and develops on atheromatous lesions with parietal ulcers, most often in cases of poorly managed, pre-existing hypertension (HTN). Type A AHs, which affect the ascending aorta, frequently progress towards an AD with a high risk of mortality, and represent a surgical indication.

Patients who have presented AD or AH, whether they have been operated or not, must undergo prolonged monitoring. This involves both clinical and radiological checks to ensure that blood pressure is properly monitored, that the parietal lesions have receded and that there are no complications.

HTN is a recognized risk factor for the onset of AD and systolic blood pressure must be brought down to between 100 and 120 mmHg perioperatively. Furthermore, HTN is also a risk factor for the rupture of unoperated type B AD. Despite this, only two studies have looked at BP management in AD patients. The first, carried out among chronic type A or B AD patients revealed that closer monitoring of blood pressure levels at home led to a better long-term prognosis. Another study revealed a 60% prevalence of non-managed clinical HTN among 40 chronic AD patients.

Whilst frequent, regular aortic wall monitoring via imaging methods (CT or MRI) is recommended after thoracic AD surgery, there is no precise recommendation as to the method of BP monitoring in very high-risk patients. A BP level of 135/80 mmHg has been suggested as a maximum limit for patients having been operated for AD. In order to achieve this, antihypertensives of several therapeutic classes must be used, with beta-blockers as a priority. The same can be said for AH, as it has been demonstrated that the absence of beta-blocker treatment is a predictive factor for poor progress.

Increased aortic stiffness can cause increased systolic blood pressure and is recognized as an independent cardiovascular risk factor. This stiffness can be detected by measuring the carotid-to-femoral pulse wave velocity (PWV). No study has as yet focused on assessing aortic stiffness in patients who have undergone AD or AH surgery.

Obstructive sleep apnea syndrome (OSAS) in thoracic AD patients is highly prevalent, and respiratory events that occur are more severe. This has prompted some to suggest that systematic detection of OSAS after AD should be carried out. No findings have yet been published about patients who have undergone AH surgery.

Condition or disease Intervention/treatment
Blood Pressure Procedure: Ambulatory blood pressure monitoring (to evaluate the level of blood pressure)

Detailed Description:

Main objective:

  • To evaluate the level of blood pressure control using ambulatory blood pressure monitoring in patients who have undergone surgery for a type A thoracic AD or AH.

Secondary objectives:

  • To study aortic stiffness within this patient population and determine its predictive parameters.
  • To determine the prevalence of OSAS among this patient population and study the relationship between respiratory data and blood pressure values.
  • To determine the respective roles of blood pressure level, aortic stiffness, and respiratory and biological parameters upon the postoperative aortic diameters of patients who have undergone surgery for type A thoracic AD or AH.

Study Type : Observational
Estimated Enrollment : 180 participants
Observational Model: Case-Only
Time Perspective: Prospective
Official Title: Blood Pressure Control and Arterial Properties After Surgical Treatment of Type A Thoracic Aortic Dissection or Haematoma
Study Start Date : May 2008
Estimated Primary Completion Date : June 2010
Estimated Study Completion Date : June 2010

Intervention Details:
  • Procedure: Ambulatory blood pressure monitoring (to evaluate the level of blood pressure)
    • Ambulatory blood pressure monitoring (to evaluate the level of blood pressure)
    • Blood pressure
    • Obstructive sleep apnea syndrome (OSAS)
    • Carotid-to-femoral pulse wave velocity (PWV)
    • Biological parameters

Primary Outcome Measures :
  1. Ambulatory blood pressure monitoring [ Time Frame: the same day as inclusion ]

Secondary Outcome Measures :
  1. Aortic stiffness, Aortic diameters [ Time Frame: the same day as inclusion ]
  2. polysomnography to research Sleep apnea [ Time Frame: within 2 months ]

Biospecimen Retention:   Samples Without DNA
Plasma samples for inflammation, oxidative stress and collagen markers

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Probability Sample
Study Population
This is a pilot, descriptive and single-centre study.

Inclusion Criteria:

Male or female patients aged 18 or over who:

  • benefit from the French social security system
  • will be monitored as outpatients
  • have given their written consent to participate in this study
  • have been operated over 6 months ago for a type A thoracic AD or AH at Grenoble University Hospital in the period from 1 January 1990 to 30 June 2007
  • are able to travel to Grenoble University Hospital

Exclusion Criteria:

  • Bedridden or reduced mobility patients.
  • Patients whose physical or psychological condition could affect their informed consent and compliance with the requirements of the protocol.
  • Adult patients protected by the law (article L1121-8 of the French Public Health Code).
  • Individuals serving a prison sentence (article L1121-8 of the French Public Health Code).
  • Women who are pregnant, have recently given birth or are breastfeeding.
  • Patients in the terminal phase of a serious illness.
  • Individuals serving a prison sentence as a result of a legal or administrative ruling, or individuals receiving legal protection.
  • Children.
  • Patients taking part in another study.
  • Individual who is not part of the social security system or who does not benefit from it.

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 identifier (NCT number): NCT01068691

Contact: BAGUET Jean-Philippe, MD, PhD (33+) 476768480

University Hospital Recruiting
Grenoble, France
Principal Investigator: BAGUET JB Jean-Philippe, Pr         
Sub-Investigator: CHAVANON OC Olivier, Pr         
Sub-Investigator: PEPIN JP Jean-Louis, Pr         
Sub-Investigator: THONY FT Frederic, Dr         
Sub-Investigator: BARONE ROCHETTE GB Gilles, Dr         
Sponsors and Collaborators
University Hospital, Grenoble
Principal Investigator: jean-philippe baguet, Pr University Hospital, Grenoble

Responsible Party: Pr Jean-Philippe BAGUET, Laboratoire Hypertension Artérielle-Pôle cardiovasculaire et thoracique Identifier: NCT01068691     History of Changes
Other Study ID Numbers: 706
2007-A01422-51 ( Registry Identifier: AFSSAPS )
First Posted: February 15, 2010    Key Record Dates
Last Update Posted: February 15, 2010
Last Verified: February 2010

Keywords provided by University Hospital, Grenoble:
aortic dissection
ambulatory blood pressure
obstructive sleep apnea syndrome
patients undergoing surgery for a dissection of the thoracic aorta