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The Predictive Value of the Heart Rate Response to Breathing Maneuvers for Inducible Myocardial Perfusion Deficits (SCREEN-MORE)

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ClinicalTrials.gov Identifier: NCT05516615
Recruitment Status : Recruiting
First Posted : August 25, 2022
Last Update Posted : March 15, 2023
Sponsor:
Information provided by (Responsible Party):
Matthias Friedrich, McGill University Health Centre/Research Institute of the McGill University Health Centre

Study Description
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Brief Summary:
Breathing maneuvers, i.e. hyperventilation followed by breath-holding, have been shown to change coronary dynamics; hyperventilating narrows the coronary arteries, puts "stress" on the heart, and increases the heart rate, whereas breath-hold dilates the coronary arteries and decreases the heart rate," rest". Heart rate response to hyperventilation has been reported to have high diagnostic accuracy to rule out heart disease. The cardiac stress test, the modality of choice for the initial assessment of patients with suspected coronary artery disease(CAD), is routinely overprescribed by physicians, which exerts a financial burden on the healthcare system. Hence, developing an inexpensive, reliable, and available tool-HR response to breathing maneuvers- may avoid unnecessary referrals for cardiac stress tests by an effective differentiation of patients with CAD from healthy people. This study aims to assess the negative predictive value of the HR response to a 4-minute breathing maneuver for inducible myocardial ischemia, avoiding further stress testing as a gatekeeper.

Condition or disease Intervention/treatment
Coronary Artery Disease Other: 4 minute breathing maneuver

Detailed Description:
Patients with suspected CAD must have a clinical indication for cardiac stress test based on the clinical judgement of their referring physician and be referred to adenosine stress first-pass perfusion MRI located at the McGill University Health Centre (MUHC). Healthy participants must have no known history of cardiovascular or respiratory diseases. At the time of recruitment, eligible participants will perform the 4-minute breathing maneuver, comprised of 2 minutes of normal breathing and 1-min hyperventilation (rate of 30 breaths or more per minute) followed by a maximal breath-hold. A portable FDA-approved device will be used to record HR and respiration patterns during breathing maneuvers, which enables us to observe the beat-to-beat HR changes during each phase of the breathing maneuvers. On the same day, the participants' socio-demographics, medications, medical history and INTERHEART risk scores will be obtained. Afterwards, patients referred for a stress test will undergo adenosine stress first-pass perfusion MRI as prescribed by their referring physician to validate the findings of the breathing maneuver and detect CAD. Inside the MRI, the participants will also be asked to perform the same 4-min breathing maneuver during Oxygenation Sensitive-Cardiac Magnetic Resonance imaging (OS-CMR) protocol. This imaging technique provides a non-invasive assessment of myocardial oxygenation, relying on the paramagnetic features of deoxygenated hemoglobin as the intrinsic contrast agent.
Study Design
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Study Type : Observational
Estimated Enrollment : 86 participants
Observational Model: Other
Time Perspective: Cross-Sectional
Official Title: The Predictive Value of the Heart Rate Response to Breathing Maneuvers for Inducible Myocardial Perfusion Deficits
Actual Study Start Date : July 14, 2020
Estimated Primary Completion Date : September 30, 2023
Estimated Study Completion Date : September 30, 2023

Resource links provided by the National Library of Medicine


Groups and Cohorts
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Group/Cohort Intervention/treatment
Healthy volunteers
  1. Aged more than 35
  2. No known current or pre-existing problems that would affect the cardiovascular or respiratory system
 Other: 4 minute breathing maneuver
The 4-minute breathing maneuver comprised of 2 minutes of normal breathing and 1-min hyperventilation (rate of 30 breaths or more per minute) followed by a maximal breath-hold.
Patient population
  1. Aged more than 35
  2. Referral of subjects with known or suspected CAD for adenosine stress first-pass perfusion MRI based on the clinical judgement of their referring physician
 Other: 4 minute breathing maneuver
The 4-minute breathing maneuver comprised of 2 minutes of normal breathing and 1-min hyperventilation (rate of 30 breaths or more per minute) followed by a maximal breath-hold.


Outcome Measures
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Primary Outcome Measures :
  1. Assess the negative predictive value of the heart rate acceleration in response to 1-min hyperventilation [ Time Frame: June 2020 - August 2021 ]

    To rule out the presence of inducible myocardial perfusion deficit in patients with suspected coronary artery disease compared to healthy volunteers

    A ROC analysis will provide an optimal cut-point value for the level of heart rate acceleration in response to 1-min hyperventilation to identify its ability to rule out myocardial perfusion deficit


  2. To assess the negative predictive value of the heart rate recovery in response to maximal voluntary breath-hold [ Time Frame: June 2020 - August 2021 ]

    To rule out the presence of inducible myocardial perfusion deficit in patients with suspected coronary artery disease compared to healthy volunteers

    A ROC analysis will provide an optimal cut-point value for the level of heart rate recovery in response to maximal voluntary breath-hold to identify its ability to rule out myocardial perfusion deficit



Secondary Outcome Measures :
  1. To assess the negative predictive value of heart rate variability during 4-min breathing maneuver to rule out the presence of inducible myocardial perfusion deficit in patients with suspected coronary artery disease compared to healthy volunteers [ Time Frame: June 2020 - August 2021 ]
    ROC analysis will provide an optimal cut-point value for heart rate variability during 4-min breathing maneuver to identify its ability to rule out myocardial perfusion deficit

  2. To assess the negative predictive value of the combination of INTERHEART risk score and HR response to breathing maneuver to rule out the presence of inducible myocardial perfusion deficit [ Time Frame: June 2020 - August 2021 ]
    ROC analysis will provide an optimal cut-point value for the combination of INTERHEART risk score and HR response to breathing maneuver to identify its ability to rule out myocardial perfusion deficit


Other Outcome Measures:
  1. To compare the myocardial oxygenation changes in OS-CMR images between healthy volunteers and patients with suspected or known CAD [ Time Frame: June 2020 - August 2021 ]
    A student's t-test will compare the myocardial oxygenation changes between healthy volunteers and patients with suspected or known CAD

  2. To assess the relationship between myocardial oxygenation changes in OS-CMR images with perfusion deficit in adenosine stress first-pass perfusion MRI [ Time Frame: June 2020 - August 2021 ]
    Pearson Correlation Coefficient will assess the correlation between myocardial oxygenation changes in OS-CMR with perfusion deficits in adenosine stress first-pass perfusion MRI


Eligibility Criteria
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Ages Eligible for Study:   35 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Sampling Method:   Probability Sample
Study Population
Healthy volunteers and patients with known or suspected Coronary Artery Disease (CAD) aged more than 35.
Criteria

Inclusion Criteria:

  • Healthy volunteers:

    1. Aged > 35
    2. No known current or pre-existing problems that would affect the cardiovascular or respiratory system

Patient population:

  1. Aged > 35
  2. Clinically indicated referral for adenosine stress first-pass perfusion MRI in subjects with known or suspected coronary artery disease

Exclusion Criteria:

Healthy Volunteers:

  1. MR incompatible devices such as pacemakers, defibrillators, implanted material, or foreign bodies.
  2. Consumption of caffeine (coffee, tea, cocoa, chocolate, "energy drink") during the 12 hours prior to the exam
  3. Presence of cardiovascular disease.
  4. Regular nicotine consumption during the last 6 months

Patient Population:

  1. MR incompatible devices such as pacemakers, defibrillators, implanted material, or foreign bodies.
  2. Vasoactive medication (e.g. nitrate, beta-blocker, calcium channel blocker) during the 12 hours prior to the exam.
  3. Consumption of caffeine (coffee, tea, cocoa, chocolate, "energy drink") during the 12 hours prior to the exam
  4. Acute Coronary Syndrome (ACS), or previous Coronary Artery Bypass Surgery
  5. Previous myocardial infarction within one month
  6. Clinically unstable condition
  7. Significant or uncontrolled arrhythmia
  8. Patients who are pregnant
  9. Active myocarditis, constrictive pericarditis, any cardiomyopathy, cardiac or systemic amyloidosis
  10. Left bundle branch block (LBBB)
  11. Established valvular regurgitation or stenosis abnormality above moderate severity
  12. Patients with a known history of heart failure (Ejection fraction<40%)
Contacts and Locations
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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): NCT05516615


Locations
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Canada, Quebec
The Research Institute of the McGill University Health Center Recruiting
Montréal, Quebec, Canada, H4A 3J1
Contact: Mahya Khaki    (438) 408-2473    mahya.khaki@mail.mcgill.ca   
Contact: Elizabeth Konidis    514-934-1934 ext 37305    elisavet.konidis@muhc.mcgill.ca   
Principal Investigator: Matthias Friedrich         
Sponsors and Collaborators
McGill University Health Centre/Research Institute of the McGill University Health Centre
More Information
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Responsible Party: Matthias Friedrich, Principal Investigator, McGill University Health Centre/Research Institute of the McGill University Health Centre
ClinicalTrials.gov Identifier: NCT05516615    
Other Study ID Numbers: 2020-6487
First Posted: August 25, 2022    Key Record Dates
Last Update Posted: March 15, 2023
Last Verified: March 2023
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Additional relevant MeSH terms:
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Coronary Artery Disease
Coronary Disease
Myocardial Ischemia
Heart Diseases
 Cardiovascular Diseases
Arteriosclerosis
Arterial Occlusive Diseases
Vascular Diseases