The Right Ventricle in Chronic Pressure Overload: Identifying Novel Molecular Targets for Functional Imaging

Not Applicable

Completed

• Conditions: Chronic Thromboembolic Pulmonary Hypertension
• Interventions: Procedure: Right ventricular biopsies

• Registration Number: NCT03199131
• Lead Sponsor: Centre Chirurgical Marie Lannelongue

Brief Summary

Chronically elevated pulmonary pressures do not immediately result in right ventricular failure. During the initial period of exposure, the RV adapts to the increased afterload by altering its metabolism and morphology so as to meet the increased work requirement. Several, interconnected adaptive mechanisms have been proposed, including myocyte hypertrophy, a switch in the primary fuel used for ATP generation, increased angiogenesis, and decreased production of mitochondrial reactive oxygen species. While adaptation is initially successful in many cases, it is temporary, and after an uncertain period of time, the ventricle begins to fail. This transition from a compensated to decompensated state is difficult to predict clinically, and patients with different etiologies of CPOS progress to overt RV failure over significantly different time periods. This variability hinders the implementation of treatments that are tailored to a specific disease stage.

Detailed Description

Chronically elevated pulmonary pressures do not immediately result in right ventricular failure. During the initial period of exposure, the RV adapts to the increased afterload by altering its metabolism and morphology so as to meet the increased work requirement. Several, interconnected adaptive mechanisms have been proposed, including myocyte hypertrophy, a switch in the primary fuel used for ATP generation, increased angiogenesis, and decreased production of mitochondrial reactive oxygen species. While adaptation is initially successful in many cases, it is temporary, and after an uncertain period of time, the ventricle begins to fail. This transition from a compensated to decompensated state is difficult to predict clinically, and patients with different etiologies of CPOS progress to overt RV failure over significantly different time periods. This variability hinders the implementation of treatments that are tailored to a specific disease stage. As right heart failure is the primary outcome determinant in patients with pulmonary hypertension, understanding the major mediators of RV compensation, failure and recovery is essential to improving patient survival. Recently, there have been significant advances in the ability to assess RV function in vivo using functional imaging techniques, including positron emission tomography (PET) and cardiac MRI (CMR). CMR is an established and validated method of precisely defining cardiac structure and function, and new PET protocols have been developed that measure glucose utilization, oxygen consumption, apoptosis and angiogenesis. Importantly, the in vivo nature of PET and CMR allow for the non-invasive collection of detailed structural, metabolic and physiologic data on the performance of the RV5. When taken in combination with established echocardiographic evaluation, these new platforms allow in-depth analysis of cardiac structure and function without the need for invasive procedures. In order to maximize the potential of these techniques, however, a molecular imaging target needs to be identified so as to allow physicians to detect the transition from a compensated to decompensated state. Such a marker has not yet been reported

Study Timeline

• Study Start: 2017-02-20
• Study First Submitted: 2017-03-22
• Study First Submitted QC: 2017-06-23
• Study First Posted: 2017-06-26
• Primary Completion: 2017-11-20
• Study Completion: 2018-10-20
• Status Verified: 2020-01
• Last Update Submitted: 2020-01-21
• Last Update Posted: 2020-01-23

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 20

Inclusion Criteria

Chronic thromboembolic pulmonary hypertension group:

• Patients undergoing pulmonary endarterectomy at Marie Lannelongue Surgical Center for the treatment of chronic thromboembolic pulmonary hypertension.

Control group:

• Patients undergoing adult cardiac surgery without evidence of pulmonary hypertension on preoperative assessment

Exclusion Criteria

Chronic thromboembolic pulmonary hypertension group:

• Insufficient biopsy material,
• pre-operative therapy with bosentan or sildenafil

Control group:

• Insufficient biopsy sample,
• ischemic cardiomyopathy,
• miral or tricuspid valve disease,
• pre-operative pulmonary hypertension.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
CTEPH	Right ventricular biopsies	Patients undergoing pulmonary endarterectomy for the treatment of chronic thromboembolic pulmonary hypertension (CTEPH).
Control group	Right ventricular biopsies	Patients undergoing adult cardiac surgery without evidence of pulmonary hypertension.

Primary Outcome Measures

Name	Time	Method
relationship between the metabolic, morphologic and functional alterations in the right ventricle	to investigate the relationship between the metabolic, morphologic and functional alterations in the right ventricle before surgery,one and six months after surgery.

Secondary Outcome Measures

Name	Time	Method
validation in human subjects of metabolic signaling pathway alterations found in animal model	analyse gene and protein expression during surgery

Trial Locations

Locations (1)

Centre Chirurgical Marie Lannelongue; 🇫🇷 Le Plessis-Robinson, France