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Phenotype Identification Based on Multimodal MRI Analysis of Patients With Bronchial Obstructive Diseases

Not Applicable
Active, not recruiting
Conditions
Asthma Copd
Registration Number
NCT04341701
Lead Sponsor
University Hospital, Bordeaux
Brief Summary

The hypothesis is that pulmonary and cardiac proton MRI allows phenotyping of patients with bronchial obstruction by cluster analysis based on quantitative multimodal imaging of bronchi, pulmonary vessels, pulmonary parenchyma, right and left ventricular function, myocardial fibrosis and pulmonary arterial pressure.

Such imaging will also offer the advantage of being non-irradiating and without contrast products, which will ultimately allow CT to be replaced by MRI in the follow-up of bronchial obstructive patients, thus avoiding the risks associated with repeated exposure to ionizing radiation.

Detailed Description

Bronchial obstructive diseases such as asthma and chronic obstructive pulmonary disease (COPD) are very common and represent a major public health problem. The distinction between these two diseases is sometimes difficult. In each of these diseases, several clinical phenotypes or biological endotypes have been defined. For example, frequent exacerbating patients and / or hypereosinophilic patients are present in both diseases. In the severe states, cardiovascular comorbidities are the most frequent comorbidities and alter the prognosis.

In these chronic obstructive patients, computed tomography (CT) allows a multimodal analysis of the bronchial wall, the lung parenchyma and pulmonary vessels. CT also allows a score analysis of coronary plaques. However, irradiation is significant and increases with repeated examinations. CT does not allow a comprehensive analysis of cardiac function, or an estimate of pulmonary artery pressure.

Magnetic Resonance Imaging (MRI) is a proton non-ionizing alternative to CT, in particular when using 3D ultra-short echo-time (UTE) sequences. These 3D-UTE sequences decrease the effects of magnetic susceptibility and provide morphological and morphometric information on bronchi and lung comparable to those obtained by CT. Moreover, dedicated sequences add functional information on bronchi. Heart MRI allows more analyses, such as right and left ventricular systolic functions, an indirect estimate of pulmonary arterial pressure and the amount of diffuse myocardial fibrosis.

Our project aims to identify morphological phenotypes through the pulmonary and heart MRI in patients with obstructive lung disease

.

Recruitment & Eligibility

Status
ACTIVE_NOT_RECRUITING
Sex
All
Target Recruitment
100
Inclusion Criteria
  • Man or woman aged between 40 and 70 years.
  • Having benefited under the current care of spirometry showing FEV / FVC pre-bronchodilation <0.70 at steady state (i.e., without exacerbation from at least 4 weeks).
  • Having a diagnosis of asthma according to GINA 2019 without smoking restrictions or COPD according to GOLD 2019 but unrestricted to any level of bronchial reversibility to bronchodilator established by the pulmonologist.
  • On stable cardiopulmonary medications for at least 4 weeks
  • Having given his written informed consent.
Exclusion Criteria
  • Subject deprived of liberty by judicial or administrative decision.
  • Major protected by law.
  • Subject not affiliated to a social security scheme, whether or not the beneficiary of such a regime.
  • Pregnant or breastfeeding women
  • Inability to complete the Questionnaire SF-36 and SGQLQ.
  • Subject in times of exclusion in relation to another protocol.
  • History of pulmonary fibrosis, primary pulmonary hypertension and cystic fibrosis.
  • History of lung resection (referred to oncological or volume reduction)
  • History of cancer except skin cancer (squamous and Basal) under 5 years
  • History of chest radiation
  • Pacemaker carrier subject or implantable defibrillator, intraocular metallic foreign body, metal clip intracranial, heart valve prosthesis kind Starr-Edwards pre-6000, or biomedical insulin pump type device, Neurostimulator or cochlear implant, Metal patches.
  • Subject claustrophobic or unable to stay elongate during 30 minutes.
  • Subject with a waist circumference greater than 200 cm.
  • Occurrence of an exacerbation between the FE and MRI
  • Uninterpretable MRI

Study & Design

Study Type
INTERVENTIONAL
Study Design
PARALLEL
Primary Outcome Measures
NameTimeMethod
Determine the number of the clustersDay 30

Number of the clusters will be defined using principal component analysis and dendrogram, based on the multimodal lung and heart MRI analysis

Determine the Quality of the clustersDay 30

Quality of the clusters will be defined using Dunn index and non-hierarchical analysis based on the multimodal lung and heart MRI analysis

Secondary Outcome Measures
NameTimeMethod
Determine the value of blood total IgEday 1
Determine of slow Vital Capacity (VC) during spirometry before and after bronchodilatorday 1
Determine of Forced Expiratory Volume in one sec (FEV-1) during spirometry before and after bronchodilatorday 1

Assessment of FEV-1/FVC during spirometry before and after bronchodilator

Determine the value of blood total IgE atday 1
Assessment of tobacco consumptionDay 1
Assessment of disease durationDay 1
Evaluation score of SF-36 questionnaireDay 1

Determine the quality of life. SF36: 36-Item Short Form health survey Minimum = 0 and maximum = 100 Higher score means better outcome

Determine of Forced Vital Capacity (FVC) during spirometry before and after bronchodilatorday 1

Assessment of FEV-1/FVC during spirometry before and after bronchodilator

Determine of Functional Residual Capacity (FRC) during spirometry before and after bronchodilatorday 1
Determine the value of blood B-type natriuretic peptideday 1
Evaluation with St Georges Quality of Life QuestionnaireDay 30

Determine the quality of life. Minimum = 0 and maximum = 100 Higher score means worse outcome

Evaluation of comorbiditiesDay 1

The presence of various comorbidities will be checked in a yes/No manner :

* rhinitis

* sinusitis

* nasal polyposis

* gastroesophageal reflux

* obstructive sleep apnea

* depression

* anxiety

* allery

* heart failure (Left or Right)

* hypertension

* myocardial infarction

* stroke

* arteriopathy

* arythmia

* diabetis

* dyslipidaemia

* obesity

* denutrition

* osteoporosis

Determine of Total Lung Capacity (TLC) during spirometry before and after bronchodilatorday 1
Determine of Residual Volume (RV) during spirometry before and after bronchodilatorday 1
Assessment of ageDay 1
Assessment of sexeDay 1
Determine the value of blood eosinophilsday 1
Determine the value of blood C-reactive proteinday 1
Determine of Carbon monoxide transfer capacity (TLCO)day 1
Determine the value of blood heamoglobinday 1

Trial Locations

Locations (6)

Centre hospitalier de la Côte Basque

🇫🇷

Bayonne, France

Clinique Saint Augustin

🇫🇷

Bordeaux, France

Centre Médical Toki Eder

🇫🇷

Cambo-les-Bains, France

Hôpital Le Cluzeau - CHU de Limoges

🇫🇷

Limoges, France

Centre de Pneumologie Bordeaux Rive droite

🇫🇷

Lormont, France

Hôpital Haut-Lévêque - CHU de Bordeaux

🇫🇷

Pessac, France

Centre hospitalier de la Côte Basque
🇫🇷Bayonne, France

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