Comparison of Differencens in VO2-max, Perfusion of the Heart and Brain and Cognitive Performance Between Patients with Type 2 Diabetes and Healthy Age Matched Controls.
- Conditions
- Microvascular DiseaseMicrovascular ComplicationsDementiaDiabetes Mellitus Type 2Cerebral Hypoperfusion
- Interventions
- Diagnostic Test: PET
- Registration Number
- NCT06628297
- Lead Sponsor
- University Hospital Bispebjerg and Frederiksberg
- Brief Summary
In the aging population, ischemic heart disease, stroke and dementia are increasingly prevalent. Diagnosis and treatment of the former two i.e., large-vessel coronary heart disease and endovascular thrombectomy of the brain in relation to stroke have improved significantly. Yet, the majority of elderly patients with ischemic heart disease do not have large-vessel heart disease and it seems that small vessel disease (SVD) may explain a large fraction of these cases as well as the cardiovascular morbidity in the elderly. Hence, the current development in diagnostics and treatments of ischemic heart disease does not address the most common subtype of ischemic disease seen in elderly patients.
It has been suggested that SVD is part of a multisystem disorder and several systematic reviews have addressed the hypothesis of a potential link between small vessel disease of the heart, brain, and kidneys. Cerebral SVD is prevalent in the aging population causing cognitive impairment, dementia, and an increased risk of stroke, and cerebral hypoperfusion is an acknowledged cause of vascular dementia and a possible cause of Alzheimer's disease. Further, cognitive impairment within multiple cognitive domains is highly prevalent in heart failure and is associated to an increased risk of dementia. The link between heart failure and dementia may be due to multisystem SVD, although a direct link between the two is possible.
Among other known risk factors such as age, hypertension, and female sex, diabetes is a major cause of SVD and is linked to coronary heart disease as well as cognitive impairment. The diagnosis of cerebral SVD relies on MRI detecting infarctions, haemorrhages, microbleeds and ischemic white matter changes, i.e. Fazekas score. In contrast, perfusion PET is used to image myocardial perfusion in patients with coronary SVD; and coronary SVD is recognized as a part of the pathophysiology in angina, coronary artery disease, and heart failure. Perfusion PET before and after adenosine-induced vasodilation allows for measuring, the myocardial flow reserve (MFR), i.e. perfusion capacity, which in the absence of regional perfusion defects, is a measure of coronary SVD. Prof. Eva Prescott have recently shown that reduced MFR obtained by 82Rb PET is a strong predictor of future microvascular events and all-cause mortality.
Exercise is well known to improve cognitive health but professor Carl-Johan Boraxbekk has shown that the effect on cognitive performance may be dependent on the initial cerebrovascular status, as patients with moderate to severe white matter changes did not improve after a 6 months physical activation intervention in contrast to patients with mild changes. Yet, it is possible to improve brain function in diabetic patients through either dietary or exercise interventions.
Systemic SVD is measured as cerebral SVD (reduced brain perfusion during acetazolamide-induced vasodilation) and coronary SVD (reduced heart perfusion during adenosine-induced vasodilation). The researchers anticipate that patients with type 2 dabetes have reduced perfusion capacity of the brain and heart correlating to reduced cognition and cardiorespiratory fitness (VO2-max).
- Detailed Description
The goal of this clinical trial is to compare baseline measurements relevant to microvascular disease between patients with diabetes and increased risk of microvascular disease with healthy age-matched control.
The researchers wish to examine if small vessel disease is a disease that affects several organs at once in the same individuals by examining it in the brain and heart in the same participants. The researchers will also test if cardiorespiratory conditioning (VO2-max), blood perfusion to the heart and brain and cognitive performance are correlated in patients with microvascular disease.
To adress these aims the researchers have defined the following assumptions that they will refute or confirm through this study:
* Patients with type 2 diabetes and increased risk of small vessel disease have significantly reduced perfusion capacity of the brain and heart compared to healthy controls as part of a multisystem disease
* Perfusion capacity of the brain and heart, the cardiorespiratory fitness level of the subjects and cognitive performance are directly linked.
48 patients with diabetes and 24 healthy age-matched controls will undergo baseline testing that include:
* Cardiopulmonal Exercise Test (CPET) to determine cardiopulmonal conditioning (VO2-max)
* Isometric knee strength (if logistically possible)
* Echocardiography
* Blood perfusion capacity of the heart and brain via \[15O\]H2O-PET scans
* Brain MRI to determine structural damages
* Blood samples for basic health check (relevant to inclusion, exclusion and safety) and blood samples looking at endothelial and neurological damage for a biobank
* Cognitive testing (SCIP-D and CANTAB)
Afterwards the researchers will compare the results between the two groups and see if there is a correlation between VO2-max, blood perfusion to the heart and brain and cognitive performance.
Recruitment & Eligibility
- Status
- NOT_YET_RECRUITING
- Sex
- All
- Target Recruitment
- 72
Not provided
Not provided
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Arm && Interventions
Group Intervention Description 48 patients with type 2 diabetes and increased risk of microvascular disease PET Baseline measurements of: * \[15O\]H2O PET of heart and brain * Blood sampling * Echocardiography * Brain MRI * Cognitive tests * Cardiorespiratory fitness test * Muscular function test 24 healthy age-matched participants PET Baseline measurements of: * \[15O\]H2O PET of heart and brain * Blood sampling * Echocardiography * Brain MRI * Cognitive tests * Cardiorespiratory fitness test * Muscular function test
- Primary Outcome Measures
Name Time Method [15O]H2O PET assessment of the blood perfusion to the brain From baseline testing to end of study, 6 months We will use the scan to determine our primary outcome: Blood perfusion to the brain. Radioactive water (\[15O\]H2O) will be used as a PET-tracer since it follows the blood and is the gold standard tracer for PET-based blood perfusion measurements. We measure the blood perfusion of both the brain as the perfusion capacity, meaning the difference between blood perfusion to the organ at rest and the maximally possible perfusion. In the brain we use injection of diamox to stimualte maximal dilation of the cerebral arteries which corresponds to the maximally possible perfusion of the brain.
[15O]H2O PET assessment of the blood perfusion of the heart From baseline testing to end of study, 6 months We will use the scan to determine our primary outcome: Blood perfusion to the heart.
Radioactive water (\[15O\]H2O) will be used as a PET-tracer since it follows the blood and is the gold standard tracer for PET-based blood perfusion measurements.
We measure the blood perfusion of both the heart as the perfusion capacity, meaning the difference between blood perfusion to the organ at rest and the maximally possible perfusion. In the heart we use injection of adenosin to stimualte maximal dilation of the coronary arteries which corresponds to the maximally possible perfusion of the heart.
- Secondary Outcome Measures
Name Time Method Cognitive performance (CANTAB) From baseline testing to end of study, 6 months Testing of a broad range of cognitive functions. The test is tablet based and one of the most \"investigator-independent\" cognitive tests available. The test takes around 45 minutes to perform.
Cognitive Performance (SCIP-D) From baseline testing to end of study, 6 months Assessed via SCIP-D in order to evaluate a broad range of cognitive areas in around 15-20 minutes. Both groups will undergo both tests. The primary investigator will receive learning in how to carry out the SCIP-D correctly.
SCIP-D is a more clinically relevant test that can be used in a clinical setting to identify patients with cognitive dysfunction.Cardiorespiratory fitness (VO2-max) From baseline testing to end of study, 6 months Will be assessed as the maximal or peak oxygen consumption (VO2-max or VO2-peak) during a cardiopulmonal exercise test (CPET).
Trial Locations
- Locations (1)
Bispebjerg and Frederiksberg Hospital
š©š°Copenhagen, Denmark