Myocardial Contrast Echocardiography for the Assessment of the Infarct Related Artery & Risk Area in Patients w/ NSTEMI.
| Status: | Completed |
|---|---|
| Conditions: | Cardiology |
| Therapuetic Areas: | Cardiology / Vascular Diseases |
| Healthy: | No |
| Age Range: | 31 - 90 |
| Updated: | 4/2/2016 |
| Start Date: | August 2012 |
| End Date: | March 2014 |
Incremental Utility of Myocardial Contrast Echocardiography for the Assessment of the Infarct Related Artery and Risk Area in Patients With Non-ST Segment Elevation Myocardial Infarction.
The goal of this study will be to assess the incremental benefit of myocardial contrast
echocardiography for the assessment of regional wall motion abnormalities and
infarct-related artery in patients presenting with their first NSTEMI.
echocardiography for the assessment of regional wall motion abnormalities and
infarct-related artery in patients presenting with their first NSTEMI.
Patients presenting with NSTEMI who are scheduled to undergo elective cardiac
catheterization and coronary angiography with primary PCI will be selected for participation
in the study. The patients will undergo a clinically indicated resting non-contrast
echocardiogram to assess LV function and regional wall motion. They will then undergo
contrast echocardiography with bolus injection of Optison™ contrast to reassess LV ejection
fraction, improve LV opacification and assess regional wall motion abnormalities. Finally,
they will be given a continuous infusion of Optison™ and will have assessment of myocardial
perfusion of each of the 17 myocardial segments using low mechanical index continuous
imaging of the myocardium and blood pool.
Two expert echocardiographers will be asked to review in a blinded fashion the non-contrast
echocardiogram, interpret the ejection fraction, and assess regional wall motion
abnormalities in each of the 17 myocardial segments. They will then be asked to predict the
infarct-related artery (either LAD, LCx, or RCA).
A proposed sample size of 100 patients presenting to Cedars-Sinai Medical Center with their
first NSTEMI will be studied. Based on hospital volume, approximately 4-5 NSTEMI patients
present to Cedars-Sinai on a weekly basis, of which at least 2 will be eligible per week.
Based on this trend, we feel we can achieve the necessary sample size within 12 months.
Inclusion criteria will be patients aged 31-90 presenting with World Health Organization
diagnosis of non-ST segment elevation myocardial infarction, which encompass 2 out of the
following 3 criteria: a clinical history of chest pain unrelieved by nitroglycerin, ECG
evidence of cardiac ischemia (ST segment depression or T wave inversion), and enzymatic
evidence of myocardial infarction (elevation of TnI or CKMB). Patients should be clinically
eligible for coronary angiography.
catheterization and coronary angiography with primary PCI will be selected for participation
in the study. The patients will undergo a clinically indicated resting non-contrast
echocardiogram to assess LV function and regional wall motion. They will then undergo
contrast echocardiography with bolus injection of Optison™ contrast to reassess LV ejection
fraction, improve LV opacification and assess regional wall motion abnormalities. Finally,
they will be given a continuous infusion of Optison™ and will have assessment of myocardial
perfusion of each of the 17 myocardial segments using low mechanical index continuous
imaging of the myocardium and blood pool.
Two expert echocardiographers will be asked to review in a blinded fashion the non-contrast
echocardiogram, interpret the ejection fraction, and assess regional wall motion
abnormalities in each of the 17 myocardial segments. They will then be asked to predict the
infarct-related artery (either LAD, LCx, or RCA).
A proposed sample size of 100 patients presenting to Cedars-Sinai Medical Center with their
first NSTEMI will be studied. Based on hospital volume, approximately 4-5 NSTEMI patients
present to Cedars-Sinai on a weekly basis, of which at least 2 will be eligible per week.
Based on this trend, we feel we can achieve the necessary sample size within 12 months.
Inclusion criteria will be patients aged 31-90 presenting with World Health Organization
diagnosis of non-ST segment elevation myocardial infarction, which encompass 2 out of the
following 3 criteria: a clinical history of chest pain unrelieved by nitroglycerin, ECG
evidence of cardiac ischemia (ST segment depression or T wave inversion), and enzymatic
evidence of myocardial infarction (elevation of TnI or CKMB). Patients should be clinically
eligible for coronary angiography.
Inclusion Criteria:
Patients presenting with NSTEMI who are scheduled to undergo elective cardiac
catheterization and coronary angiography with primary PCI
Exclusion Criteria:
Inability to undergo a contrast echocardiogram Unwillingness to consent to a contrast
echocardiogram
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