Clinical Trial: Study Looking at the Recovery of New Onset Cardiomyopathy
Study Status: Completed
Recruit Status: Completed
Study Type: Observational
Official Title: Genetic Modulation of Left Ventricular Recovery in Recent Onset Cardiomyopathy
Brief Summary:
This is a multi-center, prospective evaluation of left ventricular recovery on conventional therapy in patients with the recent onset of dilated cardiomyopathy. In some subjects with this disorder, the heart will recover significantly over the first year, while others will be left with a chronically weak heart. The proteins that help the heart recover are encoded by genes, which can differ markedly between individuals. The goal of the current study is to determine whether variation in these genes involved affect the probability that the heart will recover. We will also look at which genes are involved in inflammation and which ones are "turned on" (producing proteins) in circulating white blood cells.{These statements will only be added if the site has chosen to participate in RNA analysis}. In addition, this study will look at how levels of proteins in the blood, proteins called "cytokines' which control inflammation and proteins called "neurohormones" which are released when the heart weakens, affect the likelihood of recovery.
Enrollment will take place at 15 centers. The goal is to enroll approximately 500 adult subjects (age 18 years or older, both men and women) over the course of approximately 48 months.
Detailed Summary:
After presenting with new onset idiopathic dilated cardiomyopathy, one third of patients experience dramatic recovery of left ventricular function, while for the majority chronic heart failure and left ventricular dysfunction persist. This marked variation in clinical outcomes is determined in part by genetic heterogeneity of the systemic response to myocardial injury. This population has been excluded from most clinical trials and few studies have examined the role of cytokine and neurohormonal mediators in modulating the balance between left ventricular recovery and remodeling in early cardiomyopathy. This proposal will investigate whether genetic polymorphisms of inflammatory and neurohormonal mediators influence subsequent clinical outcomes for patients with recent onset primary (idiopathic) dilated cardiomyopathy. The study will enroll 500 patients with recent onset left ventricular dysfunction (LVEF < 0.40) due to non-ischemic primary cardiomyopathy at eleven centers and follow these patients prospectively to evaluate subsequent left ventricular recovery and freedom from clinical events.
Specific aim 1 will be to determine the correlation of echocardiographic parameters of systolic and diastolic functional entry with circulating inflammatory mediators: TNF, IL-6 and TNF receptors 1 and 2. Specific aim 2 will be to determine the predictive value of early plasma TNFα levels and of left ventricular size by transthoracic echo at baseline in predicting improvements in left ventricular ejection function (LVEF) at 6 months. Specific aim 3 will evaluate the effects of the TNFA 1/2 promoter polymorphism on circulating plasma TNF levels and its influence on subsequent improvement in LVEF. Specific aim 4 will look at the impact of the deletion allele of the angiotensin-converting enzyme and the genetic variation of beta 1 and beta 2 adrenergic receptors on left ventric
Sponsor: University of Pittsburgh
Current Primary Outcome: The primary objective of this study is to determine whether variation in genetic background influences clinical outcomes in new onset cardiomyopathy. [ Time Frame: 5 years ]
Original Primary Outcome: Same as current
Current Secondary Outcome: Determine whether cytokine or echo parameters can predict who will have significant recovery left ventricular function. [ Time Frame: 5 years ]
Original Secondary Outcome: Same as current
Information By: University of Pittsburgh
Dates:
Date Received: December 14, 2007
Date Started: January 2004
Date Completion:
Last Updated: January 14, 2016
Last Verified: January 2016
