International Consortium for Multimodality Phenotyping in Adults With Non-compaction

Study Overview
=================
Brief Summary
-----------------
Non-compaction cardiomyopathy (NCCM) is a heterogeneous, poorly understood disorder characterized by a prominent inner layer of loose myocardial tissue, and associated with heart failure, stroke, severe rhythm irregularities and death. For a growing population diagnosed with NCCM there is a need for better risk stratification to appropriately allocate (or safely withhold) these impactful preventive measures. The goal of this international consortium is to improve care of patients with non-compaction cardiomyopathy. We hypothesize that comprehensive analysis of clinical, genetic, structural and functional information will improve risk stratification. In addition, we hypothesize that detailed structural analysis will allow for differentiation of pathological and benign patterns of non-compaction. In a large cohort of adult patients with suspected NCCM we will perform in-depth phenotyping, including clinical information, pedigree data, genetics, echocardiography and MRI, and follow patients for up to 3 years. We will apply machine-learning based analytics to develop predictive models and compare their performance to currently used models and treatment criteria. Secondly, in a subset of patients we will perform high-resolution cardiac CT for detailed structural characterization of the myocardial wall. We will investigate associations between myocardial structure and regional contractile function, as assessed by echo and MRI. The aim of this proposal is to identify a structural signature associated with pathological non-compaction and improve developed risk prediction models. Discovery of pathological structural signatures through innovative imaging techniques, in relation to myocardial contractility, will advance our understanding of NCCM.

Official Title
-----------------
International Consortium for Multimodality Phenotyping in Adults With Non-compaction

Conditions
-----------------
Non-Compaction Cardiomyopathy

Intervention / Treatment
-----------------
* Diagnostic Test: Echocardiography
* Diagnostic Test: Magnetic resonance imaging (MRI)
* Diagnostic Test: Computed tomography (CT)


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: ≥18 years old Hypertrabeculation of the left ventricle fulfilling the echo-based Jenni criteria of NCCM Clinical cardiac MRI examination performed or planned Exclusion Criteria (general cohort): Complex congenital disease (including transposition great arteries, tetralogy of Fallot, tricuspid atresia, truncus arteriosis, single ventricle, hypoplastic left heart, pulmonary atresia, double-outlet RV), neuromuscular disorders or isolated RV non-compaction Inability to provide informed consent Contra-indications to MRI, which apply if the clinical cardiac MRI has not yet been performed at the time of study enrollment: permanent pacemakers/ICDs, MRI contrast medium allergy, significant arrhythmia with highly irregular RR intervals, severe dyspnea with inability to lay flat/breath hold, inability to communicate with the MRI technician or follow commands for any reason (psychosis, agitation, etc.), other site-specific contra-indications to clinical MRI of the heart. Exclusion Criteria (cardiac CT examination): Age <21 years Decompensated heart failure, or otherwise clinically unstable BMI>40 kg/m2 Pregnancy (or cannot be ruled out) Known iodine contrast medium allergy Kidney dysfunction: eGFR<45 ml/min Thyroid disease: toxic multinodular goiter, Graves' disease, Hashimoto's thyroiditis

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Multimodality imaging<br>Patients who have undergone echocardiography and cardiac MRI as part of their clinical management A research cardiac CT scan will be performed in eligible participants | Diagnostic Test: Echocardiography<br>* Standard echocardiography exam performed as part of clinical management.<br>Diagnostic Test: Magnetic resonance imaging (MRI)<br>* Standard comprehensive cardiac MRI exam of the heart performed as part of clinical management.<br>Diagnostic Test: Computed tomography (CT)<br>* ECG-triggered, contrast-enhanced CT scan of the heart performed for research purposes in eligible study participants.<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Incidence of hard embolic adverse events | Clinical neuro/systemic embolic event by autopsy, imaging or specialist evaluation | Up to 4 years after enrollment | 
| Incidence of hard arrhythmic adverse events | Sudden death (aborted), appropriate ICD discharge or VT/VF on ECG or rhythm/device monitoring | Up to 4 years after enrollment | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Incidence of hard heart failure related adverse events | Heart failure death, cardiac transplantation or mechanical circulatory support | Up to 4 years after enrollment | 
| Incidence of composite of hard adverse events | Hard embolic, arrhythmic and heart failure related adverse events (as described above) | Up to 4 years after enrollment | 
| Incidence of all embolic adverse events | Hard embolic adverse events or transient neurologic event without objective infarction | Up to 4 years after enrollment | 
| Incidence of all arrhythmic adverse events | Hard arrhythmic adverse events or syncope without recorded arrhythmia | Up to 4 years after enrollment | 
| Incidence of all heart failure related adverse events | Hard heart failure related adverse events or resynchronization therapy, heart failure hospital admission | Up to 4 years after enrollment | 
| Incidence of composite of adverse events | All embolic, arrhythmic or heart failure related adverse events (as described above) | Up to 4 years after enrollment | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Computed tomography, Prognosis, Genetics, Echocardiography, Magnetic resonance imaging