Clinical trial NCT06652763: Manganese-enhanced Magnetic Resonance Imaging (MEMRI) in Heart Failure With Preserved Ejection Fraction
Official title: Manganese-enhanced Magnetic Resonance Imaging (MEMRI) in Heart Failure With Preserved Ejection Fraction
Study type: OBSERVATIONAL
Overall status: RECRUITING
Conditions: Heart Failure With Preserved Ejection Fraction
Type 2 Diabetes
Lead sponsor: University of Leicester
Sponsor class: OTHER
First posted: 2024-10-22
Enrollment: 60
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Observational model: CASE_CONTROL
Time perspective: CROSS_SECTIONAL
Sampling method: PROBABILITY_SAMPLE
Study population: Primary and secondary care patients

Brief summary: Heart failure with preserved ejection fraction (HFpEF) is a condition in which the heart cannot fill with blood effectively. As a result, people with HFpEF suffer fatigue, breathlessness, and develop swollen limbs. The condition often requires multiple admissions to hospital and is associated with a marked loss of lifespan.

Despite being so common, very little is known about why people develop HFpEF and there are hardly any known treatments. Type 2 diabetes (T2D) is a major risk factor for HFpEF, and people with both HFpEF and diabetes are at a heightened risk of hospitalisation and premature death. It is unclear why the combination of diabetes and HFpEF is particularly harmful. This may be related to the hearts of people with type 2 diabetes being unable to take up the mineral calcium properly, as well as due to their hearts being less energy efficient. Both of these are vital to heart muscle pumping and filling, but until recently it has not been possible to assess these in humans.

New advances in heart MRI scans, with dedicated scanner techniques and dyes (manganese contrast), now allow extremely detailed pictures of heart structure, function, calcium uptake and energy efficiency, all during the same scan. The investigators will enlist 40 volunteers with HFpEF (20 with T2D and 20 without T2D), and up to 20 healthy volunteers, to undergo a heart MRI scan with manganese contrast to assess calcium uptake and energy efficiency. This will allow the comparison of people with HFpEF with and without T2D, to see how their hearts are different to healthy volunteers.


Eligibility criteria: Inclusion Criteria:

* Capacity to provide informed consent
* Symptoms (e.g. breathlessness, orthopnoea, ankle swelling, fatigue), signs (e.g. elevated jugular venous pressure, peripheral oedema, third heart sound) or established diagnosis of HF with LV ejection fraction ≥ 50%, or
* Meets HFpEF diagnostic criteria in accordance with the HFA-PEFF diagnostic algorithm form the Heart Failure Association of the European Society of Cardiology, in which a score ≥5 points confirms diagnosis of HFpEF

Exclusion Criteria:

* Known diagnosis of Type 1 Diabetes
* Pregnancy or breast-feeding or females of child bearing age without a negative pregnancy test
* Receiving an investigational drug or device within 30 days prior to participating in the study
* Decompensated heart failure or pulmonary oedema
* History of prolonged corrected QT interval or torsades de pointes
* Second- or third-degree atrioventricular block
* Abnormal liver function tests (\> 3x upper limit of normal) or history of liver disease
* Baseline eGFR \< 30mL/min/1.73m2
* Any contraindications to MRI including implanted devices/pacemakers
* Severe native valve disease, restrictive cardiomyopathy, constrictive pericarditis or hypertrophic cardiomyopathy, myocarditis or takotsubo cardiomyopathy.
* Recent myocardial infarction within the previous 3 months
* Known diagnosis of pheochromocytoma

Primary outcomes:
measure: Ki
timeFrame: Baseline
Secondary outcomes:
measure: T1 values
timeFrame: Baseline
measure: Myocardial PCr/ATP ratio
timeFrame: Baseline
measure: Left ventricular ejection fraction
timeFrame: Baseline
measure: LV global longitudinal strain
timeFrame: Baseline
measure: LV global circumferential strain
timeFrame: Baseline
measure: LV PEDSR
timeFrame: Baseline
measure: LV mass
timeFrame: Baseline
measure: LV mass/volume ratio
timeFrame: Baseline
measure: Myocardial fibrosis
timeFrame: Baseline
measure: Myocardial Perfusion
timeFrame: Baseline
measure: Associations of Ki with resting PCr/ATP
timeFrame: Baseline
measure: Associations of exercise capacity with Ki and PCr/ATP in HFpEF
timeFrame: Baseline
measure: Plasma biomarkers of metabolic dysregulation, fibrosis and inflammation
timeFrame: Baseline
measure: 10-year outcomes
timeFrame: Baseline
Other outcomes:
Locations:
city: Leicester
country: United Kingdom
facility: University of Leicester
Study officials:
affiliation: University of Leicester
name: Gerry P McCann, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: University of Leicester
name: Abhishek Dattani, MBBS
role: PRINCIPAL_INVESTIGATOR
References: