Heart Failure
Conditions
Keywords
Heart Failure, Hypertrophy, Fibrosis, Magnetic Resonance
Brief summary
The investigators hypothesised that novel MRI metrics derived from myocardium post-gadolinium T1 mapping analysis will improve the current knowledge about the role interstitial fibrosis and cardiomyocyte hypertrophy in the development of left ventricular (LV) remodelling and clinical Heart Failure (HF). The investigators believe that these recently described variables will be associated with prognostically important indices in HF development.
Detailed description
Cardiac hypertrophy is one of the earliest manifestations of myocardial disease, representing a modifiable, prognostic response to hemodynamic stimuli across physiologic (e.g., exercise) and pathologic states (e.g., hypertension, aortic stenosis). The extent of myocardial hypertrophy is determined by a combination of cardiomyocyte size and extracellular volume (ECV) expansion/interstitial fibrosis: while physiologic (exercise-induced) hypertrophy reflects mostly reversible cardiomyocyte hypertrophy, pathologic hypertrophy (e.g., in heart failure) is a combination of both interstitial fibrosis (potentially irreversible) and cardiomyocyte hypertrophy (reversible). Current methods to delineate the potential for LV reverse remodeling (e.g., natriuretic peptides and echocardiographic or clinical markers) detect primarily advanced disease, missing a critical opportunity to intervene and follow patients at an early disease phase where myocardial pathology may be reversible. Therefore, establishing novel, quantitative metrics of myocardial tissue phenotype that define a transition from hypertrophy to fibrosis, and then to irreversible LV remodeling/dysfunction may facilitate targeting therapies at a modifiable stage of disease in HF. The investigator's group has recently extended cardiac T1 mapping MRI techniques to quantify the intracellular lifetime of water (τic) serially as an index of cardiomyocyte diameter, validating this technique histologically in mouse models of pressure overload.
Interventions
OTHERAerobic exercise in treadmill
30-40min of aerobic exercise in treadmill. The aerobic intensity will be established by heart rate levels that corresponded to anaerobic threshold up to 10% below the respiratory compensation point obtained in the cardiopulmonary exercise test. This intensity corresponded to 60-72% peak V̇o2. During the exercise sessions, when a training effect will be observed, as indicated by a decrease by 8 to 10% in heart rate, the treadmill velocity or inclination will be increased to return to the target heart rate levels.
15 min of local strengthening exercises will be performed in major muscle groups (legs, arms and trunk muscles): three series of each exercise, 12-15 repetitions.
OTHERStretching exercises
5-min stretching exercises will be performed in major muscle groups (legs, arms and trunk muscles)
Sponsors
University of Campinas, Brazil
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Randomized trial in a 2:1 (intervention:control) proportion and in blocks of 6 participants.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age\> 18 years * Functional limitation (New York Heart Association Class II or worse) * No contraindication to exercise (American College of Cardiology / American Heart Association criteria) * Eligibility to take MRI (absence of metallic devices, and glomerular filtration rate \> 40ml / min / 1.73m2, etc.) * Prior diagnosis of Heart Failure (by the Framingham criterion) * Therapy with diuretic and euvolemia state (evaluated by cardiologist and cardiopulmonary exercise testing) * Transthoracic echocardiogram
Exclusion criteria
* Severe ischemia in any stress test * Hypertrophic cardiomyopathy or any infiltrative heart disease * Chronic obstructive pulmonary disease , pulmonary hypertension (Pulmonary artery pressure\> 60mmHg) * Severe left or right valve disease. * Pacemaker or implantable cardioverter defibrillator * Myocardial infarction or revascularization in 3 months * Anemia (hemoglobin \<10 grams / dl) until 1 month before cardiopulmonary exercise testing
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Myocardial remodeling assessed by CMR in rehabilitation vs usual care. | 4 months | Investigate whether rehabilitation compared to usual care is associated with significant favorable myocardial remodeling assessed by CMR determination of ECV. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in left ventricular ejection fraction | 4 months | Left Ventricular ejection fraction (%) will be determined by cardiac magnetic resonance using a previously described cine steady-state free precession imaging. All patients will be imaged with ECG gating and breath holding in a supine position. Patients will be imaged at baseline and after 4 months of the intervention. |
| Change in right ventricular ejection fraction | 4 months | Right Ventricular ejection fraction (%) will be determined by cardiac magnetic resonance using a previously described cine steady-state free precession imaging. All patients will be imaged with ECG gating and breath holding in a supine position. Patients will be imaged at baseline and after 4 months of the intervention. |
| Change in left ventricular mass (absolute/index) | 4 months | Left ventricular mass absolute (g) and index (g/m2) will be determined by cardiac magnetic resonance using a previously described cine steady-state free precession imaging. All patients will be imaged with ECG gating and breath holding in a supine position. Patients will be imaged at baseline and after 4 months of the intervention. |
| Change in left ventricular diastolic volume (absolute/index) | 4 months | Left ventricular diastolic volume absolute (ml) and index (ml/m2) will be determined by cardiac magnetic resonance using a previously described cine steady-state free precession imaging. All patients will be imaged with ECG gating and breath holding in a supine position. Patients will be imaged at baseline and after 4 months of the intervention. |
| Change in right ventricular diastolic volume (absolute/index) | 4 months | Right ventricular diastolic volume absolute (ml) and index (ml/m2) will be determined by cardiac magnetic resonance using a previously described cine steady-state free precession imaging. All patients will be imaged with ECG gating and breath holding in a supine position. Patients will be imaged at baseline and after 4 months of the intervention. |
| Change in left ventricular systolic volume (absolute/index) | 4 months | Left ventricular systolic volume absolute (ml) and index (ml/m2) will be determined by cardiac magnetic resonance using a previously described cine steady-state free precession imaging. All patients will be imaged with ECG gating and breath holding in a supine position. Patients will be imaged at baseline and after 4 months of the intervention. |
| Change in right ventricular systolic volume (absolute/index) | 4 months | Right ventricular systolic volume absolute (ml) and index (ml/m2) will be determined by cardiac magnetic resonance using a previously described cine steady-state free precession imaging. All patients will be imaged with ECG gating and breath holding in a supine position. Patients will be imaged at baseline and after 4 months of the intervention. |
| Change in left ventricular stroke volume (absolute/index) | 4 months | Left ventricular stroke volume absolute (ml) and index (ml/m2) will be determined by cardiac magnetic resonance using a previously described cine steady-state free precession imaging. All patients will be imaged with ECG gating and breath holding in a supine position. Patients will be imaged at baseline and after 4 months of the intervention. |
| Change in diastolic dysfunction assessed by transthoracic echocardiogram | 4 months | Change in parameters of diastolic dysfunction assessed before and after the intervention. |
| Change in late gadolinium enhancement | 4 months | Late gadolinium enhancement (LGE) will be determined by cardiac magnetic resonance using a previously describe inversion recovery sequence after 10-15 minutes of a cumulative dose of 0,2 mmol/kg of gadolinium diethylenetriamine pentaacetic acid. All patients will be imaged with ECG gating and breath holding in a supine position. Patients will be imaged at baseline and after 4 months of the intervention. |
| Change in LV mass/volume ratio | 4 months | LV mass/volume ratio (g/mL) will be determined by cardiac magnetic resonance using a previously described cine steady-state free precession imaging. All patients will be imaged with ECG gating and breath holding in a supine position. Patients will be imaged at baseline and after 4 months of the intervention. |
| Change in functional capacity | 4 months | VO2max will be evaluated by cardiopulmonary test. Patients will performed the cardiopulmonary test at baseline and after 4 months of the intervention. |
| Change in quality of life | 4 months | Quality of life will be evaluated by numerical score of Minnesota Questionnaire. Patients will performed the Minnesota Questionnaire at baseline and after 4 months of the intervention. |
| Change in N-Terminal pro-B-type Natriuretic Peptide (NT-proBNP) | 4 months | Change in NT-proBNP with the intervention. |
| Change in cardiac sympathetic function | 4 months | Change in cardiac sympathetic function assessed by cardiac uptake of metaiodobenzylguanidine (MIBG) labeled with I-123. Patients will performed the MIBG study at baseline and after 4 months of the intervention. |
| Change in intracellular lifetime of water (τic - a marker of cardiomyocyte hypertrophy) | 4 months | τic will be determined by cardiac magnetic resonance T1 measurements acquired before and after administration of gadolinium diethylenetriamine pentaacetic acid (0,2mmol/kg), at 2 different time points (baseline and 4-moths after the intervention) |
| Change in right ventricular stroke volume (absolute/index) | 4 months | Right ventricular stroke volume (absolute (ml) and index (ml/m2) will be determined by cardiac magnetic resonance using a previously described cine steady-state free precession imaging. All patients will be imaged with ECG gating and breath holding in a supine position. Patients will be imaged at baseline and after 4 months of the intervention. |
Countries
Brazil
Contacts
Primary ContactOTAVIO R COELHO-FILHO, MD, MPH, PhD
Backup ContactFERNANDO B CARDOSO, MD
Outcome results
None listed