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Coronary Microvascular DysfunctionFlash IIINCT05009667

A Prospective, Multi-center Clinical Trial for Evaluating the Effectiveness and Safety of Online Coronary Angiography-Derived Index of Microcirculatory Resistance (caIMR)

An observational study of Coronary Microvascular Dysfunction, run by Ge Junbo at 3 sites in China.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

More than 50% of patients with stable or unstable angina pectoris have no obstructive coronary arteries by angiographic visual estimation, in which coronary microvascular dysfunction (CMD) is one of the causes of myocardial ischemia and chest pain. Read more about this study

Who is it for?
Ages 18 to 80 years
Conditions the study is for
Coronary Microvascular Dysfunction
What is being tested?
Angiography-derived Index of Microcirculatory Resistance and Pressure wire-based Index of Microcirculatory Resistance
Type of treatment
Medical device
How many people
116 participants
Where
3 sitesChina
Study dates
14 Oct 2021to 31 Dec 2021
Phase
Observational
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 80 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Study population: Patients with stable or unstable angina, or suspected myocardial ischemia.

Who may be able to join

  • Patients aged 18 years and above, 80 years old and below, with no gender limitation;
  • Patients with stable or unstable angina or suspected myocardial ischemia;
  • Patients voluntarily participated in this clinical trial and signed an informed consent form;
  • Target coronary with <50% diameter stenosis (DS%) by visual estimation.

Who cannot join

  • Patients with suspected acute myocardial infarction;
  • Patients with old myocardial infarction;
  • Patients with primary or secondary cardiomyopathy;
  • Patients with primary or secondary heart valve disease;
  • Patients with severe cardiac insufficiency and LVEF≤35%;
  • Patients with renal insufficiency (eGFR<60ml/min (1.73m^2)) or patients undergoing dialysis;
Show all 15Show fewer
  • Patients who are allergic to iodine contrast agents, adenosine, and ATP;
  • Patients with severe organ disease or life expectancy less than 24 months;
  • Patients who are participating in other clinical studies of investigational drugs or devices and have not reached their primary endpoint;
  • The patient who has other conditions that are not suitable for clinical trials;
  • Patients with coronary artery involved in coronary fistula and myocardial bridge;
  • The contrast media is not filled, the blood vessels are overlapped, or the target blood vessel is severely distorted, and the lesion location cannot be fully exposed, or the image quality is poor and cannot be recognized;
  • Left main coronary artery disease and right coronary artery orifice disease;
  • After angiography, the investigator believes that the patient cannot tolerate any of the detection methods between caIMR and IMR;
  • The investigator believes that the patient is not suitable for clinical trials after angiography;

Trial locations and contacts

3 sites in 1 country.

China3 sites
  • Peking University First Hospital

    Beijing, Beijing Municipality, 100034

  • Zhongshan Hospital

    Shanghai, Shanghai Municipality, 200032

  • Zhongnan Hospital Of Wuhan Uniersity

    Wuhan, Hubei, 430062

Other trials in China

About this study

Official title: A Prospective, Multi-center Clinical Trial for Evaluating the Effectiveness and Safety of Coronary Angiography-Derived Index of Microcirculatory Resistance Measured Online by a Coronary Functional Measurement System

More than 50% of patients with stable or unstable angina pectoris have no obstructive coronary arteries by angiographic visual estimation, in which coronary microvascular dysfunction (CMD) is one of the causes of myocardial ischemia and chest pain. A coronary angiography-derived index of microcirculatory resistance (caIMR) is proposed for physiological assessment of microvascular diseases in coronary circulation. The aim of the trial is to assess diagnostic performance of caIMR, using wire-derived index of microcirculatory resistance (IMR) as the reference standard.

Read the detailed description

More than 50% of patients with stable or unstable angina pectoris have no obstructive coronary arteries by angiographic visual estimation, in which coronary microvascular dysfunction (CMD) is one of the causes of myocardial ischemia and chest pain. Presently, the index of microcirculatory resistance (IMR) measured by the pressure wire is recognized as standard for evaluating coronary microcirculatory function. A coronary angiography-derived index of microcirculatory resistance (caIMR) is proposed for physiological assessment of microvascular diseases in coronary circulation without pressure wire, hyperemic agents, or thermodilution method.

This study is a prospective, multi-center clinical trial. In the study, IMR (measured by pressure wire) will be used as a reference standard to evaluate the feasibility, accuracy and safety of caIMR measured by a non-invasive diagnosis system (FM21a) based on angiography images and aortic pressure wave. 116 patients eligible for inclusion criteria will be enrolled in the study. Both IMR and caIMR measurement will be performed in the same patient in a random order after angiography. The definitions of IMR and caIMR for coronary microcirculatory ischemia are IMR≥25 and caIMR≥25. The primary endpoint is the diagnostic accuracy of caIMR. The secondary endpoint is caIMR's sensitivity, specificity, positive predictive value, negative predictive value, ROC curve and AUC of caIMR diagnosis, and the diagnostic characteristics of caIMR at the vascular level.

Being tested
Angiography-derived Index of Microcirculatory Resistance, Pressure wire-based Index of Microcirculatory Resistance
Keywords
Hemodynamics, Computational fluid dynamics, Index of microcirculatory resistance, Fractional flow reserve, Angiography-derived IMR

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Angiography-derived Index of Microcirculatory ResistanceDevice

    caIMR will be measured by pressure sensors which are produced by Suzhou Rainmed Medical Technology Co., Ltd.

    caIMR is calculated based on angiography images and Hyperemic Pa estimated from resting Pa according to prespecified equation.

  • Pressure wire-based Index of Microcirculatory ResistanceDevice

    IMR will be measured by thermodilution method with pressure wire and arterial physiological detector which are produced by St. Jude Medical.

    IMR = Pd ∙Tmn

Study groups in NCT05009667
Study groupRoleWhat they receive
IMR first groupIn this group, IMR based on pressure wire and arterial physiological detector will be measured first, and then caIMR base on angiography images and pressure sensor will be measured secondly.
Receives: Device: Angiography-derived Index of Microcirculatory Resistance; Device: Pressure wire-based Index of Microcirculatory Resistance
caIMR first groupIn this group, caIMR based on angiography images and pressure sensor will be measured first, and then IMR based on pressure wire and arterial physiological detector will be measured secondly.
Receives: Device: Angiography-derived Index of Microcirculatory Resistance; Device: Pressure wire-based Index of Microcirculatory Resistance

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Diagnostic accuracy

    To compare diagnostic accuracy of caIMR for coronary microvascular dysfunction with IMR as control.

    Measured: Through study completion, an average of 7 months.

Secondary outcomes (3)
  1. Sensitivity, specificity, positive predictive value, and negative predictive value

    To compare the diagnostic performance between caIMR and IMR in the patient level, with IMR as the reference standard.

    Measured: Through study completion, an average of 7 months.

  2. ROC curve, and AUC

    Using IMR as reference standard, draw the ROC curve of caIMR. The definition of ischemia is IMR≥25.

    Measured: Through study completion, an average of 7 months.

  3. Diagnostic performance on the vessel level

    The diagnostic features of caIMR compared with IMR on the vessel level.

    Measured: Through study completion, an average of 7 months.

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted17 Aug 2021
  2. Study start14 Oct 2021
  3. Primary completion31 Dec 2021
  4. Study completion31 Dec 2021

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
116 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05009667
Sponsor's protocol ID
Flash III
Acronym
Flash III
Status last verified
Mar 2022
First submitted
23 Jul 2021
Last updated
6 Apr 2022
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Publications

  • Li J, Gong Y, Wang W, Yang Q, Liu B, Lu Y, Xu Y, Huo Y, Yi T, Liu J, Li Y, Xu S, Zhao L, Ali ZA, Huo Y. Accuracy of computational pressure-fluid dynamics applied to coronary angiography to derive fractional flow reserve: FLASH FFR. Cardiovasc Res. 2020 Jun 1;116(7):1349-1356. doi: 10.1093/cvr/cvz289.

    PubMed 31693092
  • Fearon WF, Balsam LB, Farouque HM, Caffarelli AD, Robbins RC, Fitzgerald PJ, Yock PG, Yeung AC. Novel index for invasively assessing the coronary microcirculation. Circulation. 2003 Jul 1;107(25):3129-32. doi: 10.1161/01.CIR.0000080700.98607.D1. Epub 2003 Jun 23.

    PubMed 12821539
  • Ford TJ, Berry C. How to Diagnose and Manage Angina Without Obstructive Coronary Artery Disease: Lessons from the British Heart Foundation CorMicA Trial. Interv Cardiol. 2019 May 21;14(2):76-82. doi: 10.15420/icr.2019.04.R1. eCollection 2019 May.

    PubMed 31178933
  • Kunadian V, Chieffo A, Camici PG, Berry C, Escaned J, Maas AHEM, Prescott E, Karam N, Appelman Y, Fraccaro C, Louise Buchanan G, Manzo-Silberman S, Al-Lamee R, Regar E, Lansky A, Abbott JD, Badimon L, Duncker DJ, Mehran R, Capodanno D, Baumbach A. An EAPCI Expert Consensus Document on Ischaemia with Non-Obstructive Coronary Arteries in Collaboration with European Society of Cardiology Working Group on Coronary Pathophysiology & Microcirculation Endorsed by Coronary Vasomotor Disorders International Study Group. Eur Heart J. 2020 Oct 1;41(37):3504-3520. doi: 10.1093/eurheartj/ehaa503.

    PubMed 32626906
  • Fearon WF, Farouque HM, Balsam LB, Caffarelli AD, Cooke DT, Robbins RC, Fitzgerald PJ, Yeung AC, Yock PG. Comparison of coronary thermodilution and Doppler velocity for assessing coronary flow reserve. Circulation. 2003 Nov 4;108(18):2198-200. doi: 10.1161/01.CIR.0000099521.31396.9D. Epub 2003 Oct 20.

    PubMed 14568891
  • Ai H, Feng Y, Gong Y, Zheng B, Jin Q, Zhang HP, Sun F, Li J, Chen Y, Huo Y, Huo Y. Coronary Angiography-Derived Index of Microvascular Resistance. Front Physiol. 2020 Dec 16;11:605356. doi: 10.3389/fphys.2020.605356. eCollection 2020.

    PubMed 33391020
  • Aarnoudse W, Fearon WF, Manoharan G, Geven M, van de Vosse F, Rutten M, De Bruyne B, Pijls NH. Epicardial stenosis severity does not affect minimal microcirculatory resistance. Circulation. 2004 Oct 12;110(15):2137-42. doi: 10.1161/01.CIR.0000143893.18451.0E. Epub 2004 Oct 4.

    PubMed 15466646
  • Kobayashi Y, Lee JM, Fearon WF, Lee JH, Nishi T, Choi DH, Zimmermann FM, Jung JH, Lee HJ, Doh JH, Nam CW, Shin ES, Koo BK. Three-Vessel Assessment of Coronary Microvascular Dysfunction in Patients With Clinical Suspicion of Ischemia: Prospective Observational Study With the Index of Microcirculatory Resistance. Circ Cardiovasc Interv. 2017 Nov;10(11):e005445. doi: 10.1161/CIRCINTERVENTIONS.117.005445.

    PubMed 29146670
  • Yoon MH, Tahk SJ, Yang HM, Woo SI, Lim HS, Kang SJ, Choi BJ, Choi SY, Hwang GS, Shin JH. Comparison of accuracy in the prediction of left ventricular wall motion changes between invasively assessed microvascular integrity indexes and fluorine-18 fluorodeoxyglucose positron emission tomography in patients with ST-elevation myocardial infarction. Am J Cardiol. 2008 Jul 15;102(2):129-34. doi: 10.1016/j.amjcard.2008.03.024. Epub 2008 May 29.

    PubMed 18602508
  • Williams RP, de Waard GA, De Silva K, Lumley M, Asrress K, Arri S, Ellis H, Mir A, Clapp B, Chiribiri A, Plein S, Teunissen PF, Hollander MR, Marber M, Redwood S, van Royen N, Perera D. Doppler Versus Thermodilution-Derived Coronary Microvascular Resistance to Predict Coronary Microvascular Dysfunction in Patients With Acute Myocardial Infarction or Stable Angina Pectoris. Am J Cardiol. 2018 Jan 1;121(1):1-8. doi: 10.1016/j.amjcard.2017.09.012. Epub 2017 Oct 10.

    PubMed 29132649
  • De Maria GL, Alkhalil M, Wolfrum M, Fahrni G, Borlotti A, Gaughran L, Dawkins S, Langrish JP, Lucking AJ, Choudhury RP, Porto I, Crea F, Dall'Armellina E, Channon KM, Kharbanda RK, Banning AP. Index of Microcirculatory Resistance as a Tool to Characterize Microvascular Obstruction and to Predict Infarct Size Regression in Patients With STEMI Undergoing Primary PCI. JACC Cardiovasc Imaging. 2019 May;12(5):837-848. doi: 10.1016/j.jcmg.2018.02.018. Epub 2018 Apr 18.

    PubMed 29680355
  • Huang D, Gong Y, Fan Y, Zheng B, Lu Z, Li J, Huo Y, Escaned J, Huo Y, Ge J. Coronary angiography-derived index for assessing microcirculatory resistance in patients with non-obstructed vessels: The FLASH IMR study. Am Heart J. 2023 Sep;263:56-63. doi: 10.1016/j.ahj.2023.03.016. Epub 2023 Apr 12.

    PubMed 37054908

Questions about this trial

What is this clinical trial studying?

An observational study of Coronary Microvascular Dysfunction, run by Ge Junbo at 3 sites in China.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 15 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 6 Apr 2022. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 3 sites in China. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Diagnostic accuracy (time frame: Through study completion, an average of 7 months.). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05009667, which also lists 12 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 6 Apr 2022.

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