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Microvascular DiseaseSVATNCT06628297

Comparison of Differencens in VO2-max, Perfusion of the Heart and Brain and Cognitive Performance Between Patients with Type 2 Diabetes and Healthy Age Matched Controls.

An observational study of Microvascular Disease and Microvascular Complications, run by University Hospital Bispebjerg and Frederiksberg at 1 site in Denmark.

Not yet recruiting

Opening soon. The study is approved but enrolment has not started yet. Sites may already take enquiries.

Sites and contacts
Official record
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Trial summary

In the aging population, ischemic heart disease, stroke and dementia are increasingly prevalent. Diagnosis and treatment of the former two i.e., large-vessel coronary heart disease and endovascular thrombectomy of the brain in relation to stroke have improved significantly. Read more about this study

Who is it for?
Ages 60 years and olderHealthy volunteers can take part
What is being tested?
PET
Type of treatment
Injection or infusion
How many people
72 participants
Where
1 siteDenmark
Study dates
Nov 2024to Dec 2027
Phase
Observational
Are there results?
Not yet: the study is under way

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 60 years and older
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Study population: Patients with type 2 diabetes with increased risk of microvascular disease.

Who may be able to join

  • Diabetes type II diagnose with one of the following:
  • Duration over 5 years
  • Moderate microalbuminuria
  • Non-proliferative diabetic retinopathy
  • Speaks and understands Danish (required for reliable cognitive testing)
  • Able to provide informed and written consent
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  • Age \> 60 years
  • No diagnosis of T2D according to WHO\'s criteria.
  • Speaks and understands Danish (required for reliable cognitive testing)
  • Able to provide informed and written consent

Who cannot join

  • Moderate to high intensity training \>1 times/week.
  • Previous AMI, atrial fibrillation, significant cardiac valve disease, HFrEF (LVEF \<45%), asthma.
  • Previous stroke or significant neurological disease including cognitive dysfunction.
  • Ongoing depression.
  • Hypothyroidism
  • Unable or unwilling to participate in training, e.g., due to injury, arthrosis or lung disease.
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  • Moderate to high intensity training \>2 times/week.
  • Previous AMI, atrial fibrillation, significant cardiac valve disease, HFrEF (LVEF \<45%), asthma.
  • Previous stroke or significant neurological disease including cognitive dysfunction.
  • Ongoing depression.
  • Hypothyroidism
  • Unable or unwilling to participate in training, e.g., due to injury, arthrosis or lung disease.

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Primary Investigator, Medical Doctor contact

4551903442

thomasehlighjermindjustesen@regionh.dk

Lisbeth Marner, Ph.d. contact

4591171938

lisbeth.marner@regionh.dk

Denmark1 site
  • Bispebjerg and Frederiksberg Hospital

    Copenhagen, 2400

    Anita L. Chief Biomedical Laboratory Scientist, Bachelor's Degree, +4521381056, anita.larsen.01@regionh.dk

    Thomas J. Primary Investigator, Medical doctor, +4551903442, thomasehlighjermindjustesen@regionh.dk

Other trials in Denmark

About this study

Official title: Small Vessel Disease of the Brain and Heart a PET Perfusion Study of Training Effects

In the aging population, ischemic heart disease, stroke and dementia are increasingly prevalent. Diagnosis and treatment of the former two i.e., large-vessel coronary heart disease and endovascular thrombectomy of the brain in relation to stroke have improved significantly. Yet, the majority of elderly patients with ischemic heart disease do not have large-vessel heart disease and it seems that small vessel disease (SVD) may explain a large fraction of these cases as well as the cardiovascular morbidity in the elderly. Hence, the current development in diagnostics and treatments of ischemic heart disease does not address the most common subtype of ischemic disease seen in elderly patients.

It has been suggested that SVD is part of a multisystem disorder and several systematic reviews have addressed the hypothesis of a potential link between small vessel disease of the heart, brain, and kidneys. Cerebral SVD is prevalent in the aging population causing cognitive impairment, dementia, and an increased risk of stroke, and cerebral hypoperfusion is an acknowledged cause of vascular dementia and a possible cause of Alzheimer's disease. Further, cognitive impairment within multiple cognitive domains is highly prevalent in heart failure and is associated to an increased risk of dementia. The link between heart failure and dementia may be due to multisystem SVD, although a direct link between the two is possible.

Read more

Among other known risk factors such as age, hypertension, and female sex, diabetes is a major cause of SVD and is linked to coronary heart disease as well as cognitive impairment. The diagnosis of cerebral SVD relies on MRI detecting infarctions, haemorrhages, microbleeds and ischemic white matter changes, i.e. Fazekas score. In contrast, perfusion PET is used to image myocardial perfusion in patients with coronary SVD; and coronary SVD is recognized as a part of the pathophysiology in angina, coronary artery disease, and heart failure. Perfusion PET before and after adenosine-induced vasodilation allows for measuring, the myocardial flow reserve (MFR), i.e. perfusion capacity, which in the absence of regional perfusion defects, is a measure of coronary SVD. Prof. Eva Prescott have recently shown that reduced MFR obtained by 82Rb PET is a strong predictor of future microvascular events and all-cause mortality.

Exercise is well known to improve cognitive health but professor Carl-Johan Boraxbekk has shown that the effect on cognitive performance may be dependent on the initial cerebrovascular status, as patients with moderate to severe white matter changes did not improve after a 6 months physical activation intervention in contrast to patients with mild changes. Yet, it is possible to improve brain function in diabetic patients through either dietary or exercise interventions.

Systemic SVD is measured as cerebral SVD (reduced brain perfusion during acetazolamide-induced vasodilation) and coronary SVD (reduced heart perfusion during adenosine-induced vasodilation). The researchers anticipate that patients with type 2 dabetes have reduced perfusion capacity of the brain and heart correlating to reduced cognition and cardiorespiratory fitness (VO2-max).

Read the detailed description

The goal of this clinical trial is to compare baseline measurements relevant to microvascular disease between patients with diabetes and increased risk of microvascular disease with healthy age-matched control.

The researchers wish to examine if small vessel disease is a disease that affects several organs at once in the same individuals by examining it in the brain and heart in the same participants. The researchers will also test if cardiorespiratory conditioning (VO2-max), blood perfusion to the heart and brain and cognitive performance are correlated in patients with microvascular disease.

To adress these aims the researchers have defined the following assumptions that they will refute or confirm through this study:

  • Patients with type 2 diabetes and increased risk of small vessel disease have significantly reduced perfusion capacity of the brain and heart compared to healthy controls as part of a multisystem disease
  • Perfusion capacity of the brain and heart, the cardiorespiratory fitness level of the subjects and cognitive performance are directly linked. 48 patients with diabetes and 24 healthy age-matched controls will undergo baseline testing that include:
  • Cardiopulmonal Exercise Test (CPET) to determine cardiopulmonal conditioning (VO2-max)
  • Isometric knee strength (if logistically possible)
  • Echocardiography
  • Blood perfusion capacity of the heart and brain via [15O]H2O-PET scans
  • Brain MRI to determine structural damages
  • Blood samples for basic health check (relevant to inclusion, exclusion and safety) and blood samples looking at endothelial and neurological damage for a biobank
  • Cognitive testing (SCIP-D and CANTAB)

Afterwards the researchers will compare the results between the two groups and see if there is a correlation between VO2-max, blood perfusion to the heart and brain and cognitive performance.

Being tested
PET
Keywords
microvascular disease, microvascular complications of the heart, microvascular complications of the brain, diabetes type 2, dementia, microvascular disease patophysiology
Medical subject headings
Dementia, Diabetes Mellitus, Type 2

What participants receive

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

  • PETDiagnostic test

    Also called MRI, VO2-max, cognitive testing

    PET imaging will be performed with a Discovery 710 PET/CT scanner (GE Healthcare, Milwaukee, WI, USA). Four 5-minute PET recordings will be performed of each subject within a single scanning session of 70 min. Two consecutive 5-minute scans are conducted of the heart and brain in rest. [15O]H2O, is produced on-site (GENtrace, GE, Uppsala, Sweden), and 600 MBq [15O]H2O is intravenously injected by an automatic Hidex Radiowater Generator (Hidex, Turku, Finland). To induce heart vasodilation, adenosine is infused (140 g/kg/min) for 6 min and a scan of the heart is repeated. To induce brain vasodilation, 1 g of acetazolamide is infused over 5 min and 15 min later the brain is scanned. Myocardial perfusion is calculated using CarimasCE software version 1.3.1. (Turku, Finland). Cerebral perfusion is calculated using PMOD software (PMOD Technologies, Switzerland).

Study groups in NCT06628297
Study groupRoleWhat they receive
48 patients with type 2 diabetes and increased risk of microvascular diseaseBaseline measurements of: * [15O]H2O PET of heart and brain * Blood sampling * Echocardiography * Brain MRI * Cognitive tests * Cardiorespiratory fitness test * Muscular function test
Receives: Diagnostic Test: PET
24 healthy age-matched participantsBaseline measurements of: * [15O]H2O PET of heart and brain * Blood sampling * Echocardiography * Brain MRI * Cognitive tests * Cardiorespiratory fitness test * Muscular function test
Receives: Diagnostic Test: PET

What is being measured

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

  1. [15O]H2O PET assessment of the blood perfusion to the brain

    We will use the scan to determine our primary outcome: Blood perfusion to the brain. Radioactive water ([15O]H2O) will be used as a PET-tracer since it follows the blood and is the gold standard tracer for PET-based blood perfusion measurements. We measure the blood perfusion of both the brain as the perfusion capacity, meaning the difference between blood perfusion to the organ at rest and the maximally possible perfusion. In the brain we use injection of diamox to stimualte maximal dilation of the cerebral arteries which corresponds to the maximally possible perfusion of the brain.

    Measured: From baseline testing to end of study, 6 months

  2. [15O]H2O PET assessment of the blood perfusion of the heart

    We will use the scan to determine our primary outcome: Blood perfusion to the heart.

    Radioactive water ([15O]H2O) will be used as a PET-tracer since it follows the blood and is the gold standard tracer for PET-based blood perfusion measurements.

    We measure the blood perfusion of both the heart as the perfusion capacity, meaning the difference between blood perfusion to the organ at rest and the maximally possible perfusion. In the heart we use injection of adenosin to stimualte maximal dilation of the coronary arteries which corresponds to the maximally possible perfusion of the heart.

    Measured: From baseline testing to end of study, 6 months

Secondary outcomes (3)
  1. Cognitive performance (CANTAB)

    Testing of a broad range of cognitive functions. The test is tablet based and one of the most \"investigator-independent\" cognitive tests available. The test takes around 45 minutes to perform.

    Measured: From baseline testing to end of study, 6 months

  2. Cognitive Performance (SCIP-D)

    Assessed via SCIP-D in order to evaluate a broad range of cognitive areas in around 15-20 minutes. Both groups will undergo both tests. The primary investigator will receive learning in how to carry out the SCIP-D correctly.

    SCIP-D is a more clinically relevant test that can be used in a clinical setting to identify patients with cognitive dysfunction.

    Measured: From baseline testing to end of study, 6 months

  3. Cardiorespiratory fitness (VO2-max)

    Will be assessed as the maximal or peak oxygen consumption (VO2-max or VO2-peak) during a cardiopulmonal exercise test (CPET).

    Measured: From baseline testing to end of study, 6 months

Timeline

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

  1. First posted4 Oct 2024
  2. Study startNov 2024 (estimated)
  3. Primary completionJan 2027 (estimated)
  4. Study completionDec 2027 (estimated)

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
Case-control
Time perspective
Cross-sectional
Enrolment
72 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06628297
Sponsor's protocol ID
PhD2024013-HF
Other IDs
PhD2024013-HF
Acronym
SVAT
Status last verified
Oct 2024
First submitted
30 Sep 2024
Last updated
4 Oct 2024
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: Have not gotten the necessary clearence

Questions about this trial

What is this clinical trial studying?

An observational study of Microvascular Disease and Microvascular Complications, run by University Hospital Bispebjerg and Frederiksberg at 1 site in Denmark.

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 10 inclusion and 12 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: opening soon, as of the sponsor's last update on 4 Oct 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Denmark. 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?

This study is still under way. Results are not available in the source record yet.

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

Contact Primary Investigator, Medical Doctor (4551903442, thomasehlighjermindjustesen@regionh.dk), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

[15O]H2O PET assessment of the blood perfusion to the brain (time frame: From baseline testing to end of study, 6 months). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
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 4 Oct 2024.

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