Mitral Regurgitation (MR)FLAMENCT07066904
Quantification of Mitral Regurgitation Using 4D MRI Flow : Comparison With 2D MRI Flow and Echocardiography Using the Evolution of Left Ventricular Remodeling as a Reference
A study testing Standard echocardiography, 2D phase-contrast magnetic resonance imaging and 4D flow magnetic resonance imaging in people with Mitral Regurgitation (MR), run by Assistance Publique - Hôpitaux de Paris at 3 sites in France.
Trial summary
The goal of this study is to evaluate whether 4D MRI provides a better assessment of mitral regurgitation quantification and associated ventricular remodeling than standard imaging techniques: echocardiography and 2D MRI, in patients suffuring from mitral regurgitation. Read more about this study
- Who is it for?
- Ages 18 to 85 years
- Conditions the study is for
- Mitral Regurgitation (MR)
- What is being tested?
- Standard echocardiography, 2D phase-contrast magnetic resonance imaging and 4D flow magnetic resonance imaging
- Type of treatment
- Injection or infusion
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 160 participants
- Where
- 3 sitesFrance
- Study dates
- 1 Oct 2025to 30 Apr 2028
- Phase
- Interventional
- 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 18 to 85 years
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- from 18 to 85 years old
- having signed a consent form to participate in the study
- suffering from mild, moderate or severe mitral regurgitation based on an ultrasound graduation
- able to undergo echocardiography and IRM within 7 days after recruitment and then at 6 months
Who cannot join
- suffering from aortic regurgitation or stenosis or mitral stenosis associated with more than moderate MR, intracardiac shunting or hypertrophic cardiomyopathy
- suffering from secondary MR
- having a contraindication to gadolinium-based contrast agent
- having a pacemaker, defibrillator or any other contraindication to MRI
- suffering from renal disease with an eGFR CKD-EPI < 30 ml/min
- pregnant or breastfeeding
Show all 12Show fewer
- under legal protection
- Enrolled subjects:
- with an incomplete or suboptimal ultrasound or MRI examination
- who have not attended to the 6-month follow-up visit
- with an intercurrent medical event
- will be excluded.
Trial locations and contacts
3 sites in 1 country. Contact the study team or a site near you to ask about taking part.
France3 sites
Groupe hospitalier Paris Saint-Joseph - hôpital Marie-Lannelongue
Le Plessis-Robinson, 92350
Arshid Azarine, aazarine@ghpsj.fr
AP-HP - hôpital Saint-Antoine
Paris, 75012
Ariel Cohen, ariel.cohen@aphp.fr
AP-HP - hôpital européen Georges-Pompidou,
Paris, 75015
Gilles Soulat, gilles.soulat@aphp.fr
About this study
The goal of this study is to evaluate whether 4D MRI provides a better assessment of mitral regurgitation quantification and associated ventricular remodeling than standard imaging techniques: echocardiography and 2D MRI, in patients suffuring from mitral regurgitation. 4D MRI demonstrated its superiority to 2D MRI in some other valve diseases but remains not widely used, due to a lack of evidence. The main question our study aims to answer is:
- Is mitral regurgitant volume measured on 4D MRI more strongly related to remodeling progression (after correction of regurgitation or not) than regurgitant volume measured on 2D MRI and echocardiography?
Participants will undergo 4D MRI, 2D MRI and echocardiography twice at six-month intervals.
Read the detailed description
Mitral Regurgitation (MR) is a widely prevalent valvular disease. The decision to refer patients for intervention relies on the precise quantification of MR using the mitral regurgitant volume. This quantification is primarily performed through transthoracic echocardiography (TTE), but its accuracy is limited by operator dependency and acoustic windows.
Magnetic resonance imaging (MRI) is now considered the preferred alternative technique for measuring mitral regurgitant volume using 2D phase-contrast sequences. However, it requires significant expertise from specialized centers.
4D flow MRI enables the recording of blood flow velocities in all directions across the entire cardiac volume and has demonstrated superiority over 2D MRI in other valvular diseases. However, limited data are available for validating the estimation of mitral regurgitation using 4DFlow-MRI, mainly due to the absence of a reference technique. As previously proposed for comparisons between 2D MRI and TTE, ventricular remodeling progression will be used as the evaluation criterion.
Primary Objective:
The main goal is to demonstrate that mitral regurgitant volume assessed by 4DFlow-MRI is more strongly correlated with left ventricular (LV) remodeling progression after correction or persistence of MR than mitral regurgitant volume assessed by 2D MRI or TTE, after adjustment for residual MR.
The primary outcome criterion will be the analysis of the association between the absolute change in LV end-diastolic volume (LVEDV) between baseline (M0) and 6 months after (M6) and mitral regurgitant volume at M0, as calculated by the different methods or MR severity estimated using the integrative TTE approach, adjusted for residual MR.
Secondary Objectives:
- Evaluate the association between LV remodeling and mitral regurgitant volume measured by the different methods in the subgroup of patients undergoing percutaneous intervention, where correction is incomplete and residual MR assessment is challenging.
- Evaluate the association between LV remodeling and mitral regurgitant volume measured by the different methods in the subgroup of patients undergoing surgical intervention, where correction is expected to be excellent with no residual MR.
- Analyze the determinants of LV remodeling progression using novel volumetric echocardiography methods, including specific ultrafast ultrasound sequences, allowing comparisons with data from the most innovative echocardiographic techniques.
- Investigate all determinants of LV remodeling progression at six months beyond mitral regurgitant volume, including the significance of LV remodeling, longitudinal strains of the LV and left atrium (assessed by MRI and TTE), and myocardial fibrosis derived from myocardial T1 mapping before and after gadolinium injection at M0.
Secondary Outcomes Criteria:
- Primary evaluation criterion assessed in the subgroup of patients who underwent percutaneous MR correction.
- Primary evaluation criterion assessed in the subgroup of patients who underwent surgical MR correction, disregarding residual MR.
- Primary evaluation criterion assessed using innovative echographic techniques, including specific ultrafast ultrasound sequences, and compared with the standard TTE, 2D MRI and 4D MRI.
- Changes in LV remodeling between M0 and M6, based on various indices (LVEDV, fibrosis indices, strain at M0).
- Conditions
- Mitral Regurgitation (MR)
- Being tested
- Standard echocardiography, 2D phase-contrast magnetic resonance imaging, 4D flow magnetic resonance imaging, Cardiac ultrafast ultrasound imaging
- Keywords
- Mitral regurgitation, 4D MRI, 4D-flow MRI, cardiovascular magnetic resonance, Ultrafast ultrasound imaging, ultrafast echocardiography
- Medical subject headings
- Mitral Valve Insufficiency
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Standard echocardiographyDiagnostic test
Also called Cardiac echography, TTE, Heart ultrasounds
Routine ultrasound examination with standardized recordings for the study, incorporating volumetric assessment techniques
2D phase-contrast magnetic resonance imagingDiagnostic test
Also called 2D MRI, Cardiac magnetic resonance imaging, CMR
A cardiac MRI will be performed on a 1.5 Tesla system, including a biventricular function study with a series of short-axis slices, three long-axis slices, a 2D phase-contrast acquisition orthogonal to the aortic root. Additionally, standard T1 mapping sequences will be acquired on three short-axis slices, 15 minutes after the injection of 0.2 mmol/kg of body weight of gadolinium, for myocardial and blood T1 measurements.
4D flow magnetic resonance imagingDiagnostic test
Also called 4D MRI
A sagittal 4D flow acquisition lasting between 6 and 10 minutes of free breathing to cover all four cardiac chambers is added to the 2D acquisition.
Cardiac ultrafast ultrasound imagingDiagnostic test
Also called ultrafast echocardiography
Ultrafast sequences are added to the standard echocardiography acquisition.
| Study group | Role | What they receive |
|---|---|---|
| Mild mitral regurgitation | Experimental | Patient suffuring from mild mitral regurgitation (n=30) Receives: Diagnostic Test: Standard echocardiography; Diagnostic Test: 2D phase-contrast magnetic resonance imaging; Diagnostic Test: 4D flow magnetic resonance imaging; Diagnostic Test: Cardiac ultrafast ultrasound imaging |
| Moderate mitral regurgitation | Experimental | Patient suffuring from moderate mitral regurgitation (n=30) Receives: Diagnostic Test: Standard echocardiography; Diagnostic Test: 2D phase-contrast magnetic resonance imaging; Diagnostic Test: 4D flow magnetic resonance imaging; Diagnostic Test: Cardiac ultrafast ultrasound imaging |
| Severe mitral regurgitation | Experimental | Patient suffuring from severe mitral regurgitation (n=100) Receives: Diagnostic Test: Standard echocardiography; Diagnostic Test: 2D phase-contrast magnetic resonance imaging; Diagnostic Test: 4D flow magnetic resonance imaging; Diagnostic Test: Cardiac ultrafast ultrasound imaging |
What is being measured
The primary outcome is the main question the study is designed to answer.
Absolute change in left ventricle end-diastolic volume
The primary outcome criterion will be the analysis of the association between the absolute change in LV end-diastolic volume (LVEDV) between baseline (M0) and 6 months after (M6) and mitral regurgitant volume at M0, as calculated by the different methods or MR severity estimated using the integrative TTE approach, adjusted for residual MR.
Measured: Baseline, 6 months
Mitral regurgitant volume
The primary outcome criterion will be the analysis of the association between the absolute change in LV end-diastolic volume (LVEDV) between baseline (M0) and 6 months after (M6) and mitral regurgitant volume at M0, as calculated by the different methods or MR severity estimated using the integrative TTE approach, adjusted for residual MR.
Measured: Baseline
Secondary outcomes (7)
Absolute change in left ventricle end-diastolic volume
Same outcome as the primary outcome but in a subgroup of patients who have undergone percutaneous mitral regurgitation correction.
Measured: Baseline, 6 months
Mitral regurgitant volume
Same outcome as the primary outcome but in a subgroup of patients who have undergone percutaneous mitral regurgitation correction.
Measured: Baseline
Absolute change in left ventricle end-diastolic volume
Same outcome as the primary outcome but in a subgroup of patients who have undergone surgical mitral regurgitation correction.
Measured: Baseline, 6 months
Mitral regurgitant volume
Same outcome as the primary outcome but in a subgroup of patients who have undergone surgical mitral regurgitation correction.
Measured: Baseline
Absolute change in left ventricle end-diastolic volume
Same outcome as the primary outcome but mesured using ultrafast ultrasound imaging compared to the 3 other imaging techniques performed in the study.
Measured: Baseline, 6 months
Mitral regurgitant volume
Same outcome as the primary outcome but mesured using ultrafast ultrasound imaging compared to the 3 other imaging techniques performed in the study.
Measured: Baseline
Change from baseline in left ventricle remodeling
Measured: Baseline, 6 months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted15 Jul 2025
- Study start1 Oct 2025 (estimated)
- Primary completion30 Apr 2028 (estimated)
- Study completion30 Apr 2028 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Mitral Regurgitation (MR)Studies of the same condition, open and under way.
- More trials run by Assistance Publique - Hôpitaux de ParisThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Diagnosis
- Allocation
- Non-randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 160 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Assistance Publique - Hôpitaux de Paris
- Sponsor type
- University, hospital or other
- Collaborators
- Ministry of Health, France, GIRCI IDF
- Responsible party
- Sponsor
- Investigators
- Gilles Soulat, Principal investigator, Assistance Publique - Hôpitaux de Paris
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07066904
- Sponsor's protocol ID
- APHP240794
- Other IDs
- PHRCI-2023-45, 2024-A01894-43, 25.00001.000350
- Acronym
- FLAME
- Status last verified
- Jun 2025
- First submitted
- 4 Jul 2025
- Last updated
- 15 Jul 2025
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Yes: Individual participant data (IPD) that underlie results in publication could be shared. IPD detailed in the protocol of a planned metaanalysis could be shared.
Study at a glance
From the registry record, last updated by the sponsor on 15 Jul 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Quantification of Mitral Regurgitation Using 4D MRI Flow : Comparison With 2D MRI Flow and Echocardiography Using the Evolution of Left Ventricular Remodeling as a Reference
- ClinicalTrials.gov ID
- NCT07066904
- Acronym / sponsor ID
- FLAME / APHP240794
- Conditions
- Mitral Regurgitation (MR)
- Keywords
- Mitral regurgitation, 4D MRI, 4D-flow MRI, cardiovascular magnetic resonance, Ultrafast ultrasound imaging, ultrafast echocardiography
- Study type
- Interventional
- Recruitment status
- Not yet recruiting
- Enrolment
- 160 participants (estimated)
- Lead sponsor
- Assistance Publique - Hôpitaux de ParisUniversity, hospital or other
- Collaborators
- Ministry of Health, France, GIRCI IDF
- Study start
- 1 Oct 2025 (estimated)
- Primary completion
- 30 Apr 2028 (estimated)
- Study completion
- 30 Apr 2028 (estimated)
- First posted
- 15 Jul 2025 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The goal of this study is to evaluate whether 4D MRI provides a better assessment of mitral regurgitation quantification and associated ventricular remodeling than standard imaging techniques: echocardiography and 2D MRI, in patients suffuring from mitral regurgitation. 4D MRI demonstrated its superiority to 2D MRI in some other valve diseases but remains not widely used, due to a lack of evidence. The main question our study aims to answer is:
- Is mitral regurgitant volume measured on 4D MRI more strongly related to remodeling progression (after correction of regurgitation or not) than regurgitant volume measured on 2D MRI and echocardiography?
Participants will undergo 4D MRI, 2D MRI and echocardiography twice at six-month intervals.
Detailed description
Mitral Regurgitation (MR) is a widely prevalent valvular disease. The decision to refer patients for intervention relies on the precise quantification of MR using the mitral regurgitant volume. This quantification is primarily performed through transthoracic echocardiography (TTE), but its accuracy is limited by operator dependency and acoustic windows.
Magnetic resonance imaging (MRI) is now considered the preferred alternative technique for measuring mitral regurgitant volume using 2D phase-contrast sequences. However, it requires significant expertise from specialized centers.
4D flow MRI enables the recording of blood flow velocities in all directions across the entire cardiac volume and has demonstrated superiority over 2D MRI in other valvular diseases. However, limited data are available for validating the estimation of mitral regurgitation using 4DFlow-MRI, mainly due to the absence of a reference technique. As previously proposed for comparisons between 2D MRI and TTE, ventricular remodeling progression will be used as the evaluation criterion.
Primary Objective:
The main goal is to demonstrate that mitral regurgitant volume assessed by 4DFlow-MRI is more strongly correlated with left ventricular (LV) remodeling progression after correction or persistence of MR than mitral regurgitant volume assessed by 2D MRI or TTE, after adjustment for residual MR.
The primary outcome criterion will be the analysis of the association between the absolute change in LV end-diastolic volume (LVEDV) between baseline (M0) and 6 months after (M6) and mitral regurgitant volume at M0, as calculated by the different methods or MR severity estimated using the integrative TTE approach, adjusted for residual MR.
Secondary Objectives:
- Evaluate the association between LV remodeling and mitral regurgitant volume measured by the different methods in the subgroup of patients undergoing percutaneous intervention, where correction is incomplete and residual MR assessment is challenging.
- Evaluate the association between LV remodeling and mitral regurgitant volume measured by the different methods in the subgroup of patients undergoing surgical intervention, where correction is expected to be excellent with no residual MR.
- Analyze the determinants of LV remodeling progression using novel volumetric echocardiography methods, including specific ultrafast ultrasound sequences, allowing comparisons with data from the most innovative echocardiographic techniques.
- Investigate all determinants of LV remodeling progression at six months beyond mitral regurgitant volume, including the significance of LV remodeling, longitudinal strains of the LV and left atrium (assessed by MRI and TTE), and myocardial fibrosis derived from myocardial T1 mapping before and after gadolinium injection at M0.
Secondary Outcomes Criteria:
- Primary evaluation criterion assessed in the subgroup of patients who underwent percutaneous MR correction.
- Primary evaluation criterion assessed in the subgroup of patients who underwent surgical MR correction, disregarding residual MR.
- Primary evaluation criterion assessed using innovative echographic techniques, including specific ultrafast ultrasound sequences, and compared with the standard TTE, 2D MRI and 4D MRI.
- Changes in LV remodeling between M0 and M6, based on various indices (LVEDV, fibrosis indices, strain at M0).
Study design
- Primary purpose
- Diagnosis
- Allocation
- Non-randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 3
| Arm | Type | Receives |
|---|---|---|
| Mild mitral regurgitation | Experimental | Diagnostic Test: Standard echocardiography, Diagnostic Test: 2D phase-contrast magnetic resonance imaging, Diagnostic Test: 4D flow magnetic resonance imaging, Diagnostic Test: Cardiac ultrafast ultrasound imagingPatient suffuring from mild mitral regurgitation (n=30) |
| Moderate mitral regurgitation | Experimental | Diagnostic Test: Standard echocardiography, Diagnostic Test: 2D phase-contrast magnetic resonance imaging, Diagnostic Test: 4D flow magnetic resonance imaging, Diagnostic Test: Cardiac ultrafast ultrasound imagingPatient suffuring from moderate mitral regurgitation (n=30) |
| Severe mitral regurgitation | Experimental | Diagnostic Test: Standard echocardiography, Diagnostic Test: 2D phase-contrast magnetic resonance imaging, Diagnostic Test: 4D flow magnetic resonance imaging, Diagnostic Test: Cardiac ultrafast ultrasound imagingPatient suffuring from severe mitral regurgitation (n=100) |
Who may qualify
- Ages
- 18 to 85 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (4 listed)
- from 18 to 85 years old
- having signed a consent form to participate in the study
- suffering from mild, moderate or severe mitral regurgitation based on an ultrasound graduation
- able to undergo echocardiography and IRM within 7 days after recruitment and then at 6 months
Key exclusion criteria (12 listed)
- suffering from aortic regurgitation or stenosis or mitral stenosis associated with more than moderate MR, intracardiac shunting or hypertrophic cardiomyopathy
- suffering from secondary MR
- having a contraindication to gadolinium-based contrast agent
- having a pacemaker, defibrillator or any other contraindication to MRI
- suffering from renal disease with an eGFR CKD-EPI < 30 ml/min
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Standard echocardiographyAlso: Cardiac echography, TTE, Heart ultrasoundsRoutine ultrasound examination with standardized recordings for the study, incorporating volumetric assessment techniques | Diagnostic test | Mild mitral regurgitation, Moderate mitral regurgitation, Severe mitral regurgitation |
| 2D phase-contrast magnetic resonance imagingAlso: 2D MRI, Cardiac magnetic resonance imaging, CMRA cardiac MRI will be performed on a 1.5 Tesla system, including a biventricular function study with a series of short-axis slices, three long-axis slices, a 2D phase-contrast acquisition orthogonal to the aortic root. Additionally, standard T1 mapping sequences will be acquired on three short-axis slices, 15 minutes after the injection of 0.2 mmol/kg of body weight of gadolinium, for myocardial and blood T1 measurements. | Diagnostic test | Mild mitral regurgitation, Moderate mitral regurgitation, Severe mitral regurgitation |
| 4D flow magnetic resonance imagingAlso: 4D MRIA sagittal 4D flow acquisition lasting between 6 and 10 minutes of free breathing to cover all four cardiac chambers is added to the 2D acquisition. | Diagnostic test | Mild mitral regurgitation, Moderate mitral regurgitation, Severe mitral regurgitation |
| Cardiac ultrafast ultrasound imagingAlso: ultrafast echocardiographyUltrafast sequences are added to the standard echocardiography acquisition. | Diagnostic test | Mild mitral regurgitation, Moderate mitral regurgitation, Severe mitral regurgitation |
Primary outcome
Absolute change in left ventricle end-diastolic volume
Time frame: Baseline, 6 months
The primary outcome criterion will be the analysis of the association between the absolute change in LV end-diastolic volume (LVEDV) between baseline (M0) and 6 months after (M6) and mitral regurgitant volume at M0, as calculated by the different methods or MR severity estimated using the integrative TTE approach, adjusted for residual MR.
Mitral regurgitant volume
Time frame: Baseline
The primary outcome criterion will be the analysis of the association between the absolute change in LV end-diastolic volume (LVEDV) between baseline (M0) and 6 months after (M6) and mitral regurgitant volume at M0, as calculated by the different methods or MR severity estimated using the integrative TTE approach, adjusted for residual MR.
7 secondary outcomes
Absolute change in left ventricle end-diastolic volume
Time frame: Baseline, 6 months
Mitral regurgitant volume
Time frame: Baseline
Absolute change in left ventricle end-diastolic volume
Time frame: Baseline, 6 months
Mitral regurgitant volume
Time frame: Baseline
Absolute change in left ventricle end-diastolic volume
Time frame: Baseline, 6 months
Mitral regurgitant volume
Time frame: Baseline
Change from baseline in left ventricle remodeling
Time frame: Baseline, 6 months
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 15 Jul 2025.
- Individual participant dataSharing planned: Yes. Individual participant data (IPD) that underlie results in publication could be shared. IPD detailed in the protocol of a planned metaanalysis could be shared.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Gilles Soulat principal investigator
Assistance Publique - Hôpitaux de Paris
3 sites in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Standard echocardiography, 2D phase-contrast magnetic resonance imaging and 4D flow magnetic resonance imaging in people with Mitral Regurgitation (MR), run by Assistance Publique - Hôpitaux de Paris at 3 sites in France.
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 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 15 Jul 2025. 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 France. 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 Maxime Brussieux (+33, maxime.brussieux@aphp.fr), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Absolute change in left ventricle end-diastolic volume (time frame: Baseline, 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 15 Jul 2025.