Aortic Valve StenosisPROGRESSANCT01679431
Metabolic Determinants of the Progression of Aortic Stenosis
An observational study of Aortic Valve Stenosis, run by Laval University at 1 site in Canada.
Trial summary
Calcific aortic stenosis (AS) has become the most common cardiac disease after coronary artery disease and hypertension. Unfortunately no medical therapies have been proven to decrease either the progression of valve stenosis or the resulting adverse effects on myocardial remodeling and function. Read more about this study
- Who is it for?
- Ages 21 years and olderHealthy volunteers can take part
- Conditions the study is for
- Aortic Valve Stenosis
- What is being tested?
- Doppler-echocardiography, Computed tomography and Magnetic resonance imaging
- Type of treatment
- Surgery or procedure
- How many people
- 250 participants
- Where
- 1 siteCanada
- Study dates
- Apr 2005to Jan 2024
- 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 21 years and older
- All sexes
- Healthy volunteers accepted
- Adult, Older adult
Study population: Cohort will be selected at primary care clinic
Who may be able to join
- Age >21 years
- Presence of aortic stenosis defined as peak aortic jet velocity ≥2.5 m/s
Who cannot join
- Symptomatic aortic stenosis
- Very severe aortic stenosis defined as an AVA≤0.6 cm2
- Left ventricular ejection fraction < 50%
- More than mild aortic or mitral regurgitation, or mitral stenosis
- Atrial fibrillation or flutter
- Pregnant or lactating women
- Contraindications to gadolinium-enhanced MRI
Trial locations and contacts
1 site in 1 country.
Canada1 site, 1 recruiting
- Recruiting
Institut Universitaire de Cardiologie et de Pneumologie de Québec
Québec, G1V4G5
Philippe Pibarot, PhD, 418-656-8711 ext. 5938, Philippe.Pibarot@med.ulaval.ca
Romain Capoulade, MSc, 418-656-8711 ext. 3845, Romain.Capoulade@criucpq.ulaval.ca
About this study
Official title: Metabolic Determinants of the Progression of Aortic Stenosis - PROGRESSA Study
Calcific aortic stenosis (AS) has become the most common cardiac disease after coronary artery disease and hypertension. Unfortunately no medical therapies have been proven to decrease either the progression of valve stenosis or the resulting adverse effects on myocardial remodeling and function. In light of the studies performed in PROGRESSA, it becomes obvious that: i) AS is a complex and actively regulated process that involves the interaction of several pathways including lipid infiltration and retention, chronic inflammation, osteogenic activation, and active mineralization within the valvular tissues; ii) AS is not a disease strictly limited to the aortic valve but rather a systemic disease that often involves calcification and stiffening of the aorta and impairment of LV function as a consequence of pressure overload. Our findings suggest that the dysmetabolic milieu linked to visceral obesity may accelerate the deterioration of the structure and function not only of the aortic valve but also of the aorta and of the left ventricle. These findings open new avenues of research and provide strong impetus for the elaboration of prospective studies focusing on the "valvulo-metabolic risk" in AS.
The general hypotheses are: The metabolic abnormalities linked to visceral obesity accelerate (1) the progression of valvular calcification and stenosis, aortic calcification and stiffness; (2) the progression of myocardial fibrosis and dysfunction.
Read more
The general objectives of the study are to elucidate the mechanisms implicated in the pathogenesis of AS and to identify the metabolic factors that determine the progression of: i) aortic valve calcification and stenosis; ii) myocardial fibrosis and dysfunction; and iii) clinical outcomes.
This study will contribute to identifying the key metabolic determinants of AS progression and will pave the way for the future development of non surgical therapies for this disease. The results of this study would provide strong support to the realization of randomized trial to test the efficacy of lifestyle modification program or new pharmacological treatment aiming at the reduction of visceral fat and associated metabolic abnormalities in the AS population. Furthermore, this study will contribute to the identification of novel blood and imaging biomarkers of faster disease progression, which will help to optimize risk stratification and timing of AVR in the AS population.
Read the detailed description
The hypotheses are: (1) The metabolic abnormalities linked to visceral obesity increase: i) the progression of aortic valve calcification and stenosis, of aortic calcification and stiffness, and thereby of the global hemodynamic load imposed on the LV; ii) the progression of myocardial hypertrophy, fibrosis, and dysfunction, iii) the loss in bone mineral density, and iv) the occurrence of adverse events in patients with AS. (2) Specifically, insulin resistance, the small, dense LDL and HDL phenotypes, enhanced oxidative stress \& inflammatory state, and activation of the RAS act synergistically to: i) promote infiltration, retention, and modification of lipids within the valvular and arterial tissues, ii) enhance the inflammatory and osteoblastic response to oxidized lipids, iii) activate apoptosis of VICs and apoptosis-mediated calcification of the aortic valve and aorta, iv) promote osteoclastic activity and demineralization within the bone tissues (calcification paradox) (Figs. 1\&6). These mechanisms predominate in the middle-aged patients, whereas imbalance in nuclear coregulators, alteration of adipokine system, dysregulation of mineral metabolism, and loss calcification inhibitors are the main contributing mechanisms in the elderly (Figs. 1,5,6). The contribution of visceral obesity to disease progression is more important in the patients with mildly or moderately calcified valves than in those with heavily calcified valves. In the latter, further progression of calcification and stenosis is predominantly influenced dysregulation of mineral metabolism. (3) The alteration of the myocardial energetic substrates and of the protein synthesis/degradation balance associated with visceral obesity and insulin resistance amplify the development of myocardial hypertrophy and fibrosis in response to pressure overload and accelerates the progression to myocardial dysfunction (Figs. 7\&8). The adverse LV remodelling and fibrosis resulting from the synergistic effects of pressure overload and dysmetabolism predispose to the occurrence of paradoxical low flow AS and cardiac events.
The general objectives of the study are to elucidate the mechanisms implicated in the pathogenesis of AS and to identify the metabolic factors that determine the progression of: i) aortic valve calcification and stenosis; ii) aorta calcification and stiffness, iii) myocardial remodeling, fibrosis and dysfunction; and iv) clinical outcomes in the AS population.
The specific aims of the study are:
- To obtain and analyze: i) the metabolic profile, ii) the progression of aortic valve, aorta, and coronary artery calcification measured by CT, iii) the hemodynamic progression of valve stenosis by Doppler-echocardiography, iv) the progression of myocardial remodeling, fibrosis, and dysfunction by MRI, v) the change in bone mineral density by DXA, vi) the occurrence of clinical outcomes (AVR or death), and vii) the valvular tissues explanted at the time of AVR in a series of 280 patients with AS.
- To perform histo-pathologic and genetic/protein expression analyses of valve tissues to document the lipid infiltration /retention/modification and the inflammatory and osteoblastic activities within the metabolic abnormalities, age, valve phenotype, and bone mineral density.
- To study the relationship between the cardio-metabolic determinants: i) traditional cardiovascular risk factors (hypercholesterolemia, hypertension, smoking), ii) amount of visceral fat and metabolic abnormalities associated with visceral obesity and the outcome variables: i) progression of aortic valve calcification and stenosis, aorta calcification and stiffening, bone mineral loss, and myocardial remodelling, fibrosis and dysfunction, ii) occurrence of adverse outcomes, iii) lipid infiltration/ retention/ modification, inflammatory/osteoblastic activities in the valve
- To determine if the impact of these cardio-metabolic determinants on disease progression differ according to age, gender, BAV phenotype, and degree of aortic valve calcification at baseline.
- To examine the relationship between aortic valve/aorta/coronary (i.e. ectopic) calcification and bone mineral density and determine the impact of cardio-metabolic and mineral metabolism factors on this relationship.
- To examine the respective contribution of aortic valve calcification/stenosis, aorta calcification /stiffness, coronary calcification, bone density, and myocardial fibrosis to the occurrence of clinical outcomes in this AS cohort.
- Conditions
- Aortic Valve Stenosis
- Being tested
- Doppler-echocardiography, Computed tomography, Magnetic resonance imaging, Fasting blood sample
- Keywords
- Aortic Stenosis, Obesity, Abdominal, Metabolic Syndrome X, Insulin Resistance, Echocardiography, Doppler, Multidetector Computed Tomography, Magnetic Resonance Imaging
- Medical subject headings
- Aortic Valve Stenosis, Obesity, Abdominal, Metabolic Syndrome, Insulin Resistance
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Doppler-echocardiographyDiagnostic test
Computed tomographyRadiation
Magnetic resonance imagingOther
Fasting blood sampleBiological
| Study group | Role | What they receive |
|---|---|---|
| Patients with aortic stenosis | Patients have every year: 1) an assessment of cardiometabolic risk profile with measure of body mass index, waist circumference and fasting blood sample and 2) a comprehensive Doppler-echocardiography exam.
Computed tomography and magnetic resonance imaging are performed every 2 years. Receives: Diagnostic Test: Doppler-echocardiography; Radiation: Computed tomography; Other: Magnetic resonance imaging; Biological: Fasting blood sample |
What is being measured
The primary outcome is the main question the study is designed to answer.
Progression of aortic valve stenosis
Annualized progression rate of aortic stenosis hemodynamic severity calculate as the difference between peak aortic jet velocity, transvalvular gradients, and aortic valve area measured at baseline and those measured at the last follow-up divided by the time between the first and last examinations.
Measured: Patients will be followed every 1 year, up to 5 years
Secondary outcomes (2)
Progression of aortic valve calcification
Annualized progression rate of aortic valve calcium
Measured: Patients will be followed every 2 years, up to 5 years
Progression of myocardial fibrosis and dysfunction
Annualized progression rate of myocardial fibrosis and global longitudinal myocardial strain
Measured: PPatients will be followed every 2 years, up to 5 years
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted6 Sep 2012 (estimated)
- Study startApr 2005
- Primary completionJan 2024 (estimated)
- Study completionJan 2024 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (59)Papers the sponsor has linked to this study.
- Other trials for Aortic Valve StenosisStudies of the same condition, open and under way.
- More trials run by Laval UniversityThe 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
- Observational
- Observational model
- Cohort
- Time perspective
- Prospective
- Enrolment
- 250 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Laval University
- Sponsor type
- University, hospital or other
- Collaborators
- Canadian Institutes of Health Research (CIHR), Heart and Stroke Foundation of Canada
- Responsible party
- Principal investigator, Philippe Pibarot, Laval University
- Investigators
- Philippe Pibarot, PhD, DVM, Principal investigator, Institut universitaire de cardiologie et de pneumologie de Québec, University Laval
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT01679431
- Sponsor's protocol ID
- MOP-114997
- Acronym
- PROGRESSA
- Status last verified
- Sep 2021
- First submitted
- 24 Aug 2012
- Last updated
- 21 Sep 2021
- Results posted
- No
- Data monitoring committee
- No
Publications
Capoulade R, Clavel MA, Dumesnil JG, Chan KL, Teo KK, Tam JW, Cote N, Mathieu P, Despres JP, Pibarot P; ASTRONOMER Investigators. Impact of metabolic syndrome on progression of aortic stenosis: influence of age and statin therapy. J Am Coll Cardiol. 2012 Jul 17;60(3):216-23. doi: 10.1016/j.jacc.2012.03.052.
PubMed 22789885Cote N, El Husseini D, Pepin A, Bouvet C, Gilbert LA, Audet A, Fournier D, Pibarot P, Moreau P, Mathieu P. Inhibition of ectonucleotidase with ARL67156 prevents the development of calcific aortic valve disease in warfarin-treated rats. Eur J Pharmacol. 2012 Aug 15;689(1-3):139-46. doi: 10.1016/j.ejphar.2012.05.016. Epub 2012 May 31.
PubMed 22659116Audet A, Cote N, Couture C, Bosse Y, Despres JP, Pibarot P, Mathieu P. Amyloid substance within stenotic aortic valves promotes mineralization. Histopathology. 2012 Oct;61(4):610-9. doi: 10.1111/j.1365-2559.2012.04265.x.
PubMed 22642224Carter S, Miard S, Roy-Bellavance C, Boivin L, Li Z, Pibarot P, Mathieu P, Picard F. Sirt1 inhibits resistin expression in aortic stenosis. PLoS One. 2012;7(4):e35110. doi: 10.1371/journal.pone.0035110. Epub 2012 Apr 6.
PubMed 22493735Shetty R, Girerd N, Cote N, Arsenault B, Despres JP, Pibarot P, Mathieu P. Elevated proportion of small, dense low-density lipoprotein particles and lower adiponectin blood levels predict early structural valve degeneration of bioprostheses. Cardiology. 2012;121(1):20-6. doi: 10.1159/000336170. Epub 2012 Feb 25.
PubMed 22378142Cote N, El Husseini D, Pepin A, Guauque-Olarte S, Ducharme V, Bouchard-Cannon P, Audet A, Fournier D, Gaudreault N, Derbali H, McKee MD, Simard C, Despres JP, Pibarot P, Bosse Y, Mathieu P. ATP acts as a survival signal and prevents the mineralization of aortic valve. J Mol Cell Cardiol. 2012 May;52(5):1191-202. doi: 10.1016/j.yjmcc.2012.02.003. Epub 2012 Feb 16.
PubMed 22366713Cote N, Couture C, Pibarot P, Despres JP, Mathieu P. Angiotensin receptor blockers are associated with a lower remodelling score of stenotic aortic valves. Eur J Clin Invest. 2011 Nov;41(11):1172-9. doi: 10.1111/j.1365-2362.2011.02522.x.
PubMed 21988540Gaudreault N, Ducharme V, Lamontagne M, Guauque-Olarte S, Mathieu P, Pibarot P, Bosse Y. Replication of genetic association studies in aortic stenosis in adults. Am J Cardiol. 2011 Nov 1;108(9):1305-10. doi: 10.1016/j.amjcard.2011.06.050. Epub 2011 Aug 18.
PubMed 21855833Mohty D, Pibarot P, Cote N, Cartier A, Audet A, Despres JP, Mathieu P. Hypoadiponectinemia is associated with valvular inflammation and faster disease progression in patients with aortic stenosis. Cardiology. 2011;118(2):140-6. doi: 10.1159/000327588. Epub 2011 May 19.
PubMed 21597293Page A, Dumesnil JG, Clavel MA, Chan KL, Teo KK, Tam JW, Mathieu P, Despres JP, Pibarot P; ASTRONOMER Investigators. Metabolic syndrome is associated with more pronounced impairment of left ventricle geometry and function in patients with calcific aortic stenosis: a substudy of the ASTRONOMER (Aortic Stenosis Progression Observation Measuring Effects of Rosuvastatin). J Am Coll Cardiol. 2010 Apr 27;55(17):1867-74. doi: 10.1016/j.jacc.2009.11.083.
PubMed 20413039Derbali H, Bosse Y, Cote N, Pibarot P, Audet A, Pepin A, Arsenault B, Couture C, Despres JP, Mathieu P. Increased biglycan in aortic valve stenosis leads to the overexpression of phospholipid transfer protein via Toll-like receptor 2. Am J Pathol. 2010 Jun;176(6):2638-45. doi: 10.2353/ajpath.2010.090541. Epub 2010 Apr 9.
PubMed 20382708Bosse Y, Miqdad A, Fournier D, Pepin A, Pibarot P, Mathieu P. Refining molecular pathways leading to calcific aortic valve stenosis by studying gene expression profile of normal and calcified stenotic human aortic valves. Circ Cardiovasc Genet. 2009 Oct;2(5):489-98. doi: 10.1161/CIRCGENETICS.108.820795. Epub 2009 Jul 8.
PubMed 20031625Cote N, Pibarot P, Pepin A, Fournier D, Audet A, Arsenault B, Couture C, Poirier P, Despres JP, Mathieu P. Oxidized low-density lipoprotein, angiotensin II and increased waist cirumference are associated with valve inflammation in prehypertensive patients with aortic stenosis. Int J Cardiol. 2010 Dec 3;145(3):444-9. doi: 10.1016/j.ijcard.2009.05.054. Epub 2009 Jun 13.
PubMed 19525020Mohty D, Pibarot P, Despres JP, Cartier A, Arsenault B, Picard F, Mathieu P. Age-related differences in the pathogenesis of calcific aortic stenosis: the potential role of resistin. Int J Cardiol. 2010 Jul 9;142(2):126-32. doi: 10.1016/j.ijcard.2008.12.068. Epub 2009 Jan 21.
PubMed 19162347Mathieu P, Despres JP, Pibarot P. The 'valvulo-metabolic' risk in calcific aortic valve disease. Can J Cardiol. 2007 Oct;23 Suppl B(Suppl B):32B-39B. doi: 10.1016/s0828-282x(07)71008-5.
PubMed 17932585
Study at a glance
From the registry record, last updated by the sponsor on 21 Sep 2021. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Metabolic Determinants of the Progression of Aortic Stenosis - PROGRESSA Study
- ClinicalTrials.gov ID
- NCT01679431
- Acronym / sponsor ID
- PROGRESSA / MOP-114997
- Conditions
- Aortic Valve Stenosis
- Keywords
- Aortic Stenosis, Obesity, Abdominal, Metabolic Syndrome X, Insulin Resistance, Echocardiography, Doppler, Multidetector Computed Tomography, Magnetic Resonance Imaging
- Study type
- Observational
- Recruitment status
- Unknown status
- Enrolment
- 250 participants (estimated)
- Lead sponsor
- Laval UniversityUniversity, hospital or other
- Collaborators
- Canadian Institutes of Health Research (CIHR), Heart and Stroke Foundation of Canada
- Study start
- Apr 2005
- Primary completion
- Jan 2024 (estimated)
- Study completion
- Jan 2024 (estimated)
- First posted
- 6 Sep 2012 (estimated)
- 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.
Calcific aortic stenosis (AS) has become the most common cardiac disease after coronary artery disease and hypertension. Unfortunately no medical therapies have been proven to decrease either the progression of valve stenosis or the resulting adverse effects on myocardial remodeling and function. In light of the studies performed in PROGRESSA, it becomes obvious that: i) AS is a complex and actively regulated process that involves the interaction of several pathways including lipid infiltration and retention, chronic inflammation, osteogenic activation, and active mineralization within the valvular tissues; ii) AS is not a disease strictly limited to the aortic valve but rather a systemic disease that often involves calcification and stiffening of the aorta and impairment of LV function as a consequence of pressure overload. Our findings suggest that the dysmetabolic milieu linked to visceral obesity may accelerate the deterioration of the structure and function not only of the aortic valve but also of the aorta and of the left ventricle. These findings open new avenues of research and provide strong impetus for the elaboration of prospective studies focusing on the "valvulo-metabolic risk" in AS.
The general hypotheses are: The metabolic abnormalities linked to visceral obesity accelerate (1) the progression of valvular calcification and stenosis, aortic calcification and stiffness; (2) the progression of myocardial fibrosis and dysfunction.
The general objectives of the study are to elucidate the mechanisms implicated in the pathogenesis of AS and to identify the metabolic factors that determine the progression of: i) aortic valve calcification and stenosis; ii) myocardial fibrosis and dysfunction; and iii) clinical outcomes.
This study will contribute to identifying the key metabolic determinants of AS progression and will pave the way for the future development of non surgical therapies for this disease. The results of this study would provide strong support to the realization of randomized trial to test the efficacy of lifestyle modification program or new pharmacological treatment aiming at the reduction of visceral fat and associated metabolic abnormalities in the AS population. Furthermore, this study will contribute to the identification of novel blood and imaging biomarkers of faster disease progression, which will help to optimize risk stratification and timing of AVR in the AS population.
Detailed description
The hypotheses are: (1) The metabolic abnormalities linked to visceral obesity increase: i) the progression of aortic valve calcification and stenosis, of aortic calcification and stiffness, and thereby of the global hemodynamic load imposed on the LV; ii) the progression of myocardial hypertrophy, fibrosis, and dysfunction, iii) the loss in bone mineral density, and iv) the occurrence of adverse events in patients with AS. (2) Specifically, insulin resistance, the small, dense LDL and HDL phenotypes, enhanced oxidative stress \& inflammatory state, and activation of the RAS act synergistically to: i) promote infiltration, retention, and modification of lipids within the valvular and arterial tissues, ii) enhance the inflammatory and osteoblastic response to oxidized lipids, iii) activate apoptosis of VICs and apoptosis-mediated calcification of the aortic valve and aorta, iv) promote osteoclastic activity and demineralization within the bone tissues (calcification paradox) (Figs. 1\&6). These mechanisms predominate in the middle-aged patients, whereas imbalance in nuclear coregulators, alteration of adipokine system, dysregulation of mineral metabolism, and loss calcification inhibitors are the main contributing mechanisms in the elderly (Figs. 1,5,6). The contribution of visceral obesity to disease progression is more important in the patients with mildly or moderately calcified valves than in those with heavily calcified valves. In the latter, further progression of calcification and stenosis is predominantly influenced dysregulation of mineral metabolism. (3) The alteration of the myocardial energetic substrates and of the protein synthesis/degradation balance associated with visceral obesity and insulin resistance amplify the development of myocardial hypertrophy and fibrosis in response to pressure overload and accelerates the progression to myocardial dysfunction (Figs. 7\&8). The adverse LV remodelling and fibrosis resulting from the synergistic effects of pressure overload and dysmetabolism predispose to the occurrence of paradoxical low flow AS and cardiac events.
The general objectives of the study are to elucidate the mechanisms implicated in the pathogenesis of AS and to identify the metabolic factors that determine the progression of: i) aortic valve calcification and stenosis; ii) aorta calcification and stiffness, iii) myocardial remodeling, fibrosis and dysfunction; and iv) clinical outcomes in the AS population.
The specific aims of the study are:
- To obtain and analyze: i) the metabolic profile, ii) the progression of aortic valve, aorta, and coronary artery calcification measured by CT, iii) the hemodynamic progression of valve stenosis by Doppler-echocardiography, iv) the progression of myocardial remodeling, fibrosis, and dysfunction by MRI, v) the change in bone mineral density by DXA, vi) the occurrence of clinical outcomes (AVR or death), and vii) the valvular tissues explanted at the time of AVR in a series of 280 patients with AS.
- To perform histo-pathologic and genetic/protein expression analyses of valve tissues to document the lipid infiltration /retention/modification and the inflammatory and osteoblastic activities within the metabolic abnormalities, age, valve phenotype, and bone mineral density.
- To study the relationship between the cardio-metabolic determinants: i) traditional cardiovascular risk factors (hypercholesterolemia, hypertension, smoking), ii) amount of visceral fat and metabolic abnormalities associated with visceral obesity and the outcome variables: i) progression of aortic valve calcification and stenosis, aorta calcification and stiffening, bone mineral loss, and myocardial remodelling, fibrosis and dysfunction, ii) occurrence of adverse outcomes, iii) lipid infiltration/ retention/ modification, inflammatory/osteoblastic activities in the valve
- To determine if the impact of these cardio-metabolic determinants on disease progression differ according to age, gender, BAV phenotype, and degree of aortic valve calcification at baseline.
- To examine the relationship between aortic valve/aorta/coronary (i.e. ectopic) calcification and bone mineral density and determine the impact of cardio-metabolic and mineral metabolism factors on this relationship.
- To examine the respective contribution of aortic valve calcification/stenosis, aorta calcification /stiffness, coronary calcification, bone density, and myocardial fibrosis to the occurrence of clinical outcomes in this AS cohort.
Study design
- Observational model
- Cohort
- Time perspective
- Prospective
- Number of arms
- 1
| Arm | Type | Receives |
|---|---|---|
| Patients with aortic stenosis | – | Diagnostic Test: Doppler-echocardiography, Radiation: Computed tomography, Other: Magnetic resonance imaging, Biological: Fasting blood samplePatients have every year: 1) an assessment of cardiometabolic risk profile with measure of body mass index, waist circumference and fasting blood sample and 2) a comprehensive Doppler-echocardiography exam. Computed tomography and magnetic resonance imaging are performed every 2 years. |
Who may qualify
- Ages
- 21 years and older
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult, Older adult
- Study population
- Cohort will be selected at primary care clinic
Key inclusion criteria (2 listed)
- Age >21 years
- Presence of aortic stenosis defined as peak aortic jet velocity ≥2.5 m/s
Key exclusion criteria (7 listed)
- Symptomatic aortic stenosis
- Very severe aortic stenosis defined as an AVA≤0.6 cm2
- Left ventricular ejection fraction < 50%
- More than mild aortic or mitral regurgitation, or mitral stenosis
- Atrial fibrillation or flutter
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 |
|---|---|---|
| Doppler-echocardiography | Diagnostic test | Patients with aortic stenosis |
| Computed tomography | Radiation | Patients with aortic stenosis |
| Magnetic resonance imaging | Other | Patients with aortic stenosis |
| Fasting blood sample | Biological | Patients with aortic stenosis |
Primary outcome
Progression of aortic valve stenosis
Time frame: Patients will be followed every 1 year, up to 5 years
Annualized progression rate of aortic stenosis hemodynamic severity calculate as the difference between peak aortic jet velocity, transvalvular gradients, and aortic valve area measured at baseline and those measured at the last follow-up divided by the time between the first and last examinations.
2 secondary outcomes
Progression of aortic valve calcification
Time frame: Patients will be followed every 2 years, up to 5 years
Progression of myocardial fibrosis and dysfunction
Time frame: PPatients will be followed every 2 years, up to 5 years
Results and safety
Results are not available in the source record.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 21 Sep 2021.
- Background: PubMed 22789885Capoulade R, Clavel MA, Dumesnil JG, Chan KL, Teo KK, Tam JW, Cote N, Mathieu P, Despres JP, Pibarot P; ASTRONOMER Investigators. Impact of metabolic syndrome on progression of aortic stenosis: influence of age and statin therapy. J Am Coll Cardiol. 2012 Jul 17;60(3):216-23. doi: 10.1016/j.jacc.2012.03.052.
- Background: PubMed 22659116Cote N, El Husseini D, Pepin A, Bouvet C, Gilbert LA, Audet A, Fournier D, Pibarot P, Moreau P, Mathieu P. Inhibition of ectonucleotidase with ARL67156 prevents the development of calcific aortic valve disease in warfarin-treated rats. Eur J Pharmacol. 2012 Aug 15;689(1-3):139-46. doi: 10.1016/j.ejphar.2012.05.016. Epub 2012 May 31.
- Background: PubMed 22642224Audet A, Cote N, Couture C, Bosse Y, Despres JP, Pibarot P, Mathieu P. Amyloid substance within stenotic aortic valves promotes mineralization. Histopathology. 2012 Oct;61(4):610-9. doi: 10.1111/j.1365-2559.2012.04265.x.
- Background: PubMed 22493735Carter S, Miard S, Roy-Bellavance C, Boivin L, Li Z, Pibarot P, Mathieu P, Picard F. Sirt1 inhibits resistin expression in aortic stenosis. PLoS One. 2012;7(4):e35110. doi: 10.1371/journal.pone.0035110. Epub 2012 Apr 6.
- Background: PubMed 22378142Shetty R, Girerd N, Cote N, Arsenault B, Despres JP, Pibarot P, Mathieu P. Elevated proportion of small, dense low-density lipoprotein particles and lower adiponectin blood levels predict early structural valve degeneration of bioprostheses. Cardiology. 2012;121(1):20-6. doi: 10.1159/000336170. Epub 2012 Feb 25.
- Background: PubMed 22366713Cote N, El Husseini D, Pepin A, Guauque-Olarte S, Ducharme V, Bouchard-Cannon P, Audet A, Fournier D, Gaudreault N, Derbali H, McKee MD, Simard C, Despres JP, Pibarot P, Bosse Y, Mathieu P. ATP acts as a survival signal and prevents the mineralization of aortic valve. J Mol Cell Cardiol. 2012 May;52(5):1191-202. doi: 10.1016/j.yjmcc.2012.02.003. Epub 2012 Feb 16.
- Background: PubMed 21988540Cote N, Couture C, Pibarot P, Despres JP, Mathieu P. Angiotensin receptor blockers are associated with a lower remodelling score of stenotic aortic valves. Eur J Clin Invest. 2011 Nov;41(11):1172-9. doi: 10.1111/j.1365-2362.2011.02522.x.
- Background: PubMed 21855833Gaudreault N, Ducharme V, Lamontagne M, Guauque-Olarte S, Mathieu P, Pibarot P, Bosse Y. Replication of genetic association studies in aortic stenosis in adults. Am J Cardiol. 2011 Nov 1;108(9):1305-10. doi: 10.1016/j.amjcard.2011.06.050. Epub 2011 Aug 18.
- Background: PubMed 21597293Mohty D, Pibarot P, Cote N, Cartier A, Audet A, Despres JP, Mathieu P. Hypoadiponectinemia is associated with valvular inflammation and faster disease progression in patients with aortic stenosis. Cardiology. 2011;118(2):140-6. doi: 10.1159/000327588. Epub 2011 May 19.
- Background: PubMed 20413039Page A, Dumesnil JG, Clavel MA, Chan KL, Teo KK, Tam JW, Mathieu P, Despres JP, Pibarot P; ASTRONOMER Investigators. Metabolic syndrome is associated with more pronounced impairment of left ventricle geometry and function in patients with calcific aortic stenosis: a substudy of the ASTRONOMER (Aortic Stenosis Progression Observation Measuring Effects of Rosuvastatin). J Am Coll Cardiol. 2010 Apr 27;55(17):1867-74. doi: 10.1016/j.jacc.2009.11.083.
- Background: PubMed 20382708Derbali H, Bosse Y, Cote N, Pibarot P, Audet A, Pepin A, Arsenault B, Couture C, Despres JP, Mathieu P. Increased biglycan in aortic valve stenosis leads to the overexpression of phospholipid transfer protein via Toll-like receptor 2. Am J Pathol. 2010 Jun;176(6):2638-45. doi: 10.2353/ajpath.2010.090541. Epub 2010 Apr 9.
- Background: PubMed 20031625Bosse Y, Miqdad A, Fournier D, Pepin A, Pibarot P, Mathieu P. Refining molecular pathways leading to calcific aortic valve stenosis by studying gene expression profile of normal and calcified stenotic human aortic valves. Circ Cardiovasc Genet. 2009 Oct;2(5):489-98. doi: 10.1161/CIRCGENETICS.108.820795. Epub 2009 Jul 8.
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Intravascular Lithotripsy in High Risk Calcified Iliac Anatomy for Transfemoral TAVR
Iliac Disease, Aortic Valve Stenosis
Not yet recruiting
NHLBI SESAME (SEptal Scoring Along Midline Endocardium) Multi-Center Prospective Study Using Improvised Off-Label Devices
Hypertrophic Cardiomyopathy, Left Ventricular Outflow Obstruction
Recruiting
Exercise and Diet Supplements for Older Patients Undergoing TAVI: the IRON-TAVI Trial
Aortic Stenosis Disease, Aortic Stenosis Symptomatic
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. This study is not recruiting at the moment.
Philippe Pibarot, PhD, DVM principal investigator
Institut universitaire de cardiologie et de pneumologie de Québec, University Laval
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Aortic Valve Stenosis, run by Laval University at 1 site in Canada.
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 2 inclusion and 7 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: status not confirmed, as of the sponsor's last update on 21 Sep 2021. 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 Canada. 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?
Results are not available in the source record.
How can a doctor refer a patient or contact the research team?
Contact Philippe Pibarot, PhD, DVM (418-656-8711 ext. 5938, Philippe.Pibarot@med.ulaval.ca), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Progression of aortic valve stenosis (time frame: Patients will be followed every 1 year, up to 5 years). 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 NCT01679431, which also lists 59 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 21 Sep 2021.