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Vascular Inflammation ReDuction and Perivascular Fat Imaging by Computed Tomography (VIRDICT)

Primary Purpose

Coronary Artery Disease, Atheroscleroses, Coronary, Vascular Inflammation

Status
Recruiting
Phase
Not Applicable
Locations
Greece
Study Type
Interventional
Intervention
CaRi-Heart device
Sponsored by
Hippocration General Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Coronary Artery Disease focused on measuring vascular inflammation, fat attenuation index, pericoronary adipose tissue, coronary computed tomography angiography

Eligibility Criteria

30 Years - 80 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Participants must satisfy the following conditions: Male or female, aged 30 to 80 years CCTA scan showing mild coronary artery plaques (<50% luminal stenosis) and CaRi-Heart Risk ≥ 5% and/or FAI-Score ≥ 75th percentile in the left anterior coronary or right coronary artery or FAI-Score ≥ 95th percentile in the circumflex coronary within the last 6 months. Willing and able (in the Investigators opinion) to comply with all study requirements. Able to understand both verbal or written Greek No definite clinical indication for a change in treatment based on European Society of Cardiology guidelines or planned revascularization Exclusion Criteria: The participant may not enter the study if ANY of the following are known to apply: Previous documented history of coronary artery disease requiring treatment. This includes any of the following: i. Acute myocardial infarction ii. Unstable angina iii. Coronary revascularization procedure iv. Clinically significant coronary artery disease diagnosed by invasive or non-invasive testing. History of New York Heart Association (NYHA) Class III or IV heart failure within the past 12 months of consent. Autoimmune disease requiring immunosuppressive therapy or systemic corticosteroid therapy Active chronic treatment with any anti-inflammatory agents (e.g. NSAIDs, systemic corticosteroids) Active neoplasm requiring surgery, chemotherapy, or radiation within the prior 12 months (subjects with a history of malignancy who have undergone curative resection or otherwise not requiring treatment for at least 12 months prior to screening with no detectable recurrence are allowed) Contraindication for statin therapy. Patients with intolerance to colchicine therapy may be included but they will receive statin treatment only. Severe Chronic kidney disease (estimated glomerular filtration rate < 30 mL/min/1.73 m² and/or serum creatinine > 2.5 mg/dL or 220 µmol/l). Hepatic dysfunction (aspartate aminotransferase [AST] or alanine aminotransferase [ALT] > 3 × the upper limit of normal [ULN] measured on local labs in last 6 months) Any clinically significant abnormality identified at the time of screening that, in the opinion of the Investigator, would preclude safe completion of the study. Any other significant disease or disorder which, in the opinion of the Investigator, may either put the participants at risk because of participation in the study, or may influence the result of the study, or the participant's ability to participate in the study. Participants who have participated in another research study involving a treatment intervention or an investigational product, in the past 12 weeks. Patients unable to understand verbal or written English. Contraindication to contract dye for CCTA. Pregnancy

Sites / Locations

  • 1st Cardiology Department, Hippokration General Hospital of AthensRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

No Intervention

Experimental

Arm Label

Standard of care management

Coronary inflammation-based management

Arm Description

Patients will receive standard of care treatment.

Participants classified as moderate risk (FAI-Score 75th-89th percentile for the RCA or the LAD or ≥ 95th percentile for the LCx) or CaRi-Heart risk≥ 5% and <10%) will receive atorvastatin 40mg daily, if they do not already receive statin therapy, while if they already receive statin, it will be discontinued and they will be given atorvastatin 80 mg daily. Participants classified as high risk (FAI-Score≥ 90th percentile for the RCA or the LAD or CaRi-Heart risk≥ 10%) will receive atorvastatin 80 mg daily and colchicine 0.5 mg daily. Tolerance and compliance will be monitored during the study follow-up and participants will be informed at enrollment about possible treatment side effects. In case of colchicine intolerance, colchicine will be discontinued. If the patient cannot tolerate atorvastatin, then half dose may be prescribed daily. In case of severe adverse events related to atorvastatin, atorvastatin will be discontinued and the participant will withdraw from the study.

Outcomes

Primary Outcome Measures

Change in Fat Attenuation Index (FAI) in the proximal right coronary (RCA), left anterior descending (LAD) and circumflex (Cx) coronary arteries
FAI change will be compared between the standard of care arm and the inflammation-based treatment arm

Secondary Outcome Measures

% change in plasma LDL-c
Change in LDL-c will be compared between the standard of care arm and the inflammation-based treatment arm
% change in plasma HDL-c
Change in HDL-c will be compared between the standard of care arm and the inflammation-based treatment arm
% change in plasma triglycerides
Change in triglycerides will be compared between the standard of care arm and the inflammation-based treatment arm
% change in plasma high sensitivity C-reactive protein (hsCRP)
Change in hsCRP values will be compared between the standard of care arm and the inflammation-based treatment arm
% change in plasma IL-6
Change in IL-6 values will be compared between the standard of care arm and the inflammation-based treatment arm
% change and absolute change in FAI-Score
Change in FAI-Score value will be compared between the standard of care arm and the inflammation-based treatment arm
% change and absolute change in CaRi-Heart Risk
Change in CaRi-Heart Risk value will be compared between the standard of care arm and the inflammation-based treatment arm
% change of FAI around identified individual coronary plaques
Change in FAI around identified individual coronary plaques will be compared between the standard of care arm and the inflammation-based treatment arm
FAI around identified individual coronary plaques
FAI around identified individual coronary plaques will be measured in both arms

Full Information

First Posted
October 5, 2023
Last Updated
October 11, 2023
Sponsor
Hippocration General Hospital
Collaborators
Biomedical Research Foundation, Academy of Athens
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1. Study Identification

Unique Protocol Identification Number
NCT06083337
Brief Title
Vascular Inflammation ReDuction and Perivascular Fat Imaging by Computed Tomography
Acronym
VIRDICT
Official Title
Vascular Inflammation ReDuction and Perivascular Fat Imaging by Computed Tomography
Study Type
Interventional

2. Study Status

Record Verification Date
October 2023
Overall Recruitment Status
Recruiting
Study Start Date
January 22, 2022 (Actual)
Primary Completion Date
July 22, 2025 (Anticipated)
Study Completion Date
July 22, 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Hippocration General Hospital
Collaborators
Biomedical Research Foundation, Academy of Athens

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
The goal of this clinical trial is to compare the effect of standard of care management vs. CaRi-Heart based management on vascular inflammation in patients with increased Fat Attenuation Index-Score. The main questions it aims to answer are: Does treatment intensification reduce vascular inflammation detected by perivascular fat imaging to a greater extent than standard of care treatment? Do changes in vascular inflammation biomarkers correlate with changes in lipid metrics or inflammatory biomarkers, such as interleukin-6? Participants will be randomized either to standard of care treatment or intensified treatment with maximum dose of atorvastatin +/- low dose of colchicine. After their inclusion, study participants will be followed-up for 6 months with regular monitoring for adverse events and blood will be drawn at 3 and 6 months. After the 6-month follow-up, participants will undergo CCTA imaging for fat attenuation index measurements. Researchers will compare standard of care and vascular inflammation-based treatment to see if inflammation-based treatment is more potent against vascular inflammation.
Detailed Description
The VIRDICT study is a randomized, open-label clinical study including participants aged 30-80 years old, who underwent coronary computed tomography angiography (CCTA) and had no obstructive coronary stenoses. CCTA images will be transferred as pseudonymized DICOM data to Caristo Diagnostics Ltd for perivascular fat analysis. Individuals with evidence of coronary inflammation, as assessed by fat attenuation index (FAI) will be eligible for the VIRDICT study. Participants will be randomized either to standard of care treatment or inflammation-based treatment with atorvastatin ± colchicine. Participants will be followed-up for 6 months post randomization, with four follow-up visits (two by telephone call and two by onsite visit). At the end of their follow-up, participants will undergo a second CCTA and the relevant images will be analyzed for pericoronary inflammation. 140 participants are expected be included in the study. Interim analyses will be performed after sufficient patients (approximately 80 patients) have completed 24 weeks of follow-up. This is a pilot study to establish the ability of CCTA-derived FAI quantification to detect a change in coronary artery inflammation, following a period of treatment with medications with known anti-inflammatory properties (statin and colchicine).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Coronary Artery Disease, Atheroscleroses, Coronary, Vascular Inflammation
Keywords
vascular inflammation, fat attenuation index, pericoronary adipose tissue, coronary computed tomography angiography

7. Study Design

Primary Purpose
Prevention
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Model Description
Participants of the VIRDICT study will be randomized either to standard of care management or high-dose atorvastatin +/- colchicine.
Masking
None (Open Label)
Allocation
Randomized
Enrollment
140 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Standard of care management
Arm Type
No Intervention
Arm Description
Patients will receive standard of care treatment.
Arm Title
Coronary inflammation-based management
Arm Type
Experimental
Arm Description
Participants classified as moderate risk (FAI-Score 75th-89th percentile for the RCA or the LAD or ≥ 95th percentile for the LCx) or CaRi-Heart risk≥ 5% and <10%) will receive atorvastatin 40mg daily, if they do not already receive statin therapy, while if they already receive statin, it will be discontinued and they will be given atorvastatin 80 mg daily. Participants classified as high risk (FAI-Score≥ 90th percentile for the RCA or the LAD or CaRi-Heart risk≥ 10%) will receive atorvastatin 80 mg daily and colchicine 0.5 mg daily. Tolerance and compliance will be monitored during the study follow-up and participants will be informed at enrollment about possible treatment side effects. In case of colchicine intolerance, colchicine will be discontinued. If the patient cannot tolerate atorvastatin, then half dose may be prescribed daily. In case of severe adverse events related to atorvastatin, atorvastatin will be discontinued and the participant will withdraw from the study.
Intervention Type
Device
Intervention Name(s)
CaRi-Heart device
Intervention Description
Open-label treatment with atorvastatin +/- low-dose colchicine medications based on CaRi-Heart algorithm management.
Primary Outcome Measure Information:
Title
Change in Fat Attenuation Index (FAI) in the proximal right coronary (RCA), left anterior descending (LAD) and circumflex (Cx) coronary arteries
Description
FAI change will be compared between the standard of care arm and the inflammation-based treatment arm
Time Frame
6 months
Secondary Outcome Measure Information:
Title
% change in plasma LDL-c
Description
Change in LDL-c will be compared between the standard of care arm and the inflammation-based treatment arm
Time Frame
6 months
Title
% change in plasma HDL-c
Description
Change in HDL-c will be compared between the standard of care arm and the inflammation-based treatment arm
Time Frame
6 months
Title
% change in plasma triglycerides
Description
Change in triglycerides will be compared between the standard of care arm and the inflammation-based treatment arm
Time Frame
6 months
Title
% change in plasma high sensitivity C-reactive protein (hsCRP)
Description
Change in hsCRP values will be compared between the standard of care arm and the inflammation-based treatment arm
Time Frame
6 months
Title
% change in plasma IL-6
Description
Change in IL-6 values will be compared between the standard of care arm and the inflammation-based treatment arm
Time Frame
6 months
Title
% change and absolute change in FAI-Score
Description
Change in FAI-Score value will be compared between the standard of care arm and the inflammation-based treatment arm
Time Frame
6 months
Title
% change and absolute change in CaRi-Heart Risk
Description
Change in CaRi-Heart Risk value will be compared between the standard of care arm and the inflammation-based treatment arm
Time Frame
6 months
Title
% change of FAI around identified individual coronary plaques
Description
Change in FAI around identified individual coronary plaques will be compared between the standard of care arm and the inflammation-based treatment arm
Time Frame
6 months
Title
FAI around identified individual coronary plaques
Description
FAI around identified individual coronary plaques will be measured in both arms
Time Frame
6 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
30 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Participants must satisfy the following conditions: Male or female, aged 30 to 80 years CCTA scan showing mild coronary artery plaques (<50% luminal stenosis) and CaRi-Heart Risk ≥ 5% and/or FAI-Score ≥ 75th percentile in the left anterior coronary or right coronary artery or FAI-Score ≥ 95th percentile in the circumflex coronary within the last 6 months. Willing and able (in the Investigators opinion) to comply with all study requirements. Able to understand both verbal or written Greek No definite clinical indication for a change in treatment based on European Society of Cardiology guidelines or planned revascularization Exclusion Criteria: The participant may not enter the study if ANY of the following are known to apply: Previous documented history of coronary artery disease requiring treatment. This includes any of the following: i. Acute myocardial infarction ii. Unstable angina iii. Coronary revascularization procedure iv. Clinically significant coronary artery disease diagnosed by invasive or non-invasive testing. History of New York Heart Association (NYHA) Class III or IV heart failure within the past 12 months of consent. Autoimmune disease requiring immunosuppressive therapy or systemic corticosteroid therapy Active chronic treatment with any anti-inflammatory agents (e.g. NSAIDs, systemic corticosteroids) Active neoplasm requiring surgery, chemotherapy, or radiation within the prior 12 months (subjects with a history of malignancy who have undergone curative resection or otherwise not requiring treatment for at least 12 months prior to screening with no detectable recurrence are allowed) Contraindication for statin therapy. Patients with intolerance to colchicine therapy may be included but they will receive statin treatment only. Severe Chronic kidney disease (estimated glomerular filtration rate < 30 mL/min/1.73 m² and/or serum creatinine > 2.5 mg/dL or 220 µmol/l). Hepatic dysfunction (aspartate aminotransferase [AST] or alanine aminotransferase [ALT] > 3 × the upper limit of normal [ULN] measured on local labs in last 6 months) Any clinically significant abnormality identified at the time of screening that, in the opinion of the Investigator, would preclude safe completion of the study. Any other significant disease or disorder which, in the opinion of the Investigator, may either put the participants at risk because of participation in the study, or may influence the result of the study, or the participant's ability to participate in the study. Participants who have participated in another research study involving a treatment intervention or an investigational product, in the past 12 weeks. Patients unable to understand verbal or written English. Contraindication to contract dye for CCTA. Pregnancy
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Alexios S Antonopoulos, MD, PhD
Phone
+306947607442
Email
antonopoulosal@yahoo.gr
First Name & Middle Initial & Last Name or Official Title & Degree
Spyridon D Simantiris, MD
Phone
+306949402966
Email
spyrsim@gmail.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Alexios S Antonopoulos, MD, PhD
Organizational Affiliation
1st Cardiology Department, Hippokration General Hospital of Athens
Official's Role
Principal Investigator
Facility Information:
Facility Name
1st Cardiology Department, Hippokration General Hospital of Athens
City
Athens
State/Province
Attica
ZIP/Postal Code
11527
Country
Greece
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Alexios S Antonopoulos, MD, PhD
Phone
+306947607442
Email
antonopoulosal@yahoo.gr
First Name & Middle Initial & Last Name & Degree
Spyridon D Simantiris, MD
Phone
+306949402966
Email
spyrsim@gmail.com

12. IPD Sharing Statement

Learn more about this trial

Vascular Inflammation ReDuction and Perivascular Fat Imaging by Computed Tomography

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