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Cardiopulmonary Exercise Testing to Evaluate Pulmonary AVMs With and Without Airflow Obstruction (ExercisePAVM2)

Primary Purpose

Pulmonary Arteriovenous Malformations, Hereditary Hemorrhagic Telangiectasia, Asthma

Status
Unknown status
Phase
Not Applicable
Locations
Study Type
Interventional
Intervention
Cardiopulmonary exercise test
Sponsored by
Imperial College London
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional supportive care trial for Pulmonary Arteriovenous Malformations focused on measuring workload, oxygen level, oxygen consumption, breathing reserve, ventilatory efficiency

Eligibility Criteria

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

Inclusion Criteria:

  • Ability to provide informed consent
  • Pulmonary AVMs no airflow obstruction: Pulmonary AVMs confirmed by CT scan and no evidence or history of airflow obstruction on clinical grounds, or by spirometric evaluations.
  • Pulmonary AVMs with airflow obstruction: Pulmonary AVMs confirmed by CT scan and evidence or history of airflow obstruction on clinical grounds, and/or by spirometric evaluations (such as FEV1/VC ratio <80%).

Exclusion Criteria:

  • Inability to provide informed consent
  • Any known cardiovascular abnormality including a history of syncope (faintness, dizziness, lightheadedness or loss of consciousness due to an abnormality of the cardiovascular system).
  • Current respiratory tract infection (eg a cold).
  • Pregnancy.
  • Claustrophobia or needle phobia

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm Type

    Experimental

    Experimental

    Arm Label

    Patients with pulmonary AVMs and no airflow obstruction

    Patients with pulmonary AVMs and airflow obstruction

    Arm Description

    30 patients with pulmonary AVMs and no airflow obstruction will undergo cardiopulmonary exercise testing

    30 patients with pulmonary AVMs and airflow obstruction will undergo cardiopulmonary exercise testing

    Outcomes

    Primary Outcome Measures

    Total body oxygen consumption in mls/min/kg, at peak exercise (VO2 max).
    Of the many measurements and derived indices that can be measured during cardiopulmonary exercise testing, the peak consumption of oxygen (VO2 max) is perhaps the best indicator of integrated cardiorespiratory capacity. The principle research question will therefore test the null hypothesis that "The VO2 max does not differ between PAVM patients with and without airflow obstruction."

    Secondary Outcome Measures

    Breathing reserve
    We will also test in univariate and multiple regression analyses whether breathing reserve differs between PAVM patients with and without airflow obstruction.
    Ventilatory efficiency
    We will also test in univariate and multiple regression analyses whether ventilatory efficiency differs between PAVM patients with and without airflow obstruction.

    Full Information

    First Posted
    May 28, 2015
    Last Updated
    May 29, 2015
    Sponsor
    Imperial College London
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    1. Study Identification

    Unique Protocol Identification Number
    NCT02458703
    Brief Title
    Cardiopulmonary Exercise Testing to Evaluate Pulmonary AVMs With and Without Airflow Obstruction
    Acronym
    ExercisePAVM2
    Official Title
    Hypoxemia, Dyspnea, and Exercise Tolerance in Patients With Pulmonary Arteriovenous Malformations , With and Without Airflow Obstruction
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    April 2015
    Overall Recruitment Status
    Unknown status
    Study Start Date
    May 2015 (undefined)
    Primary Completion Date
    May 2018 (Anticipated)
    Study Completion Date
    May 2018 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    Imperial College London

    4. Oversight

    Data Monitoring Committee
    No

    5. Study Description

    Brief Summary
    Pulmonary arteriovenous malformations (PAVMs) are a rare vascular condition affecting the lungs. PAVMs lead to low blood oxygen levels, yet are very well tolerated by patients. This study will examine the exercise capacity of PAVM patients using formal cardiopulmonary exercise tests performed on a stationary bicycle, and whether this is affected by the presence of concurrent airflow obstruction, such as due to asthma.
    Detailed Description
    It is well known that the lung is the site at which oxygen enters the blood stream, diffusing from the alveolar air sacs into the pulmonary capillaries. This newly oxygenated blood is carried to the heart in the pulmonary veins, then passes into the systemic circulation to provide oxygen to the tissues. Patients with pulmonary arteriovenous malformations (PAVMs) have abnormal vascular connections between pulmonary arteries and pulmonary veins in the lung. Blood flowing through PAVMs therefore bypasses the oxygenation sites in the pulmonary capillaries. Low blood oxygen levels (hypoxemia) is frequent in PAVM patients but breathlessness (dyspnea) is not. The investigators have shown that dyspnea was not a common presenting complaint in a large UK series, and that there is little correlation between severity of dyspnea in PAVM patients, and blood oxygen levels. In this study the investigators will address the question "Do PAVM patients have lower exercise tolerance if they have concurrent airflow obstruction?" The primary outcome measure will be the total body oxygen consumption in mls/min/kg, at peak exercise (the V[dot]O2 peak (also known as "VO2 max")). The investigators will address this by first performing standardised cardiopulmonary exercise testing, as used in the clinic and our previous study (11/H0803/9), on age and sex matched patients with PAVMs. 30 will be recruited with airflow obstruction, and 30 without airflow obstruction. Physiological parameters will be compared, to test the null hypothesis that the impact of exercise on PAVM patients' cardiopulmonary systems does not differ according to the presence or absence of airflow obstruction. Cellular and molecular methods will be used to dissect mechanistic pathways.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Pulmonary Arteriovenous Malformations, Hereditary Hemorrhagic Telangiectasia, Asthma, COPD
    Keywords
    workload, oxygen level, oxygen consumption, breathing reserve, ventilatory efficiency

    7. Study Design

    Primary Purpose
    Supportive Care
    Study Phase
    Not Applicable
    Interventional Study Model
    Parallel Assignment
    Masking
    None (Open Label)
    Allocation
    Non-Randomized
    Enrollment
    60 (Anticipated)

    8. Arms, Groups, and Interventions

    Arm Title
    Patients with pulmonary AVMs and no airflow obstruction
    Arm Type
    Experimental
    Arm Description
    30 patients with pulmonary AVMs and no airflow obstruction will undergo cardiopulmonary exercise testing
    Arm Title
    Patients with pulmonary AVMs and airflow obstruction
    Arm Type
    Experimental
    Arm Description
    30 patients with pulmonary AVMs and airflow obstruction will undergo cardiopulmonary exercise testing
    Intervention Type
    Other
    Intervention Name(s)
    Cardiopulmonary exercise test
    Other Intervention Name(s)
    CPET
    Intervention Description
    Subjects will have the test in the Exercise Suite of Hammersmith Hospital, London, UK. They will have painless skin probes placed on their fingers, chest, and legs to monitor heart rate, ECG, blood oxygen levels, and oxygen delivery during the test. Subjects will also be shown how to breathe through a mouthpiece with a nose clip on, and how to indicate on a sliding device whether they feel breathless. They will then start cycling against a very low resistance at a steady speed. As long as they feel comfortable, there will be a gradual increase in work load until they feel they cannot keep going at the same speed. They can also stop sooner for any reason. Afterwards, while they are "cooling down", they will fill in a short questionnaire describing how they feel. 20-30mls of blood will be taken for analysis.
    Primary Outcome Measure Information:
    Title
    Total body oxygen consumption in mls/min/kg, at peak exercise (VO2 max).
    Description
    Of the many measurements and derived indices that can be measured during cardiopulmonary exercise testing, the peak consumption of oxygen (VO2 max) is perhaps the best indicator of integrated cardiorespiratory capacity. The principle research question will therefore test the null hypothesis that "The VO2 max does not differ between PAVM patients with and without airflow obstruction."
    Time Frame
    Same day (within 1 hour), at end of exercise study
    Secondary Outcome Measure Information:
    Title
    Breathing reserve
    Description
    We will also test in univariate and multiple regression analyses whether breathing reserve differs between PAVM patients with and without airflow obstruction.
    Time Frame
    Same day (within 1 hour), at end of exercise study
    Title
    Ventilatory efficiency
    Description
    We will also test in univariate and multiple regression analyses whether ventilatory efficiency differs between PAVM patients with and without airflow obstruction.
    Time Frame
    Same day (within 1 hour), at end of exercise study

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    16 Years
    Maximum Age & Unit of Time
    80 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: Ability to provide informed consent Pulmonary AVMs no airflow obstruction: Pulmonary AVMs confirmed by CT scan and no evidence or history of airflow obstruction on clinical grounds, or by spirometric evaluations. Pulmonary AVMs with airflow obstruction: Pulmonary AVMs confirmed by CT scan and evidence or history of airflow obstruction on clinical grounds, and/or by spirometric evaluations (such as FEV1/VC ratio <80%). Exclusion Criteria: Inability to provide informed consent Any known cardiovascular abnormality including a history of syncope (faintness, dizziness, lightheadedness or loss of consciousness due to an abnormality of the cardiovascular system). Current respiratory tract infection (eg a cold). Pregnancy. Claustrophobia or needle phobia
    Central Contact Person:
    First Name & Middle Initial & Last Name or Official Title & Degree
    Claire L Shovlin, PhD FRCP
    Phone
    44 208 282 2352
    Email
    c.shovlin@imperial.ac.uk
    First Name & Middle Initial & Last Name or Official Title & Degree
    Luke Howard, DPhil FRCP
    Phone
    44 208 282 2352
    Email
    l.howard@imperial.ac.uk
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Claire L Shovlin, PhD FRCP
    Organizational Affiliation
    Hammersmith Hospital, Du Cane Rd, London, United Kingdom, W12 0NN
    Official's Role
    Principal Investigator

    12. IPD Sharing Statement

    Citations:
    PubMed Identifier
    24676541
    Citation
    Howard LSGE, Santhirapala V, Murphy K, Mukherjee B, Busbridge M, Tighe HC, Jackson JE, Hughes JMB, Shovlin CL. Cardiopulmonary exercise testing demonstrates maintenance of exercise capacity in patients with hypoxemia and pulmonary arteriovenous malformations. Chest. 2014 Sep;146(3):709-718. doi: 10.1378/chest.13-2988.
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    Cardiopulmonary Exercise Testing to Evaluate Pulmonary AVMs With and Without Airflow Obstruction

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