Active clinical trials for "Heart Diseases"

The aim of the study is to evaluate the value of postoperative troponin in the prediction of mid term and long term mortality and morbidity in children with congenital heart disease undergoing cardiac surgery.

Cardiac output (CO) is an important hemodynamic variable in the management of critically ill patients. The pulmonary artery catheter (PAC) requires invasive techniques with potential complications and there is increasing interest in less invasive methods of measuring CO. This study is designed to compare CO values from PAC thermodilution (COTD) and ultrasound dilution (COUD).

This is a prospective, multi-center study examining the clinical impact of the Corus CAD (Age/Sex/Gene Expression score - ASGES) assay in approximately 250 evaluable subjects with no history of obstructive coronary artery disease who now present with chest pain or anginal-equivalent symptoms to a primary care physician (PCP) for evaluation.

Diastolic function is poorly studied in children with congenital heart disease. This is mainly due to the lack of validated techniques. Cardiac MRI offers two advantages compared to echocardiography: 1. accurate measurements of ventricular volumes and mass; 2. tissue characterization. The main advantage of echocardiography is a better temporal resolution which allows the study of short events like early relaxation. Overall there is a lack of studies correlating different echocardiographic and MRI parameters of heart function in pediatric populations with congenital or acquired heart diseases. This study will address specific questions on specific groups of patients that might bring more insight into chamber interaction and cardiac function. This study hypothesizes the following: Atrial enlargement is a marker of chronic increase in filling pressures and 3D echo might be the best method for follow-up. Cardiac remodeling associated with chronic loading results in changes in diastolic properties related to changes in cardiac mass and volume. This is related to changes in cardiac mechanics influencing diastolic parameters. Especially the influence on twisting and untwisting will be studied. Regional myocardial fibrosis and scarring may account for regional systolic and diastolic dysfunction with possible prognostic impact

Congenital heart disease with need for early surgery in newborns is associated with an increased incidence in global impairment in development. The causes of these late adverse neurologic outcomes are multifactoral and include both fixed (or patient-specific factors) and modifiable factors. They relate to both the mechanism of central nervous system injury associated with congenital heart disease and its treatment. Measuring cerebral oxygenation is a promising non-invasive way of cerebral monitoring in a neonatal intensive care unit. The importance of cerebral monitoring in neonates with congenital heart problems at risk of developing neurological complications is increasingly recognized. In this way the most vulnerable moments for the newborn brain can be detected and ,if possible, lead to change in (timing of) treatment.

The objective of these studies is to identify genetic factors that contribute to the pathogenesis of complex congenital heart disease and other more rare conditions resulting from disturbances in organ positioning. These are a group of medical conditions that are thought to stem from a poorly understood disturbance in the establishment of the basic body plan in the embryo. While the outside of the human body is generally symmetric with mirror image left and right sides, the positions of some internal organs are distinctly asymmetric. For example, the heart could not function properly as a mechanical pump if its connections to major blood vessels retained their initial symmetry. The left ventricle of the heart normally pumps blood to the body, while the right ventricle normally pumps blood to the lungs. Reversals in these blood vessel connections can be fatal. Similarly, the gut characteristically loops in a counterclockwise direction placing the stomach on the left side in most cases. Rare laterality anomalies can occur if this looping is in the other direction, or randomized (equally likely to loop in either direction). Serious medical problems can be caused by disturbances in the establishment, or maintenance of left-right (L-R) differences as key organs are developing in the embryo. We have established formal collaborative agreements with three major centers who have collected a large number of coded cases of congenital cardiac disease. Our research objective is to try to understand if specific genetic changes can contribute to a range of cardiac malformations. We utilize mutational analysis of candidate genes as our principal tool to study the genetics of L-R axis malformations. This protocol is also open to other conditions whose basis is also thought to result from L-R problems. In all cases, the patients continue under the care of the referring physician. We anticipate a minor role of NIH researchers and genetic counseling services if subjects either do not have, or cannot afford, similar services in their local area. This is not a treatment protocol. Our empiric ability to generate medically significant research results is limited by the extensive genetic and other etiologic heterogeneity. Therefore, this research is not a diagnostic study. At this stage of research, we are not sufficiently confident that our research results will have direct medical implications for research subjects. Results that are of potential medical importance will be discussed with the primary physician who is (in most cases) a trained cardiologist (and/or medical geneticist). We will emphasize that these are only preliminary research findings, that they are not CLIA-approved, and must be disclosed to the patient or included in the medical record. Repeat testing in a CLIA-approved lab under another protocol would be required before the genetic information could be shared with the patient and family.

To determine the rate of progression of sub-clinical cardiovascular disease as measured in carotid intimal medial thickness over a period of 8 to 10 years.

To identify new dilated cardiomyopathy genes by genetic linkage and mutational analyses.

To investigate the role of racial and socioeconomic disparities in coronary heart disease (CHD) mortality in the United States.

Genetically inherited heart diseases like hypertrophic cardiomyopathy (HCM) are conditions affecting the heart passed on to family members by abnormalities in genetic information. These conditions are responsible for many heart related deaths and illnesses. Presently, there are several research studies being conducted in order to improve the understanding of disease processes and symptoms associated with genetically inherited heart diseases. This study is designed to determine the eligibility of patients diagnosed with or suspected to have inherited heart disease to participate in these research studies.