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Trial registered on ANZCTR
Registration number
ACTRN12611000495921
Ethics application status
Approved
Date submitted
10/05/2011
Date registered
11/05/2011
Date last updated
15/05/2014
Type of registration
Prospectively registered
Titles & IDs
Public title
Multi-Parametric Cardiovascular Magnetic Resonance Assessment of Hypertrophic Cardiomyopathy - Therapeutic Metformin sub-study
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Scientific title
Multi-Parametric Cardiovascular Magnetic Resonance Assessment of Hypertrophic Cardiomyopathy - Therapeutic Metformin sub-study
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Secondary ID [1]
262143
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None
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Universal Trial Number (UTN)
U1111-1121-2660
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Hypertrophic Cardiomopathy
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Condition category
Condition code
Cardiovascular
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0
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Other cardiovascular diseases
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
From the main study criteria (ACTRN12611000479909), patients with reduced PCR/ATP ratio of < 1.7 will be eligible to participate in the therapeutic metformin sub-study. They will have a baseline 10ml blood sample before having 12 weeks treatment of either metformin 1g orally 3 x daily or placebo orally 3 x daily before crossing over to the other treatment after a 4 week drug wash-out period. At the end of each 12 week treatment phase they will have another 10ml blood sample, cardiac magnetic resonance imaging with gadolinium contrast (0.025mmol/kg body weight), cardiac magnetic resonance spectroscopy with adenosine intravenously (140mcg/kg/min) for 3-6 mins and echocardiography.
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Intervention code [1]
264556
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Treatment: Drugs
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Comparator / control treatment
40 patients will take part in the therapeutic metformin sub-study. In a double-blind randomised control trial manner, they will either receive metformin tablets 1g 3 x daily or placebo tablets 3 x daily for 12 weeks, and be crossed over to the other treatment arm after a 4 week drug wash-out period. Placebo is packed with microcrystalline cellulose.
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Control group
Placebo
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Outcomes
Primary outcome [1]
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Phosphocreatine (PCr)/Adenosinetriphosphate (ATP) ratio. Method: Cardiac magnetic resonance spectroscopy will be used to measure cardiac high energy phosphate metabolism in-vivo. The novel SLOOP method (spatial localisation with optimum pointspread function) allows accurate measurement of absolute concentrations of high-energy phosphates.
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Assessment method [1]
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Timepoint [1]
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28 weeks
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Secondary outcome [1]
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AMPK activity as measured by peripheral blood test
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Assessment method [1]
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Timepoint [1]
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28 weeks
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Secondary outcome [2]
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Absolute concentration of high-energy phosphates as measured by cardiac magnetic spectroscopy.
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Assessment method [2]
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Timepoint [2]
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28 weeks
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Secondary outcome [3]
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LV diastolic function as measured by cardiac magnetic resonance imaging and doppler echocardiography
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Assessment method [3]
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Timepoint [3]
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28 weeks
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Secondary outcome [4]
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Regional function as measured by cardiac magnetic resonance imaging
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Assessment method [4]
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Timepoint [4]
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28 weeks
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Secondary outcome [5]
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LV systolic function as measured by cardiac magnetic resonance imaging
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Assessment method [5]
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Timepoint [5]
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28 weeks
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Eligibility
Key inclusion criteria
Hypertrophic cardiomyopathy patients aged between 18 and 75; phenotype positive (established by echocardiography or cardiac magnetic resonance scan); genotype positive for cardiac myosin binding protein-C gene mutations or cardiac beta-myosin heavy chain gene mutations; patients with reduced baseline PCR/ATP ratio of <1.7
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Minimum age
18
Years
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Maximum age
75
Years
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
Impaired LV systolic function (EF <50%) as detected on echocardiography or cardiac magnetic resonance scan; history of diabetes mellitus, calculated GFR <30mls/hr; significant derranged liver function defined as liver enzymes of 3 x ULN; current therapy with metformin or amiodarone; absolute contraindication of having MRI scan.
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Allocation is not concealed
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
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Intervention assignment
Crossover
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Other design features
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Phase
Phase 2
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
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Recruitment
Recruitment status
Not yet recruiting
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Date of first participant enrolment
Anticipated
1/07/2011
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Actual
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
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Actual
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Sample size
Target
120
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
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Funding & Sponsors
Funding source category [1]
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Charities/Societies/Foundations
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Name [1]
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National Heart Foundation
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Address [1]
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Heart Foundation
Research Program
Level 12, 500 Collins Street,
Melbourne VIC 3000,
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Country [1]
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Australia
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Primary sponsor type
Individual
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Name
Professor Joseph Selvanayagam
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Address
Department of Cardiovascular Medicine
Flinders Medical Centre
1 Flinders Drive
BEDFORD PARK SA 5042
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Country
Australia
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Secondary sponsor category [1]
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Individual
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Name [1]
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Professor John Horowitz
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Address [1]
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Department of Cardiology
The Queen Elizabeth Hospital
Woodville South, Adelaide
South Australia 5011
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Country [1]
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Australia
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Secondary sponsor category [2]
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Individual
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Name [2]
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Professor Christopher Semsarian
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Address [2]
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Molecular Cardiology, Centenary Institute
Royal Prince Alfred Hospital
Missenden Rd
Camperdown, NSW 2050
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Country [2]
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Australia
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
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Flinders Clinical Research Ethics Committee
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Ethics committee address [1]
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Flinders Medical Centre Flinders Drive BEDFORD PARK South Australia 5042
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Ethics committee country [1]
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Australia
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Date submitted for ethics approval [1]
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09/09/2010
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Approval date [1]
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17/12/2010
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Ethics approval number [1]
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36910
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Summary
Brief summary
HCM is the most common cardiovascular genetic disorder and can cause significant morbidity and mortality, including the most serious complications of heart failure and sudden death. At present, there are no proven pharmacological therapies that either prevent or cause regression of clinical features. This is largely due to a lack of knowledge in our understanding of the molecular and functional consequences of the disease-causing gene mutations leading to the clinical disease. The proposed study will aim to test whether cardiac energetic compromise is a central pathophysiological mechanism in HCM. We will investigate potentially beneficial treatments based on our hypothesis, by trialling the use of metformin in an HCM group. If the results from this ‘proof of concept study’ are confirmatory, it could pave the way for larger multi-centre randomised studies (with longer duration of treatment) with either metformin or facilitators of fatty acid oxidation such as ranolazine. If realised, these treatments could prevent the vicious cycle of cardiac hypertrophy and myocardial dysfunction seen in hypertrophic cardiomyopathy, leading to improved morbidity and mortality. These investigations will establish early phenotype changes in HCM patients and provide insights into potential therapeutic interventions for a condition that currently has little therapeutic evidence base. This therapeutic sub-study is linked to the main study ACTRN12611000479909.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Address
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Country
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Phone
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Fax
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Email
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Contact person for public queries
Name
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Christine Edwards
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Address
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Flinders Clinical Research
Level 3A
Mark Oliphant Building
Laffer Drive
BEDFORD PARK SA 5042
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Country
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Australia
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Phone
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+61 8 8204 5656
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Fax
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+61 8 8204 7047
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Email
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[email protected]
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Contact person for scientific queries
Name
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Professor Joseph Selvanayagam
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Address
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Department of Cardiovascular Medicine
Flinders Medical Centre
1 Flinders Drive
BEDFORD PARK SA 5042
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Country
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Australia
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Phone
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+61 8 8404 2195
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Fax
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Email
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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