Relationship Between Abnormal Myocardial Perfusion and Diastolic Dysfunction in Sickle Cell Disease Using PET

Purpose

There is limited information on what causes injury to the heart in individuals with Sickle Cell Disease (SCD). Researchers in this study want to see if decreased blood flow to the heart during stress could be causing the heart damage seen in SCD patients. They also want to test people who don't have SCD to see if their hearts react the same way under stress. Primary Objective - To estimate the coronary flow reserve (CFR) (also referred to as myocardial perfusion reserve), as measured by PET stress-rest myocardial perfusion imaging, in SCD patients with and without diastolic dysfunction, and healthy controls. Secondary Objectives - To investigate the relationship between decreased CFR (quantified with PET stress- rest myocardial perfusion imaging) and presence of abnormal diastolic parameters

Condition

  • Sickle Cell Disease

Eligibility

Eligible Ages
Between 18 Years and 21 Years
Eligible Sex
All
Accepts Healthy Volunteers
Yes

Inclusion Criteria

  • Stratum A: Sickle cell patients with diastolic dysfunction - 18 to 21 years of age - Black - Diagnosis of SCD of HbSS and HbSβ0thalassemia genotypes - Three or more abnormal diastolic parameters (based on guidelines by American Society of echocardiography) Inclusion Criteria - Stratum B: Sickle cell patients without diastolic dysfunction - 18 to 21 years of age - Black - Diagnosis of SCD of HbSS and HbSβ0thalassemia genotypes - Two or less abnormal diastolic parameters Inclusion Criteria - Stratum C: Healthy controls - 18 to 21 years of age - Black - Two or less abnormal diastolic parameters

Exclusion Criteria

  • Stratum A: - Recent hospitalization for vaso-occlusive pain crisis or acute chest syndrome in last 4 weeks - Blood transfusion in the last 3 months - Individuals with signs, symptoms or EKG findings of acute myocardial ischemia, infarction or unstable angina - Individuals with history of VT/VF or SVT - Previous cardiac surgery - Known congenital heart disease (other than patent ductus arteriosus or Atrial septal defect) - Stenotic valvular disease or left main coronary artery stenosis - History of myo/pericarditis - Left ventricle systolic dysfunction - Cardiovascular instability/uncontrolled hypertension (h/o hypertensive urgency or emergency) - History of sinus node dysfunction or high grade AV nodal block - History of aborted sudden cardiac death or cardiac arrest - Current seizure disorder on AED - Pregnant/Breast-feeding - Any medical or social reason, which, in the opinion of the principal investigators would make the participation of the subject ill-advised. Exclusion Criteria - Stratum B: - Diagnosed with three or more abnormal diastolic parameters (based on guidelines by American Society of echocardiography) - Recent hospitalization for vaso-occlusive pain crisis or acute chest syndrome in last 4 weeks - Blood transfusion in the last 3 months - Individuals with signs, symptoms or EKG findings of acute myocardial ischemia, infarction or unstable angina - Individuals with history of VT/VF or SVT - Previous cardiac surgery - Known congenital heart disease (other than patent ductus arteriosus or Atrial septal defect) - Stenotic valvular disease or left main coronary artery stenosis - History of myo/pericarditis - Left ventricle systolic dysfunction - Cardiovascular instability/uncontrolled hypertension (h/o hypertensive urgency or emergency) - History of sinus node dysfunction or high-grade AV nodal block - History of aborted sudden cardiac death or cardiac arrest - Current seizure disorder on AED - Pregnant/Breast-feeding - Any medical or social reason, which, in the opinion of the principal investigators would make the participation of the subject ill-advised. Exclusion Criteria - Stratum C: - All genotypes of SCD - Diagnosed with three or more abnormal diastolic parameters (based on guidelines by American Society of echocardiography) - Anemia of grade 2 or worse (per CTCAE v5.0) at study visit 1 - Individuals with signs, symptoms or EKG findings of acute myocardial ischemia, infarction or unstable angina - Individuals with history of VT/VF or SVT - Previous cardiac surgery - Known congenital heart disease (other than patent ductus arteriosus or Atrial septal defect) - Stenotic valvular disease or left main coronary artery stenosis - History of myo/pericarditis - Left ventricle systolic dysfunction - Cardiovascular instability/uncontrolled hypertension (h/o hypertensive urgency or emergency) - History of sinus node dysfunction or high-grade AV nodal block - History of aborted sudden cardiac death or cardiac arrest - Current seizure disorder on AED - Pregnant/Breast- feeding - Any medical or social reason, which, in the opinion of the principal investigators would make the participation of the subject ill-advised.

Study Design

Phase
Phase 2
Study Type
Interventional
Allocation
Non-Randomized
Intervention Model
Parallel Assignment
Primary Purpose
Diagnostic
Masking
None (Open Label)

Arm Groups

ArmDescriptionAssigned Intervention
Experimental
Stratum A
Sickle Cell patients with diastolic dysfunction
  • Drug: [13N]NH3
    Ammonia N 13 (a radioactive tracer) will be given per intravenous (IV) injection for diagnostic purposes in conjunction with positron emission tomography (PET) imaging.
    Other names:
    • [N-13] Ammonia
    • azane
    • CAS# 34819-78-8
  • Drug: Lexiscan
    Given IV prior to PET stress test
    Other names:
    • Regadenoson
  • Diagnostic Test: Positron emission tomography
    Participants will complete a onetime PET (stress-rest) myocardial perfusion scan.
    Other names:
    • PET
Experimental
Stratum B
Sickle cell patients without diastolic dysfunction
  • Drug: [13N]NH3
    Ammonia N 13 (a radioactive tracer) will be given per intravenous (IV) injection for diagnostic purposes in conjunction with positron emission tomography (PET) imaging.
    Other names:
    • [N-13] Ammonia
    • azane
    • CAS# 34819-78-8
  • Drug: Lexiscan
    Given IV prior to PET stress test
    Other names:
    • Regadenoson
  • Diagnostic Test: Positron emission tomography
    Participants will complete a onetime PET (stress-rest) myocardial perfusion scan.
    Other names:
    • PET
Experimental
Stratum C
Healthy controls
  • Drug: [13N]NH3
    Ammonia N 13 (a radioactive tracer) will be given per intravenous (IV) injection for diagnostic purposes in conjunction with positron emission tomography (PET) imaging.
    Other names:
    • [N-13] Ammonia
    • azane
    • CAS# 34819-78-8
  • Drug: Lexiscan
    Given IV prior to PET stress test
    Other names:
    • Regadenoson
  • Diagnostic Test: Positron emission tomography
    Participants will complete a onetime PET (stress-rest) myocardial perfusion scan.
    Other names:
    • PET

Recruiting Locations

St. Jude Children's Research Hospital
Memphis 4641239, Tennessee 4662168 38105

More Details

Status
Recruiting
Sponsor
St. Jude Children's Research Hospital

Study Contact

Parul Rai, MD
866-278-5833
referralinfo@stjude.org

Detailed Description

This study requires two visits. The first visit includes blood tests, an electrocardiogram (EKG), and an echocardiogram. The second visit includes a positron emission tomography (PET) stress test and a blood test. Subjects will be considered off-study one week after all post PET imaging study tests have been completed along with the next day and one-week follow-up phone calls are completed.