Cardiac MRI Technique for Coronary Artery Disease

(CATCH Trial)

Overseen By Rosalia (Sally) A De Leon

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Cedars-Sinai Medical Center

Disqualifiers: Cardiovascular disease, Implants, Pregnancy, Claustrophobia, Renal issues, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 1

150 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to develop a new MRI technique to better evaluate coronary artery disease (CAD), which affects the heart's blood vessels. By using this approach, the researchers aim to make the scanning process faster and more reliable than current methods. Participants may receive a beta blocker (a medication that reduces blood pressure) and contrast during their MRI to enhance imaging. Individuals diagnosed with CAD or suspected of having it, as well as healthy adults without a history of heart disease, might be suitable for this study. As an unphased study, this trial offers participants the chance to contribute to innovative research that could improve future heart disease diagnostics.

Do I need to stop taking my current medications for the trial?

The trial information does not specify whether you need to stop taking your current medications.

What prior data suggests that this MRI technique is safe for coronary artery disease evaluation?

Research has shown that cardiac MRI is generally safe, though some risks exist. The magnetic field and radio waves used in imaging pose these risks, but they are usually well-controlled, making serious problems rare.

Studies indicate that gadolinium-based contrast agents used in MRI are mostly safe, with a lower chance of causing allergic reactions compared to other types. Some individuals might experience side effects like kidney issues or allergic reactions, but these are uncommon.

Beta blockers, which slow down the heart, are FDA-approved for other heart-related conditions and are usually well-tolerated. Common side effects include fatigue, dizziness, or a slow heartbeat, while serious side effects are rare.

In summary, the treatments in this study generally have a good safety record. Serious problems are rare, and most people handle the procedures and medications well. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it explores a cutting-edge Cardiac MRI technique for detecting coronary artery disease (CAD). Unlike traditional methods like stress tests or angiograms, this approach could offer a less invasive and more detailed view of the heart, potentially improving early diagnosis and treatment planning. By using contrast-enhanced imaging and beta blockers tailored to each patient's safety profile, this technique may provide clearer images of coronary arteries, helping doctors make more accurate assessments. This could be a game-changer in how CAD is diagnosed and managed, offering hope for more personalized and effective treatment strategies.

What evidence suggests that this MRI technique is effective for coronary artery disease?

Studies have shown that Cardiac MRI effectively diagnoses coronary artery disease (CAD), correctly identifying CAD in 83% of cases. This non-invasive and accurate imaging method provides a reliable choice for assessing heart conditions. In this trial, participants, including those with CAD and healthy volunteers, will receive either non-contrast or contrast-enhanced Cardiac MRI. Contrast agents in MRI are safe and enhance image quality, with serious allergic reactions being rare. Although beta blockers are often used for heart issues, they have not shown significant benefit for patients with stable CAD. Combining these imaging techniques offers a promising way to evaluate heart disease accurately and safely. ^{6 7 8 9 10}

Who Is on the Research Team?

Debiao Li, PhD

Principal Investigator

Cedars-Sinai Medical Center

Are You a Good Fit for This Trial?

The CATCH trial is for adults over 18 with a BMI under 30, who are either healthy volunteers without cardiovascular disease or patients stable after coronary artery disease diagnosis and treatment. It excludes those with MR imaging contraindications like certain implants, claustrophobia, severe allergies to animal dander, poor kidney function (GFR <45ml/min), or past reactions to gadolinium contrast.

Exclusion Criteria

Non-compliant with visit instructions, including following procedure instructions

You cannot have metal implants or be pregnant because they can interfere with the MRI scan.

You cannot hold your breath for a short time or have a fear of small, enclosed spaces.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Imaging

Participants undergo non-contrast or contrast-enhanced MRI to evaluate coronary atherosclerosis

1 day

1 visit (in-person)

Follow-up

Participants are monitored for safety and effectiveness after imaging

2-4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Beta blocker
• Cardiac MRI
• Contrast

Trial Overview

CATCH aims to develop an MRI technique that enhances the evaluation of coronary atherosclerosis. The study will test this new method against traditional ones by comparing image quality and scanning efficiency. Participants may receive cardiac MRI scans using contrast agents and possibly beta blockers during the procedure.

How Is the Trial Designed?

Group I: Healthy Volunteers Experimental Treatment 3 Interventions

Approximately 110 healthy male/female adult "normals" or "controls" will receive non-contrast or contrast-enhanced Cardiac MRI. Imaging may include administration of contrast and a beta blocker, based upon the focus of the study at the time of the scan, as well as the safety profile of the participant.

Group II: Coronary Artery Disease (CAD) Patients Experimental Treatment 3 Interventions

40 male/female adult outpatients who are suspected of having or have been diagnosed with coronary artery disease (CAD) will receive non-contrast or contrast-enhanced Cardiac MRI. Imaging may include administration of contrast and a beta blocker, based upon the focus of the study at the time of the scan, as well as the safety profile of the participant.

Who Is Running the Clinical Trial?

Cedars-Sinai Medical Center

Lead Sponsor

Trials

523

Recruited

165,000+

Published Research Related to This Trial

Beta-blockers are effective in treating various cardiovascular diseases, showing positive outcomes in reducing mortality for conditions like hypertension, post-infarction recovery, and heart failure, particularly with drugs like carvedilol, bisoprolol, and metoprolol.

Recent evidence highlights the life-prolonging benefits of beta-blockers in heart failure, especially in patients classified as NYHA stages 2 and 3, while the presence of intrinsic sympathomimetic activity (ISA) in some beta-blockers, like bucindolol, may limit their effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Comparison beta-blockers and their relevance to pharmacologic therapy of cardiovascular diseases]. Wehling, M.[2007]

Beta-blockers are effective treatments for various cardiovascular conditions, but they are often underprescribed due to concerns about safety and tolerability, especially in high-risk populations.

Newer beta-blockers like nebivolol and carvedilol offer additional benefits, such as vasodilation and improved insulin resistance, which may enhance their efficacy and reduce side effects compared to older, nonselective beta-blockers.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Realities of newer beta-blockers for the management of hypertension. Manrique, C., Giles, TD., Ferdinand, KC., et al.[2021]

In a study of 20 patients with systolic heart failure, nebivolol was found to improve hemodynamic parameters by decreasing systemic vascular resistance without negatively affecting cardiac output, unlike metoprolol, which worsened heart function.

The results suggest that nebivolol may be a safer option for initiating treatment in systolic heart failure patients, as it does not require a long up-titration period to avoid adverse effects seen with metoprolol.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Acute hemodynamic effects of moderate doses of nebivolol versus metoprolol in patients with systolic heart failure. Triposkiadis, F., Giamouzis, G., Kelepeshis, G., et al.[2019]

Cardiovascular magnetic resonance imaging (MRI) has advanced significantly, transitioning from an experimental technique to a clinically accepted method for detecting coronary artery disease and assessing heart viability.

Current MRI technologies, including dobutamine/atropine MRI and perfusion techniques, are effective for evaluating ischemia and blood flow in both native coronary arteries and grafts, suggesting a promising future for widespread clinical use.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Magnetic resonance imaging in detection and functional assessment of coronary artery disease. Mazur, W., Brucks, S., Darty, SN., et al.[2019]

Beta-adrenergic receptor blockers, such as bisoprolol, metoprolol, and carvedilol, have been proven to significantly improve survival rates and reduce hospitalization in heart failure patients, leading to better overall patient well-being.

While investigational beta-blocker bucindolol showed only mild improvements in survival, the differences in properties among beta-blockers, such as selectivity and vasodilation effects, remain to be fully understood in terms of their impact on treatment outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Are all beta-blockers the same for chronic heart failure? Gottlieb, SS.[2019]

In a study of 29 heart failure patients, replacing carvedilol with propranolol did not worsen heart function, as measured by ejection fraction, after 6 months, indicating that propranolol can be a safe alternative.

The study found that propranolol led to a significant increase in ejection fraction, suggesting it may be effective in improving heart function in patients previously stabilized on carvedilol.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Replacement of carvedilol for propranolol in patients with heart failure. Marques, F., Castro, RB., Nobre, F., et al.[2019]

Cardiac magnetic resonance (CMR) imaging is a powerful noninvasive tool that can assess both the function and structure of the heart, as well as evaluate the severity and reversibility of coronary heart disease.

Recent advancements in technology, such as improved magnet and coil designs and new contrast media, have enhanced the effectiveness of CMR, making it a versatile option for diagnosing and managing coronary artery disease.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Assessment of myocardial ischemia and viability using cardiac magnetic resonance. Sanz, J., Rius, T., Kuschnir, P., et al.[2019]

Cardiac magnetic resonance imaging (CMR) is now considered the gold standard for diagnosing coronary artery disease and acute myocardial infarction, effectively distinguishing between ischemic and non-ischemic heart injuries.

CMR is recognized for its safety and is indicated for various cardiac assessments, although there are specific contraindications that must be considered before use.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[The role of cardiac magnetic resonance imaging (cardiovascular magnetic resonance) in defining the prognosis of patients with acute ST-segment elevation myocardial infarction. Part 1. Indications and contraindications to cardiovascular magnetic resonance]. Terenicheva, MA., Stukalova, OV., Shakhnovich, RM., et al.[2022]

Only three beta-blockers—carvedilol, bisoprolol, and metoprolol succinate—have shown positive effects on prognosis in chronic heart failure patients, highlighting their importance in treatment.

Carvedilol not only blocks beta(1)-adrenergic receptors but also beta(2)- and alpha(1)-adrenergic receptors, and has additional properties that may contribute to its superior mortality reduction compared to metoprolol, as demonstrated in the COMET trial.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Beta-blockers in heart failure: are pharmacological differences clinically important? Metra, M., Cas, LD., di Lenarda, A., et al.[2018]

Cardiovascular MRI is a safe and highly effective imaging technique that provides detailed anatomical and functional information about the heart, making it the best choice for measuring changes in heart function after treatment.

It is particularly useful for diagnosing various heart conditions, including ischemic and nonischemic cardiomyopathies, and is emerging as a reliable alternative to traditional methods for detecting coronary artery disease.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Clinical applications of cardiovascular magnetic resonance imaging. Marcu, CB., Beek, AM., van Rossum, AC.[2018]

Magnetic resonance imaging (MRI) is increasingly used for cardiac diagnosis, particularly with the help of paramagnetic contrast agents that enhance the visibility of heart conditions.

Contrast-enhanced MRI can effectively detect and characterize various cardiac issues, such as intracardiac masses, thrombi, and myocarditis, and is also useful in diagnosing myocardial ischemia and infarction.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Contrast-enhanced MR imaging of the heart: overview of the literature. Edelman, RR.[2007]

In a study of 70 patients with chronic heart failure, both nebivolol and carvedilol improved left ventricular function, with increases in ejection fraction and decreases in end-systolic volume after 6 months of treatment, although the differences between the two drugs were not statistically significant.

Both medications resulted in a significant reduction in heart rate and blood pressure, and there were no significant differences in adverse events, indicating that nebivolol is as safe and effective as carvedilol for treating patients with reduced left ventricular systolic function.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of nebivolol versus carvedilol on left ventricular function in patients with chronic heart failure and reduced left ventricular systolic function. Lombardo, RM., Reina, C., Abrignani, MG., et al.[2018]

In a study of 160 hypertensive patients with chronic heart failure over 24 months, both nebivolol and carvedilol significantly improved left ventricular ejection fraction (LVEF) and exercise capacity, showing similar efficacy in treatment.

Both medications led to a reduction in heart rate and improvement in functional class, with comparable rates of cardiac events, indicating that nebivolol and carvedilol are equally effective options for managing chronic heart failure.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparative long term effects of nebivolol and carvedilol in hypertensive heart failure patients. Marazzi, G., Volterrani, M., Caminiti, G., et al.[2018]

Citations

1.

jacc.org

jacc.org/doi/10.1016/j.jacc.2023.04.021

Association of Beta-Blocker Therapy With Cardiovascular ...

Previous studies have failed to show a cardioprotective benefit of beta-blockers in patients with stable coronary artery disease (CAD).

2.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC9257156/

The Clinical Impact of β-Blocker Therapy on Patients With ...

Overall, β-blockers demonstrated no significant benefit in primary outcome (hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.63–1.24), all-cause death ( ...

3.

sciencedirect.com

sciencedirect.com/science/article/pii/S073510972305461X

Association of Beta-Blocker Therapy With Cardiovascular ...

In this cohort study, beta-blockers (BB) were associated with a significant 1.8% absolute and 8.0% relative reduction in the composite of all-cause death and ...

4.

nejm.org

nejm.org/doi/full/10.1056/NEJMoa2505985?query=featured_home

Beta-Blockers after Myocardial Infarction in Patients without ...

Clinical trials from the era before coronary reperfusion therapies showed that beta-blockers reduced the risk of death from any cause and of new ...

5.

jamanetwork.com

jamanetwork.com/journals/jama/fullarticle/1367524

β-Blocker Use and Clinical Outcomes in Stable Outpatients ...

Available evidence suggests that β-blocker use is associated with benefit in patients with acute MI (without impending shock or heart block), ...

6.

ncbi.nlm.nih.gov

ncbi.nlm.nih.gov/books/NBK532906/

Beta Blockers - StatPearls - NCBI Bookshelf

Beta-blockers are indicated and have FDA approval for the treatment of tachycardia, hypertension, myocardial infarction, congestive heart failure, cardiac ...

7.

ncbi.nlm.nih.gov

ncbi.nlm.nih.gov/books/NBK548127/

Beta Adrenergic Blocking Agents - LiverTox - NCBI Bookshelf

Common side effects are those that are caused by the beta-adrenergic blockade and include bradycardia, fatigue, dizziness, depression, memory ...

8.

mayoclinic.org

mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/beta-blockers/art-20044522

Beta blockers

These medicines block the effects of the hormone epinephrine, also known as adrenaline. Beta blockers cause the heart to beat more slowly and with less force.

9.

jacc.org

jacc.org/doi/10.1016/j.jacadv.2024.101566

Beta-Blockers After PCI for Stable Coronary Artery Disease ...

Early beta-blocker initiation after PCI for stable CAD with preserved LVEF was associated with higher mortality, with no impact on cardiovascular events.

10.

tandfonline.com

tandfonline.com/doi/full/10.1080/03007995.2024.2317433

Full article: Safety and tolerability of β-blockers: importance ...

Cardioselective β-blockade is generally well tolerated in practice and contraindications to this therapy are uncommon.