E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Suspected or known Coronary Artery Disease |
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E.1.1.1 | Medical condition in easily understood language |
Suspected or known Coronary Artery Disease |
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E.1.1.2 | Therapeutic area | Diseases [C] - Cardiovascular Diseases [C14] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 18.1 |
E.1.2 | Level | HLGT |
E.1.2 | Classification code | 10011082 |
E.1.2 | Term | Coronary artery disorders |
E.1.2 | System Organ Class | 10007541 - Cardiac disorders |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
Primary Objectives:
To assess the efficacy of SonoVue®-enhanced dobutamine stress echocardiography (DSE) in subjects with suspected or known CAD having suboptimal left ventricular (LV) endocardial border delineation (EBD) at unenhanced echocardiography in terms of:
- Sensitivity and specificity for the detection or exclusion of CAD in unenhanced versus SonoVue®-enhanced DSE using coronary angiography or clinical follow-up as the truth standard;
- Critical shift from suboptimal (≥2 adjacent segments inadequate on any apical view) at unenhanced dobutamine stress echocardiography (UE-DSE) to adequate images (reduction of suboptimal adjacent segments) for LV EBD at contrast-enhanced dobutamine stress echocardiography (CE-DSE).
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E.2.2 | Secondary objectives of the trial |
Secondary Objectives:
- Change from peak stress non-contrast ultrasound (UE-DSE) versus peak stress contrast-enhanced ultrasound (CE-DSE) in total LV EBD score.
- To obtain safety data in subjects undergoing DSE with SonoVue®. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
- Provides written Informed Consent and is willing to comply with protocol requirements;
- Is at least 18 years of age;
- Has suspected or known CAD and is scheduled to undergo coronary angiography within 6 months after the SonoVue® DSE.
- Has undergone a previous echocardiography prior to enrollment; resulting in suboptimal unenhanced images at rest, defined as ≥ 2 suboptimal adjacent segments in any apical view. |
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E.4 | Principal exclusion criteria |
- Is a pregnant or lactating female. Exclude the possibility of pregnancy:
by testing on site at the institution (serum or urine βHCG) within 24 hours prior to the start of SonoVue®
administration(s),
by surgical history (e.g., tubal ligation or hysterectomy),
post menopausal with a minimum 1 year without menses;
- Has any known hypersensitivity to 1 or more ingredients of SonoVue® (sulfur hexafluoride or to any components of SonoVue®);
- Has any known hypersensitivity to dobutamine;
- Has an ongoing or recent (within the last 30 days) acute myocardial infarction;
- Has known right-to-left, bidirectional or transient cardiac shunt (ruled out with agitated saline study performed before administration of SonoVue®);
- Has electrolyte (especially potassium and magnesium) abnormalities;
- Has unstable pulmonary and/or systemic hemodynamic conditions e.g.:
decompensated or inadequately controlled congestive heart failure (NYHA Class IV);
hypovolemia;
uncontrolled hypertension, i.e. resting systolic blood pressure >200 mmHg or diastolic blood pressure >110 mmHg;
unstable angina;
acute coronary syndrome;
aortic dissection;
acute pericarditis, myocarditis, or endocarditis;
stenosis of the main left coronary artery
hemodynamically significant outflow obstruction of the left ventricle, including hypertrophic obstructive
cardiomyopathy;
hemodynamically significant cardiac valvular defect;
acute pulmonary embolism;
- Has uncontrolled cardiac arrhythmias;
- Has significant disturbance in conduction;
- Has hypertrophic subaortic stenosis;
- Has an acute illness (e.g., infections, hyperthyroidism, or severe anemia);
- Was previously entered into this study or received an investigational compound within 30 days before admission into this study;
- Has been treated with any other contrast agent either intravascularly or orally within 48 hours of the first SonoVue® administration;
- Has any medical condition or other circumstances which would significantly decrease the chances of obtaining reliable data, achieving study objectives, or completing the study and/or postdose follow-up examinations; |
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E.5 End points |
E.5.1 | Primary end point(s) |
Primary endoint:
Sensitivity and specificity for detection and exclusion of CAD:
• CE-DSE is superior to UE-DSE for at least 2 out of the 3 blinded readers and for the same 2 readers a lower limit of 2-sided 95% CI for sensitivity/specificity is ≥ 50% (a rate considered greater than chance);
Co-Primary endpoint:
Critical shift of subjects with suboptimal images at UE-DSE to adequate images at CE-DSE:
• For at least 2 out of the 3 blinded readers lower limit of 2-sided 95% CI is above 35%. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
At the end of the blinded reading |
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E.5.2 | Secondary end point(s) |
Change in total LV EBD scores at peak stress from UE-DSE to CE-DSE. |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
At the end of the blinded reading |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | Yes |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | No |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | No |
E.8.1.1 | Randomised | No |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 2 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 5 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
Belgium |
Canada |
Netherlands |
United Kingdom |
United States |
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E.8.7 | Trial has a data monitoring committee | No |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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The end of the study is defined as the last subject’s image review conducted by the off-site blinded assessor(s). |
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 1 |
E.8.9.1 | In the Member State concerned months | 2 |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial years | 1 |
E.8.9.2 | In all countries concerned by the trial months | 3 |