Cardiac Dysfunction

Brief Summary This study is a multicenter, randomized, double-blind, placebo-controlled trial designed to evaluate whether an injectable form of Coenzyme I (also known as nicotinamide adenine dinucleotide, or NAD⁺) is safe and effective for treating children with cardiac dysfunction (weak heart pumping). Who can join? We plan to enroll 180 children under 18 years of age who are hospitalized with cardiac dysfunction, meaning their heart's pumping ability (left ventricular ejection fraction, or LVEF) is below 55%. Children will be recruited from five hospitals in China. Children with certain serious conditions, such as end-stage heart failure, severe liver or kidney problems, known allergy to the study drug, or active participation in another drug trial, will not be eligible. What will participants receive? All children will receive standard heart failure care as recommended by current guidelines. In addition, they will be randomly assigned (like drawing lots) to one of three groups: Placebo group - receives standard care plus a saltwater (normal saline) infusion that looks like the study drug but contains no active medicine (60 children). Low-dose group - receives standard care plus Coenzyme I injection at 2 mg per kg of body weight per day (maximum 100 mg) (60 children). High-dose group - receives standard care plus Coenzyme I injection at 4 mg per kg of body weight per day (maximum 200 mg) (60 children). The study drug or placebo is given as a slow intravenous (IV) infusion once daily for 7 days. Each infusion takes at least 2 hours. What is the main goal? The main question is whether adding Coenzyme I improves heart function more than standard care alone. The primary endpoint is the change in LVEF from baseline to 4 weeks after treatment, measured by echocardiography. We will also assess NT-proBNP, a blood test that reflects the strain on the heart, at several time points. What else will we look at? We will also evaluate quality of life (using a child-friendly questionnaire), heart function grade (NYHA/ROSS), exercise capacity (6-minute walk test), growth and development, cardiac structure and remodeling (by echocardiography), global longitudinal strain (GLS), and clinical events such as heart failure-related rehospitalization, emergency interventions, and death. We will carefully monitor for any side effects or safety concerns throughout the study. Why is this important? Children with cardiac dysfunction often do not respond well enough to current treatments, and there are few specific therapies designed for them. Coenzyme I (NAD⁺) is a natural substance in the body that helps heart cells produce energy. Studies in adults and in laboratory models suggest it may protect the heart and improve its function. This trial is the first large-scale pediatric study to test whether it can help children with heart pumping problems. How long will participation last? Each child will be in the study for about 48 weeks - 7 days of treatment in the hospital, followed by follow-up visits at 4 weeks, 12 weeks, and 24 weeks after treatment, and a final telephone or clinic visit at 48 weeks to collect clinical event data. Safety and oversight An independent Data and Safety Monitoring Board (DSMB) will regularly review all safety information. The study has been approved by the ethics committees of all participating hospitals and is conducted in accordance with the Declaration of Helsinki and Chinese Good Clinical Practice guidelines. All enrolled children are covered by clinical trial liability insurance.

Allogeneic hematopoietic stem cell transplantation (HSCT) represents a major therapeutic strategy for malignant hematologic diseases, with the number of procedures steadily increasing in France each year. Conditioning and maintenance regimens carry a risk of both short- and long-term cardiotoxicity, leading to serious cardiovascular events including acute coronary syndrome (ACS), cardiac dysfunction, arrhythmias, pulmonary hypertension, and pericardial effusion. The pathophysiology of cardiotoxicity in HSCT patients remains poorly understood. It is therefore crucial to investigate underlying mechanisms and identify predictive factors of cardiotoxicity in order to provide appropriate cardiological follow-up and management. Current European Society of Cardiology guidelines recommend routine monitoring of HSCT patients with echocardiography and cardiac biomarkers (NT-proBNP, troponin), although these recommendations are based on small-scale studies. The cardiodepressor factor DPP3 has shown promising results in cardio-oncology, with a causal role in anthracycline-induced cardiac dysfunction. Its role in HSCT-related cardiotoxicity requires further evaluation. This multicenter study of HSCT recipients will be a valuable resource, enabling a better understanding of the pathophysiology of cardiotoxicity and prognosis. It will highlight imaging (echocardiography, calcium score, supra-aortic Doppler), electrocardiographic, and biological markers (including DPP3) associated with prognosis.

This multicenter, prospective cohort study evaluates early cardiac dysfunction in adult survivors of childhood cancer. The hypothesis of this study is that cardiac dysfunction can be detected earlier when using speckle tracking echocardiography as novel echocardiographic technique compared to conventional echocardiography.

A randomized controlled trial was conducted to evaluate the efficacy and safety of Yangxinshi tablets in improving the condition of patients with coronary heart disease complicated by cardiac dysfunction.

Acute kidney injury (AKI) is a frequent disease in conventional hospital departments and in intensive care units. It's associated with a high risk to develop chronic kidney disease (CKD), even after a single small AKI episode. It's also associated with an important morbi-mortality, particularly cardiovascular (CV). Some studies have already showed a link between AKI and CV risk but pathologic mechanisms implicated are still unknown. In AKI and CKD, numerous substances, called uremic toxins (UT) are accumulating in blood. In CKD, those toxins, and particularly Indoxyl sulfate (IS), are known to have cardiac and vascular deleterious consequences. However, in AKI, whether acute accumulation of UT may trigger CV complications is unknown. The purpose of this study is that during AKI, a high UT concentration, in particular IS, would be associated with early vascular and cardiac dysfunctions that can be characterized by the persistence of an accelerated pulse wave velocity (PWV). The main objective is to evaluate the correlation between UT concentrations (especially IS) and arterial stiffness (PWV measurement) at three months of an AKI episode in conventional hospital departments and in the intensive care unit of nephrology.