<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT01685385</url>
  </required_header>
  <id_info>
    <org_study_id>MGIMS001/2012</org_study_id>
    <nct_id>NCT01685385</nct_id>
  </id_info>
  <brief_title>B-type NAtriuretic Peptide In Critically Ill : A Multicentric Diagnostic Study (B-rAPID)</brief_title>
  <acronym>B-RAPID</acronym>
  <official_title>B-type NAtriuretic Peptide In Critically Ill : A Multicentric Diagnostic Study (B-rAPID)</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>Mahatma Gandhi Institute of Medical Sciences</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
  </sponsors>
  <source>Mahatma Gandhi Institute of Medical Sciences</source>
  <oversight_info>
    <has_dmc>No</has_dmc>
  </oversight_info>
  <brief_summary>
    <textblock>
      Difficulty in breathing or increased rate of breathing are common causes of admission to&#xD;
      intensive care unit. This may be due to heart failure, or other causes such as infection in&#xD;
      the lungs. Treating doctors usually perform Chest X-ray, ECG, and other tests to know if&#xD;
      breathlessness is due to heart failure or other cause. Doctors also give medicines to treat&#xD;
      heart failure, or other conditions of the lungs based on the symptoms and investigation&#xD;
      results. BNP is released by heart which is not functioning well. However BNP levels are also&#xD;
      high in case of severe infection.Hence there is equipoise in utility of BNP measurements&#xD;
      among critically ill patients, and it is not a current standard of care. The current cost of&#xD;
      this test (about 1000 rupees per measurement) is high, and hence its utility needs to be&#xD;
      carefully examined before a widespread use. The investigators intend to test the hypothesize&#xD;
      that that on-admission BNP measurements, help clinicians identify CHF early, which may modify&#xD;
      therapeutic decisions, and improve outcomes. The current study is designed with an objective&#xD;
      to determine if on-admission BNP value and availability of its test results to treating&#xD;
      physicians will reduce in-hospital, and 30-day mortality and in-hospital morbidity.&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      There usually remains a diagnostic uncertainty as differentiation between cardiogenic or&#xD;
      non-cardiogenic cause of dyspnea. Often there are multiple underlying etiologies for acute&#xD;
      onset dyspnea, and their evaluation leads to diagnostic delays, and hence longer hospital&#xD;
      stay. While various clinical symptoms, signs and imaging based investigations are used in&#xD;
      this differentiation, their accuracy remains low, and overlapping features preclude such&#xD;
      differentiation. Echocardiography is an important adjunct in making such differentiation, but&#xD;
      operator skill, and lack of availability of this technique at point of care are barriers in&#xD;
      use of this modality. B-type natriuretic peptide (BNP), a rapidly-assayed, serum biomarker,&#xD;
      has been found to be effective in distinguishing congestive heart failure (CHF) from other&#xD;
      causes of dyspnea in the emergency or urgent care settings. Recently this test has become&#xD;
      available at point of care (Alere Heart-Check). Ease, low cost, and objectivity in&#xD;
      measurement of BNP has led to widespread incorporation of BNP and its precursor NT-pro-BNP&#xD;
      into the clinical evaluation of CHF.&#xD;
&#xD;
      Circulating levels of BNP/NT-proBNP are normally very low in healthy individuals. In response&#xD;
      to increased myocardial wall stress due to volume- or pressure-overload states (such as in&#xD;
      CHF), the BNP gene is activated in cardiomyocytes. This results in the production of an&#xD;
      intracellular precursor propeptide (proBNP108); further processing of this propeptide results&#xD;
      in release of the biologically inert aminoterminal fragment (NT-proBNP) and the biologically&#xD;
      active BNP.Various studies have been performed to determine cut-off level to make a&#xD;
      differentiation between presence or absence of CHF using this test. BNP level below 50pg/ml&#xD;
      rules out CHF with a negative predictive value of 96%. (3) In the same study by Maisel et al&#xD;
      the diagnostic accuracy of B-type natriuretic peptide to rule in CHF at a cutoff of 100 pg&#xD;
      per milliliter or more was 83.4 percent. However subsequent studies have instead suggested a&#xD;
      multiple cut-point strategy (Less than 100pg/ml rules out CHF (NPV 90%), more than 400 pg/ml&#xD;
      rules in CHF (91% specificity) while intermediate values representing a grey zone.&#xD;
      Individuals with renal dysfunction have elevated BNP levels, and a lower cut-off to exclude&#xD;
      CHF in such patients is 200pg/ml. Individuals with a high BMI have falsely low levels and a&#xD;
      BMI adjusted correction is used (Lower cut-off of 54pg/mL if BMI &gt;35kg/m2). The levels of BNP&#xD;
      as well as NT-Pro-BNP have similar elevations in CHF, later being three times as much higher.&#xD;
      (1) Use of BNP to differentiate CHF from other causes of dyspnea, (4) and ease in its&#xD;
      measurement has resulted in increase in its use in intensive care settings, as point-of-care&#xD;
      testing has a potential to change outcomes. However when the test is used in this setting,&#xD;
      very high BNP levels were detected in critically ill patients with sepsis and shock. In&#xD;
      patients with shock, levels below 1200pg/ml had a negative predictive value of 92% for&#xD;
      cardiogenic shock. Such high levels in patients with compromised systolic function have&#xD;
      questioned utility of this measure to distinguish between CHF and other causes in critical&#xD;
      care settings. It is debated that in critically ill patients, coexisting other organ&#xD;
      dysfunction, rapid changes in volume status, variable bioavailability and burst synthesis of&#xD;
      BNP may all confound interpretation of BNP levels. However despite this confounding, even in&#xD;
      critically ill patients higher values are associated with adverse prognosis, and very low&#xD;
      levels (less than 100pg/ml) will mean a preserved left ventricular function. Thus, while it&#xD;
      is known that BNP really gives useful information, not already available from other clinical,&#xD;
      radiologic and biochemical measurements, what the investigators do not know is if the test&#xD;
      results become available in an intensive care unit setting, will it help treating physicians&#xD;
      to make meaningful clinical decisions.&#xD;
&#xD;
      Given above considerations, there is equipoise in utility of BNP measurements among&#xD;
      critically ill patients, and it is not a current standard of care. The current cost of this&#xD;
      test (about 1000 rupees per measurement) is high, and hence its utility needs to be carefully&#xD;
      examined before a widespread use. The investigators intend to test the hypothesize that that&#xD;
      on-admission BNP measurements, help clinicians identify CHF early, which may modify&#xD;
      therapeutic decisions, and improve outcomes. The current study is designed with an objective&#xD;
      to determine if on-admission BNP value and availability of its test results to treating&#xD;
      physicians will reduce in-hospital, and 30-day mortality and in-hospital morbidity.&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Unknown status</overall_status>
  <last_known_status>Recruiting</last_known_status>
  <start_date>October 2012</start_date>
  <completion_date type="Anticipated">December 2013</completion_date>
  <primary_completion_date type="Anticipated">September 2013</primary_completion_date>
  <phase>N/A</phase>
  <study_type>Interventional</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <allocation>Randomized</allocation>
    <intervention_model>Parallel Assignment</intervention_model>
    <primary_purpose>Diagnostic</primary_purpose>
    <masking>None (Open Label)</masking>
  </study_design_info>
  <primary_outcome>
    <measure>In hospital mortality</measure>
    <time_frame>From admission to death in hospital and upto 30 days after admission to the hospital, whichever is earlier</time_frame>
    <description>Assessment of In hospital mortality within 30-days of admission, and comparison between groups A and B.</description>
  </primary_outcome>
  <primary_outcome>
    <measure>30-day mortality</measure>
    <time_frame>Upto 30 days from admission to hospital</time_frame>
    <description>Mortality will be assessed after discharge from the hospital and upto 30 days from hospital admission and compared between groups A and B</description>
  </primary_outcome>
  <secondary_outcome>
    <measure>In-hospital morbidity</measure>
    <time_frame>Time of admission to ICU till death or discharge or 30days after admission, whichever is earlier</time_frame>
    <description>In-hospital morbidity, measured as a) duration of ICU stay, duration of hospital stay, need for mechanical ventilation or renal replacement during hospitalization, measured upto 30-days after admission to hospital</description>
  </secondary_outcome>
  <other_outcome>
    <measure>Intensity of In-hospital therapies administered</measure>
    <time_frame>First 24 hrs of ICU stay</time_frame>
    <description>To compare the difference in cumulative dose of diuretics, parenteral antibiotics, corticosteroids, and bronchodilators administered within first 24 hours of admission to ICU, between groups A and B.</description>
  </other_outcome>
  <other_outcome>
    <measure>Time to initiate heart failure specific therapies</measure>
    <time_frame>During hospital stay and upto 30-days after admission to hospital</time_frame>
    <description>To Compare the difference in time to initiate heart failure specific therapies (diuretics, angiotensin converting enzyme inhibitors, beta-blockers, and spironolactone) in groups A and B, during hospital stay and upto 30-days of admission to hospital.</description>
  </other_outcome>
  <number_of_arms>2</number_of_arms>
  <enrollment type="Anticipated">800</enrollment>
  <condition>Heart Failure</condition>
  <condition>Congestive Cardiac Failure</condition>
  <condition>Dyspnoea</condition>
  <arm_group>
    <arm_group_label>Diagnostic intervention group A</arm_group_label>
    <arm_group_type>Active Comparator</arm_group_type>
    <description>Patients who will receive the BNP test</description>
  </arm_group>
  <arm_group>
    <arm_group_label>Group B</arm_group_label>
    <arm_group_type>No Intervention</arm_group_type>
    <description>Patients who will not receive the BNP test.</description>
  </arm_group>
  <intervention>
    <intervention_type>Other</intervention_type>
    <intervention_name>Patients who will receive the BNP test</intervention_name>
    <description>Patients in Diagnostic Intervention Group A will receive the point-of-care BNP test, in addition to all other diagnostics they receive in addition</description>
    <arm_group_label>Diagnostic intervention group A</arm_group_label>
  </intervention>
  <eligibility>
    <criteria>
      <textblock>
        Inclusion Criteria:&#xD;
&#xD;
        We will include all consecutive patients admitted to intensive care units in participating&#xD;
        sites with all of the following features:&#xD;
&#xD;
          -  Adult aged 18 years or more&#xD;
&#xD;
          -  Acute onset dyspnea (duration 3 days or less) , defined as respiratory rate of 20 or&#xD;
             more.&#xD;
&#xD;
          -  Treating physician considers patient to be critically ill so as to warrant care in&#xD;
             intensive care unit.&#xD;
&#xD;
        Exclusion Criteria:&#xD;
&#xD;
        Patients for whom consent is not obtained will be excluded from the study&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>18 Years</minimum_age>
    <maximum_age>N/A</maximum_age>
    <healthy_volunteers>No</healthy_volunteers>
  </eligibility>
  <overall_official>
    <last_name>Dr.Rajnish Joshi, MD</last_name>
    <role>Principal Investigator</role>
    <affiliation>Sikkim Manipal Institute of Medical Sciences</affiliation>
  </overall_official>
  <overall_official>
    <last_name>Dr.Vishakha Jain, MD</last_name>
    <role>Principal Investigator</role>
    <affiliation>Mahatma Gandhi Institute of Medical Science</affiliation>
  </overall_official>
  <overall_contact>
    <last_name>Dr.Rajnish Joshi, MD</last_name>
    <phone>919434026378</phone>
    <email>rjoshimgims@gmail.com</email>
  </overall_contact>
  <overall_contact_backup>
    <last_name>Dr,Vishakha Jain, MD</last_name>
    <phone>919545765581</phone>
    <email>vishakhajain@mgims.ac.in</email>
  </overall_contact_backup>
  <location>
    <facility>
      <name>Assam Medical College</name>
      <address>
        <city>Dibrugarh</city>
        <state>Assam</state>
        <zip>786002</zip>
        <country>India</country>
      </address>
    </facility>
    <status>Not yet recruiting</status>
    <contact>
      <last_name>Dr.BN Mahanta</last_name>
      <email>bhupen_mahanta@yahoo.co.in</email>
    </contact>
    <investigator>
      <last_name>Dr.BN Mahanta, MD</last_name>
      <role>Principal Investigator</role>
    </investigator>
    <investigator>
      <last_name>Dr.DJ Dutta, DM</last_name>
      <role>Sub-Investigator</role>
    </investigator>
    <investigator>
      <last_name>Dr.Tulika Goswami, MD</last_name>
      <role>Sub-Investigator</role>
    </investigator>
  </location>
  <location>
    <facility>
      <name>Jawaharlal Nehru Medical college</name>
      <address>
        <city>Wardha</city>
        <state>Maharashtra</state>
        <zip>44022</zip>
        <country>India</country>
      </address>
    </facility>
    <status>Recruiting</status>
    <contact>
      <last_name>Dr.Bharti Taksande, MD</last_name>
      <phone>917152287701</phone>
      <email>bhartiganvir@mgims.ac.in</email>
    </contact>
    <investigator>
      <last_name>Dr.Bharti Taksande, MD</last_name>
      <role>Principal Investigator</role>
    </investigator>
    <investigator>
      <last_name>Dr.SK Diwan, MD</last_name>
      <role>Sub-Investigator</role>
    </investigator>
    <investigator>
      <last_name>Dr.Parimal Tayade, MD</last_name>
      <role>Sub-Investigator</role>
    </investigator>
  </location>
  <location>
    <facility>
      <name>Mahatma Gandhi Institute of Medical Sciences</name>
      <address>
        <city>Wardha</city>
        <state>Maharashtra</state>
        <zip>442102</zip>
        <country>India</country>
      </address>
    </facility>
    <status>Recruiting</status>
    <contact>
      <last_name>Dr.Omprakash Gupta, MD</last_name>
      <phone>917152284341</phone>
      <phone_ext>363</phone_ext>
      <email>gupta_op@hotmail.com</email>
    </contact>
    <contact_backup>
      <last_name>Dr.Vishakha Jain, MD</last_name>
      <phone>917152284341</phone>
      <phone_ext>363</phone_ext>
      <email>vishakhajain@mgims.ac.in</email>
    </contact_backup>
    <investigator>
      <last_name>Dr.Omprakash Gupta, MD</last_name>
      <role>Principal Investigator</role>
    </investigator>
    <investigator>
      <last_name>Dr.Samir Yelwatkar, MD</last_name>
      <role>Sub-Investigator</role>
    </investigator>
  </location>
  <location>
    <facility>
      <name>Sikkim Manipal Institute of Medical Sciences</name>
      <address>
        <city>Gangtok</city>
        <state>Sikkim</state>
        <zip>737102</zip>
        <country>India</country>
      </address>
    </facility>
    <status>Recruiting</status>
    <contact>
      <last_name>Dr.Bidita Khandelwal, MD</last_name>
      <phone>913592270535</phone>
      <email>drbidita@gmail.com</email>
    </contact>
    <contact_backup>
      <last_name>Dr.Rajnish Joshi, MD</last_name>
      <phone>913592270535</phone>
      <email>rjoshimgims@gmail.com</email>
    </contact_backup>
    <investigator>
      <last_name>Dr.Bidita Khandelwal, MD</last_name>
      <role>Principal Investigator</role>
    </investigator>
    <investigator>
      <last_name>Dr.Dheeraj Khatri, MD</last_name>
      <role>Sub-Investigator</role>
    </investigator>
    <investigator>
      <last_name>Dr.Nitin Shrivastav, MD</last_name>
      <role>Sub-Investigator</role>
    </investigator>
  </location>
  <location_countries>
    <country>India</country>
  </location_countries>
  <verification_date>October 2012</verification_date>
  <study_first_submitted>September 8, 2012</study_first_submitted>
  <study_first_submitted_qc>September 13, 2012</study_first_submitted_qc>
  <study_first_posted type="Estimate">September 14, 2012</study_first_posted>
  <last_update_submitted>October 10, 2012</last_update_submitted>
  <last_update_submitted_qc>October 10, 2012</last_update_submitted_qc>
  <last_update_posted type="Estimate">October 12, 2012</last_update_posted>
  <responsible_party>
    <responsible_party_type>Principal Investigator</responsible_party_type>
    <investigator_affiliation>Mahatma Gandhi Institute of Medical Sciences</investigator_affiliation>
    <investigator_full_name>Rajnish joshi</investigator_full_name>
    <investigator_title>Dr.Rajnish Joshi</investigator_title>
  </responsible_party>
  <keyword>Dyspnoea</keyword>
  <keyword>BNP</keyword>
  <keyword>Chronic heart failure</keyword>
  <keyword>congestive heart failure</keyword>
  <condition_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Dyspnea</mesh_term>
    <mesh_term>Heart Failure</mesh_term>
  </condition_browse>
  <!-- Results have not yet been posted for this study                                          -->
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT01685385
org study id: MGIMS001/2012
nct id: NCT01685385
lead sponsor: 
has dmc: No
Difficulty in breathing or increased rate of breathing are common causes of admission to
      intensive care unit. This may be due to heart failure, or other causes such as infection in
      the lungs. Treating doctors usually perform Chest X-ray, ECG, and other tests to know if
      breathlessness is due to heart failure or other cause. Doctors also give medicines to treat
      heart failure, or other conditions of the lungs based on the symptoms and investigation
      results. BNP is released by heart which is not functioning well. However BNP levels are also
      high in case of severe infection.Hence there is equipoise in utility of BNP measurements
      among critically ill patients, and it is not a current standard of care. The current cost of
      this test (about 1000 rupees per measurement) is high, and hence its utility needs to be
      carefully examined before a widespread use. The investigators intend to test the hypothesize
      that that on-admission BNP measurements, help clinicians identify CHF early, which may modify
      therapeutic decisions, and improve outcomes. The current study is designed with an objective
      to determine if on-admission BNP value and availability of its test results to treating
      physicians will reduce in-hospital, and 30-day mortality and in-hospital morbidity.
There usually remains a diagnostic uncertainty as differentiation between cardiogenic or
      non-cardiogenic cause of dyspnea. Often there are multiple underlying etiologies for acute
      onset dyspnea, and their evaluation leads to diagnostic delays, and hence longer hospital
      stay. While various clinical symptoms, signs and imaging based investigations are used in
      this differentiation, their accuracy remains low, and overlapping features preclude such
      differentiation. Echocardiography is an important adjunct in making such differentiation, but
      operator skill, and lack of availability of this technique at point of care are barriers in
      use of this modality. B-type natriuretic peptide (BNP), a rapidly-assayed, serum biomarker,
      has been found to be effective in distinguishing congestive heart failure (CHF) from other
      causes of dyspnea in the emergency or urgent care settings. Recently this test has become
      available at point of care (Alere Heart-Check). Ease, low cost, and objectivity in
      measurement of BNP has led to widespread incorporation of BNP and its precursor NT-pro-BNP
      into the clinical evaluation of CHF.

      Circulating levels of BNP/NT-proBNP are normally very low in healthy individuals. In response
      to increased myocardial wall stress due to volume- or pressure-overload states (such as in
      CHF), the BNP gene is activated in cardiomyocytes. This results in the production of an
      intracellular precursor propeptide (proBNP108); further processing of this propeptide results
      in release of the biologically inert aminoterminal fragment (NT-proBNP) and the biologically
      active BNP.Various studies have been performed to determine cut-off level to make a
      differentiation between presence or absence of CHF using this test. BNP level below 50pg/ml
      rules out CHF with a negative predictive value of 96%. (3) In the same study by Maisel et al
      the diagnostic accuracy of B-type natriuretic peptide to rule in CHF at a cutoff of 100 pg
      per milliliter or more was 83.4 percent. However subsequent studies have instead suggested a
      multiple cut-point strategy (Less than 100pg/ml rules out CHF (NPV 90%), more than 400 pg/ml
      rules in CHF (91% specificity) while intermediate values representing a grey zone.
      Individuals with renal dysfunction have elevated BNP levels, and a lower cut-off to exclude
      CHF in such patients is 200pg/ml. Individuals with a high BMI have falsely low levels and a
      BMI adjusted correction is used (Lower cut-off of 54pg/mL if BMI >35kg/m2). The levels of BNP
      as well as NT-Pro-BNP have similar elevations in CHF, later being three times as much higher.
      (1) Use of BNP to differentiate CHF from other causes of dyspnea, (4) and ease in its
      measurement has resulted in increase in its use in intensive care settings, as point-of-care
      testing has a potential to change outcomes. However when the test is used in this setting,
      very high BNP levels were detected in critically ill patients with sepsis and shock. In
      patients with shock, levels below 1200pg/ml had a negative predictive value of 92% for
      cardiogenic shock. Such high levels in patients with compromised systolic function have
      questioned utility of this measure to distinguish between CHF and other causes in critical
      care settings. It is debated that in critically ill patients, coexisting other organ
      dysfunction, rapid changes in volume status, variable bioavailability and burst synthesis of
      BNP may all confound interpretation of BNP levels. However despite this confounding, even in
      critically ill patients higher values are associated with adverse prognosis, and very low
      levels (less than 100pg/ml) will mean a preserved left ventricular function. Thus, while it
      is known that BNP really gives useful information, not already available from other clinical,
      radiologic and biochemical measurements, what the investigators do not know is if the test
      results become available in an intensive care unit setting, will it help treating physicians
      to make meaningful clinical decisions.

      Given above considerations, there is equipoise in utility of BNP measurements among
      critically ill patients, and it is not a current standard of care. The current cost of this
      test (about 1000 rupees per measurement) is high, and hence its utility needs to be carefully
      examined before a widespread use. The investigators intend to test the hypothesize that that
      on-admission BNP measurements, help clinicians identify CHF early, which may modify
      therapeutic decisions, and improve outcomes. The current study is designed with an objective
      to determine if on-admission BNP value and availability of its test results to treating
      physicians will reduce in-hospital, and 30-day mortality and in-hospital morbidity.
allocation: Randomized
intervention model: Parallel Assignment
primary purpose: Diagnostic
masking: None (Open Label)
measure: In hospital mortality
time frame: From admission to death in hospital and upto 30 days after admission to the hospital, whichever is earlier
description: Assessment of In hospital mortality within 30-days of admission, and comparison between groups A and B.
measure: 30-day mortality
time frame: Upto 30 days from admission to hospital
description: Mortality will be assessed after discharge from the hospital and upto 30 days from hospital admission and compared between groups A and B
measure: In-hospital morbidity
time frame: Time of admission to ICU till death or discharge or 30days after admission, whichever is earlier
description: In-hospital morbidity, measured as a) duration of ICU stay, duration of hospital stay, need for mechanical ventilation or renal replacement during hospitalization, measured upto 30-days after admission to hospital
measure: Intensity of In-hospital therapies administered
time frame: First 24 hrs of ICU stay
description: To compare the difference in cumulative dose of diuretics, parenteral antibiotics, corticosteroids, and bronchodilators administered within first 24 hours of admission to ICU, between groups A and B.
measure: Time to initiate heart failure specific therapies
time frame: During hospital stay and upto 30-days after admission to hospital
description: To Compare the difference in time to initiate heart failure specific therapies (diuretics, angiotensin converting enzyme inhibitors, beta-blockers, and spironolactone) in groups A and B, during hospital stay and upto 30-days of admission to hospital.
arm group label: Diagnostic intervention group A
arm group type: Active Comparator
description: Patients who will receive the BNP test
arm group label: Group B
arm group type: No Intervention
description: Patients who will not receive the BNP test.
intervention type: Other
intervention name: Patients who will receive the BNP test
description: Patients in Diagnostic Intervention Group A will receive the point-of-care BNP test, in addition to all other diagnostics they receive in addition
arm group label: Diagnostic intervention group A
criteria: 
gender: All
minimum age: 18 Years
maximum age: N/A
healthy volunteers: No
last name: Dr.Rajnish Joshi, MD
role: Principal Investigator
affiliation: Sikkim Manipal Institute of Medical Sciences
last name: Dr.Vishakha Jain, MD
role: Principal Investigator
affiliation: Mahatma Gandhi Institute of Medical Science
last name: Dr.Rajnish Joshi, MD
phone: 919434026378
email: rjoshimgims@gmail.com
last name: Dr,Vishakha Jain, MD
phone: 919545765581
email: vishakhajain@mgims.ac.in
facility: 
status: Not yet recruiting
contact: 
investigator: 
investigator: 
investigator: 
facility: 
status: Recruiting
contact: 
investigator: 
investigator: 
investigator: 
facility: 
status: Recruiting
contact: 
contact backup: 
investigator: 
investigator: 
facility: 
status: Recruiting
contact: 
contact backup: 
investigator: 
investigator: 
investigator: 
country: India
responsible party type: Principal Investigator
investigator affiliation: Mahatma Gandhi Institute of Medical Sciences
investigator full name: Rajnish joshi
investigator title: Dr.Rajnish Joshi
mesh term: Dyspnea
mesh term: Heart Failure