Beta Blockers and Angiotensin Receptor Blockers in Bicuspid Aortic Valve Disease Aortopathy (BAV Study)
Overview
- Phase
- Phase 3
- Intervention
- Atenolol
- Conditions
- Cardiac Disease
- Sponsor
- Hamilton Health Sciences Corporation
- Enrollment
- 85
- Locations
- 13
- Primary Endpoint
- Change From Baseline in Ascending Aorta Size, as Evaluated by MRI
- Status
- Terminated
- Last Updated
- 6 years ago
Overview
Brief Summary
The purpose of this study is to determine whether long-term treatment with a beta-blocker (BB) such as atenolol and/or an angiotensin receptor blocker (ARB) such as telmisartan, given to adult patients with bicuspid aortic valve (BAV) disease (aortopathy) reduces the widening (dilatation) of the aorta from its baseline size.
Detailed Description
Bicuspid aortic valve (BAV) is the most common congenital heart disease lesion with an estimated 280 000 to 560 000 people affected in the Canada. Dilatation of the ascending aorta is a common feature in patients with BAV and is a result of inherent vascular abnormalities with superimposed effects of age and acquired cardiovascular risk factors. Severe aortic dilatation (\> 50mm) leads to aortic dissection and premature death. Histopathological studies of the aortas in patients with BAVs report similar findings to that of patients with Marfan syndrome. Beta Blocker (BB) therapy and more recently, Angiotensin Receptor Blocker (ARB) therapy, have been shown to decrease to rate of aortic dilatation and be of benefit to patients with Marfan syndrome. There is no such data however in patients with BAV and aortopathy. Within the context of a randomized clinical trial, the investigators proposed to test the hypothesis that BB or ARB will reduce the rate of progressive aortic dilatation in adults with BAVs and ascending aortopathy as compared to placebo. Design: Multicentre, randomized, double-blind, placebo-controlled, trial of adult patients with bicuspid aortic valve aortopathy. Patients who are eligible to take either study medication will be randomly allocated to participate in either the BB (atenolol) vs. placebo arm, or the ARB (telmisartan) vs. placebo arm. Patients who are ineligible for the BB arm will be assigned to the ARB vs. placebo arm and patients who are ineligible for the ARB arm will be assigned to the BB vs. placebo arm. Within each arm, all participants will be randomized to take either placebo or active medication. The atenolol arm will be up-titrated to100mg/day and the telmisartan arm will be up-titrated to 80 mg/day, or to the maximum tolerated dose.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Age =\> 18 years
- •Men and women with BAV and ascending aorta measuring \> 37mm.
- •Written informed consent
- •General Study Exclusion Criteria
- •History of cardiac diseases, such as
- •Symptomatic aortic stenosis or aortic regurgitation referred for surgical intervention or asymptomatic severe aortic stenosis or regurgitation based on current guidelines
- •Uncontrolled heart failure, right ventricular failure due to pulmonary hypertension
- •Cardiogenic shock
- •Systolic blood pressure \< 100 mmHg
- •History of drug sensitivity, contraindication or adverse reaction to both BB and ARB. Participants who are able to tolerate only a BB will be allocated to the BB vs. placebo arm, and participants who are able to tolerate only an ARB will be allocated to the ARB vs. placebo arm, assuming no other exclusion criteria are met.
Exclusion Criteria
- Not provided
Arms & Interventions
Atenolol
Atenolol or matching placebo 25 mg up-titrated to 100 mg.
Intervention: Atenolol
Telmisartan
Telmisartan or matching placebo 40 mg up-titrated to 80mg
Intervention: Telmisartan
Outcomes
Primary Outcomes
Change From Baseline in Ascending Aorta Size, as Evaluated by MRI
Time Frame: The difference between baseline measures (2012-2013) and Year 3 measure (2015-2016)
The primary analyses include the evaluation of the effects of monotherapy (atenolol vs. placebo, telmisartan vs. placebo) on the change in aortic root size measured at 3 years. Change is measured in centimeters squared (final measurement - baseline measurement). Original outcome measure time frame was scheduled for 5 years, however due to poor study participant and site recruitment study was closed early and final outcome measures taken at approximately 3 years.
Secondary Outcomes
- Rate of Change in Ascending Aorta Size Evaluated by Transthoracic Echocardiography (TEE)(The difference between baseline measures (2012-2013) and Year 3 measure (2015-2016))