Evaluation of The Effects of Nebivolol in Comparison to Atenolol on Wall Shear Stress and Rupture Prone Coronary Plaques
| Status: | Completed |
|---|---|
| Conditions: | Peripheral Vascular Disease, Cardiology, Hematology |
| Therapuetic Areas: | Cardiology / Vascular Diseases, Hematology |
| Healthy: | No |
| Age Range: | Any |
| Updated: | 11/18/2012 |
| Start Date: | February 2010 |
| End Date: | December 2011 |
| Contact: | Saurabh Dhawan, MD |
| Email: | sdhawa3@emory.edu |
| Phone: | 404-712-0171 |
The Evaluation of The Effects of Nebivolol in Comparison to Atenolol on Wall Shear Stress and Rupture Prone Coronary Artery Plaques in Patients With Moderate Coronary Artery Disease
Nebivolol is a novel blood pressure lowering drug with an additional effect on the inner
lining of blood vessels to release a compound called nitric oxide that can relax blood
vessels. Atenolol is a blood pressure reducing agent without the ability to release nitric
oxide and effect additional blood vessel relaxation.
The goal of this proposal is to compare Nebivolol and Atenolol with respect to the following
parameters:
- Plaque within arteries supplying the heart in terms of its volume and composition as
assessed by ultrasound within these arteries.
- Ability of small arteries in the heart to open up and deliver an enhanced blood supply
in response to drug called Adenosine (routinely used in the cardiac catheterization
laboratory) as assessed by pressure and flow detecting catheters within these arteries.
- Ability of the inner lining of arteries that supply the heart to release a relaxing
compound called nitric oxide in response to injection of Acetylcholine (also used in
the cardiac catheterization laboratory) as assessed by squirting dye into these
arteries
- Local forces that affect blood flow in the arteries supplying the heart as assessed by
superimposing the above data into complex maps created offline at Georgia Institute of
Technology.
It is likely that Nebivolol causes the plaque within arteries supplying the heart to change
from the 'vulnerable' type to the 'stable' type plaque. There are several features of
"vulnerable plaques" that can be detected in arteries of the heart using intravascular
ultrasound (a small ultrasound camera that goes in the arteries of the heart). The
investigators hypothesis is that Nebivolol will prove superior to Atenolol in reducing
'vulnerable plaques', improve blood flow within the small arteries and the health of inner
lining of these arteries at the 1 year time point. The investigators plan to enroll 20
patients into the study (26 patient including dropouts) who will be randomized in a 1:1
manner to Nebivolol Vs Atenolol for 1 year and repeat evaluation at that time point.
Primary hypothesis:
Nebivolol therapy will reduce the number of thin-cap fibroatheromas, VH-IVUS defined
"vulnerable plaques" compared to Atenolol in patients undergoing serial angiography and
IVUS.
Secondary Hypotheses:
- Nebivolol therapy will improve coronary microvascular function
- Nebivolol therapy will improve coronary endothelial function
- Nebivolol therapy will improve coronary wall shear stress
Specific Aims:
To evaluate, in patients with stable angina or acute coronary syndromes and moderate
angiographic coronary artery disease, the effects of Nebivolol 5 mg a day compared to
Atenolol 50 mg a day on:
- The number of thin cap fibroatheromas, percent necrotic core, and percent atheroma
volume as defined by the novel Virtual Histology IVUS (VH™ IVUS).
- The coronary shear stress profile measured using 3 dimensional vessel reconstruction,
flow velocity measurements, and computational fluid dynamics.
- Microvascular function as determined by coronary flow reserve and fractional flow
reserve measured by invasive Doppler/pressure assessment.
- Endothelial function as determined by the response of quantitative coronary angiography
and Doppler assessment to intracoronary acetylcholine challenge.
Inclusion Criteria:
- Patients with stable angina or acute coronary syndrome
- Moderate coronary lesion (defined as a lesion significant enough by the treating
physician to warrant further evaluation using CFR or FFR or intravascular ultrasound
assessment).
- Lesion located in the proximal 60mm of the RCA or LAD.
- On stable medical therapy for other cardiac risk factors.
Exclusion Criteria:
- Left Main lesion greater than 50% stenosis
- Patients with a history of coronary artery bypass surgery
- Severe valvular heart disease
- Patients presenting with a STEMI.
- Inability to provide informed consent prior to randomization
- Creatinine >1.5
- Lesions located beyond 60mm in an epicardial vessel
- Coronary anatomy requiring CABG
- Prior B-blocker therapy
- Bradycardia (HR<50 bpm)
- Hypotension (SBP<100mmHg)
- Severe COPD by pulmonary function testing
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