title: Acute effects of nicardipine and esmolol on the cardiac cycle, intracardiac hemodynamic and endothelial shear stress in patients with unstable angina pectoris and moderate coronary stenosis: results from single center, randomized study.
abstract: OBJECTIVE
  This study aimed to compare the acute effects of nicardipine and esmolol on hemodynamic and endothelial shear stress (ESS) in patients with unstable angina (UA) and moderate coronary stenosis (MCS).
  
  
  BACKGROUND
  Nicardipine and esmolol exhibit cardioprotection via different mechanisms. However, their acute effects on hemodynamic and ESS are still unknown.
  
  
  METHODS
  One-hundred sixteen patients with UA and MSC were randomly divided into nicardipine (n = 59) and esmolol (n = 57) groups. Drugs were injected as a bolus followed by continuous infusion to achieve the steady states defined as the mean blood pressure (MBP) reduced by ≥ 10% or a heart-rate change by ≥ 15 bpm, lasting for at least 10 min. The aortic pressure (AP), EKG, blood velocity, right atrial pressure, distal coronary pressure (DCP), systolic time (ST), isovolumetric diastolic time (IVDT), speed filling time (SFT), and ESS were simultaneously calculated at baseline and steady states.
  
  
  RESULTS
  Both drugs significantly reduced blood pressure and rate-pressure load. Infusion of nicardipine was associated with negative remodeling of the distal segment (P= 0.005). Esmolol, rather than nicardipine, increased minimal lumen diameter (P= 0.040), prolonged SFT (0.34 ± 0.03 s vs. 0.41 ± 0.03 s, P < 0.001), reduced DCP (P < 0.001) and increased blood velocity (33.65 ± 1.07 cm/s vs. 43.36 ± 1.25 cm/s, P < 0.001) at SFT stages, with increased blood-flow (P < 0.001). Both drugs increased downstream ESS. Esmolol significantly reversed abnormally increased ESS (P < 0.001) and increased upstream ESS compared with nicardipine (P < 0.001).
  
  
  CONCLUSIONS
  Beyond a similar reduction of AP, patients with UA and MCS could benefit more from the reduction of heart rate induced by esmolol (ChiCTR-TRC-10000964).
authors.affiliation: Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 21006, China. chmengx@126.com
authors.forename: Shao-Liang
authors.initials: SL
authors.lastname: Chen
authors.forename: Zuo-Ying
authors.initials: ZY
authors.lastname: Hu
authors.forename: Jun-Jie
authors.initials: JJ
authors.lastname: Zhang
authors.forename: Fei
authors.initials: F
authors.lastname: Ye
authors.forename: Jing
authors.initials: J
authors.lastname: Kan
authors.forename: Tian
authors.initials: T
authors.lastname: Xu
authors.forename: Zhi-Zhong
authors.initials: ZZ
authors.lastname: Liu
authors.forename: Yao-Jun
authors.initials: YJ
authors.lastname: Zhang
authors.forename: Jun-Xia
authors.initials: JX
authors.lastname: Zhang
authors.forename: Mengxuan
authors.initials: M
authors.lastname: Chen
mesh_terms: D058671:Adrenergic beta-1 Receptor Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D000368:Aged; D000704:Analysis of Variance; D000789:Angina, Unstable / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D001783:Blood Flow Velocity / Q000187:drug effects; D001794:Blood Pressure / Q000187:drug effects; D002121:Calcium Channel Blockers / Q000008:administration & dosage / Q000627:therapeutic use*; D006328:Cardiac Catheterization; D016009:Chi-Square Distribution; D002681:China; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000187:drug effects; D023921:Coronary Stenosis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D003331:Coronary Vessels / Q000187:drug effects* / Q000503:physiopathology; D004730:Endothelium, Vascular / Q000187:drug effects* / Q000503:physiopathology; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009529:Nicardipine / Q000008:administration & dosage / Q000627:therapeutic use*; D011412:Propanolamines / Q000008:administration & dosage / Q000627:therapeutic use*; D012720:Severity of Illness Index; D013314:Stress, Mechanical; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D058671:Adrenergic beta-1 Receptor Antagonists; D002121:Calcium Channel Blockers; D011412:Propanolamines; D009529:Nicardipine; C036604:esmolol