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
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
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DOI：
10.1111/j.1755-5922.2011.00298.x
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发表时间：
2012-01-01
影响因子：
3.1
通讯作者：
Chen, Mengxuan
中科院分区：
文献类型：
--
作者：
Chen, Shao-Liang;Hu, Zuo-Ying;Chen, Mengxuan
目的：本研究旨在比较尼卡地平和艾司洛尔对不稳定心绞痛（UA）和中度冠状动脉狭窄（MCS）患者血流动力学和内皮剪切应力（ESS）的急性影响。背景：尼卡地平和艾司洛尔通过不同的机制表现出心脏保护作用。然而，它们对血流动力学和 ESS 的急性影响仍然未知。方法：116 例 UA 和 MSC 患者随机分为尼卡地平组 (n = 59) 和艾司洛尔组 (n = 57)。药物以推注形式注射，然后连续输注以达到稳态，定义为平均血压（MBP）降低= 10％或心率变化= 15 bpm，持续至少10分钟。在基线和稳态时同时计算主动脉压（AP）、心电图、血流速度、右心房压、远端冠状动脉压（DCP）、收缩时间（ST）、等容舒张时间（IVDT）、快速充盈时间（SFT）和ESS。结果：两种药物均显着降低血压和心率压力负荷。尼卡地平的输注与远端节段的负重塑相关（P = 0.005）。艾司洛尔，而不是尼卡地平，增加了最小管腔直径（P = 0.040），延长了SFT（0.34 +/- 0.03 s vs. 0.41 +/- 0.03 s，P < 0.001），降低了DCP（P < 0.001）并增加了血流速度（33.65 +/- 1.07 cm/s vs. 43.36 +/-） 1.25 cm/s，P < 0.001）在 SFT 阶段，血流量增加（P < 0.001）。两种药物都会增加下游 ESS。与尼卡地平相比，艾司洛尔显着逆转异常增加的 ESS（P < 0.001）并增加上游 ESS（P < 0.001）。结论：除了类似的 AP 降低之外，UA 和 MCS 患者还可以从艾司洛尔引起的心率降低中获益更多 (ChiCTR-TRC-10000964)。
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). Conclusion: 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).