Comprehensive Assessment of Coronary Plaque Progression With Advanced Intravascular Imaging, Physiological Measures, and Wall Shear Stress: A Pilot Double-Blinded Randomized Controlled Clinical Trial of Nebivolol Versus Atenolol in Nonobstructive Coronary Artery Disease

Journal of the American Heart Association
Olivia Y HungHabib Samady

Abstract

We hypothesized that nebivolol, a β-blocker with nitric oxide-mediated activity, compared with atenolol, a β-blocker without such activity, would decrease oxidative stress and improve the effects of endothelial dysfunction and wall shear stress (WSS), thereby reducing atherosclerosis progression and vulnerability in patients with nonobstructive coronary artery disease. In this pilot double-blinded randomized controlled trial, 24 patients treated for 1 year with nebivolol 10 mg versus atenolol 100 mg plus standard medical therapy underwent baseline and follow-up coronary angiography with assessments of inflammatory and oxidative stress biomarkers, microvascular function, endothelial function, and virtual histology intravascular ultrasound. WSS was calculated from computational fluid dynamics. Virtual histology intravascular ultrasound segments were assessed for vessel volumetrics and remodeling. There was a trend toward more low-WSS segments in the nebivolol cohort (P=0.06). Low-WSS regions were associated with greater plaque progression (P<0.0001) and constrictive remodeling (P=0.04); conversely, high-WSS segments demonstrated plaque regression and excessive expansive remodeling. Nebivolol patients had decreased lumen and vesse...Continue Reading

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Citations

Jul 10, 2018·Current Opinion in Cardiology·Janet WeiC Noel Bairey Merz
Nov 11, 2017·Arteriosclerosis, Thrombosis, and Vascular Biology·Jaryl NgNicolas Foin

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Methods Mentioned

BETA
coronary artery bypass
pharmacotherapies
pharmacotherapy

Clinical Trials Mentioned

NCT01230892

Software Mentioned

Fluent ANSYS
ANGUS
SAS
Research Randomizer
Stata
WebIDS
echoPlaque

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