Comparing invasive hemodynamic responses in adenosine hyperemia versus physical exercise stress in chronic coronary syndromes.

Autor: Cook CM; Imperial College London, London, UK; Essex Cardiothoracic Centre, Basildon, UK. Electronic address: Christopher.cook@nhs.net., Howard JP; Imperial College London, London, UK., Ahmad Y; Imperial College London, London, UK., Shun-Shin MJ; Imperial College London, London, UK., Sethi A; Imperial College London, London, UK., Clesham GJ; Essex Cardiothoracic Centre, Basildon, UK; Anglia Ruskin University, UK., Tang KH; Essex Cardiothoracic Centre, Basildon, UK; Anglia Ruskin University, UK., Nijjer SS; Imperial College London, London, UK., Kelly PA; Essex Cardiothoracic Centre, Basildon, UK., Davies JR; Essex Cardiothoracic Centre, Basildon, UK; Anglia Ruskin University, UK., Malik IS; Imperial College London, London, UK., Kaprielian R; Imperial College London, London, UK., Mikhail G; Imperial College London, London, UK., Petraco R; Imperial College London, London, UK., Warisawa T; Imperial College London, London, UK., Al-Janabi F; Essex Cardiothoracic Centre, Basildon, UK; Anglia Ruskin University, UK., Karamasis GV; Essex Cardiothoracic Centre, Basildon, UK; Anglia Ruskin University, UK., Mohdnazri S; Essex Cardiothoracic Centre, Basildon, UK; Anglia Ruskin University, UK., Gamma R; Essex Cardiothoracic Centre, Basildon, UK., Stathogiannis KE; Essex Cardiothoracic Centre, Basildon, UK., de Waard GA; Imperial College London, London, UK., Al-Lamee R; Imperial College London, London, UK., Keeble TR; Essex Cardiothoracic Centre, Basildon, UK; Anglia Ruskin University, UK., Mayet J; Imperial College London, London, UK., Sen S; Imperial College London, London, UK., Francis DP; Imperial College London, London, UK., Davies JE; The Hammersmith Hospital, London, UK.
Jazyk: angličtina
Zdroj: International journal of cardiology [Int J Cardiol] 2021 Nov 01; Vol. 342, pp. 7-14. Date of Electronic Publication: 2021 Aug 04.
DOI: 10.1016/j.ijcard.2021.07.064
Abstrakt: Objectives: Adenosine hyperemia is an integral component of the physiological assessment of obstructive coronary artery disease in patients with chronic coronary syndrome (CCS). The aim of this study was to compare systemic, coronary and microcirculatory hemodynamics between intravenous (IV) adenosine hyperemia versus physical exercise stress in patients with CCS and coronary stenosis.
Methods: Twenty-three patients (mean age, 60.6 ± 8.1 years) with CCS and single-vessel coronary stenosis underwent cardiac catheterization. Continuous trans-stenotic coronary pressure-flow measurements were performed during: i) IV adenosine hyperemia, and ii) physical exercise using a catheter-table-mounted supine ergometer. Systemic, coronary and microcirculatory hemodynamic responses were compared between IV adenosine and exercise stimuli.
Results: Mean stenosis diameter was 74.6% ± 10.4. Median (interquartile range) FFR was 0.54 (0.44-0.72). At adenosine hyperemia versus exercise stress, mean aortic pressure (Pa, 91 ± 16 mmHg vs 99 ± 15 mmHg, p < 0.0001), distal coronary pressure (Pd, 58 ± 21 mmHg vs 69 ± 24 mmHg, p < 0.0001), trans-stenotic pressure ratio (Pd/Pa, 0.63 ± 0.18 vs 0.69 ± 0.19, p < 0.0001), microvascular resistance (MR, 2.9 ± 2.2 mmHg.cm -1 .sec -1 vs 4.2 ± 1.7 mmHg.cm -1 .sec -1 , p = 0.001), heart rate (HR, 80 ± 15 bpm vs 85 ± 21 bpm, p = 0.02) and rate-pressure product (RPP, 7522 ± 2335 vs 9077 ± 3200, p = 0.0001) were all lower. Conversely, coronary flow velocity (APV, 23.7 ± 9.5 cm/s vs 18.5 ± 6.8 cm/s, p = 0.02) was higher. Additionally, temporal changes in Pa, Pd, Pd/Pa, MR, HR, RPP and APV during IV adenosine hyperemia versus exercise were all significantly different (p < 0.05 for all).
Conclusions: In patients with CCS and coronary stenosis, invasive hemodynamic responses differed markedly between IV adenosine hyperemia versus physical exercise stress. These differences were observed across systemic, coronary and microcirculatory hemodynamics.
(Copyright © 2021. Published by Elsevier B.V.)
Databáze: MEDLINE
Externí odkaz: