Maximal Hyperemia in the Assessment of Fractional Flow Reserve
| Autor: | Andrea Gardi, Carlo Trani, Antonio Maria Leone, Dolores Russo, Giampaolo Niccoli, Filippo Crea, Eloisa Basile, Rocco Mongiardo, Mario Attilio Mazzari, Alberto Ranieri De Caterina, Domenico Laezza, Francesco Burzotta, Antonio Giuseppe Rebuzzi, Italo Porto, Andrea Aurelio |
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| Rok vydání: | 2012 |
| Předmět: |
medicine.medical_specialty
business.industry medicine.medical_treatment Vasodilation Fractional flow reserve medicine.disease Adenosine Dose–response relationship Bolus (medicine) Anesthesia Internal medicine medicine Cardiology Sodium nitroprusside Cardiology and Cardiovascular Medicine business Atrioventricular block medicine.drug Cardiac catheterization |
| Zdroj: | JACC: Cardiovascular Interventions. 5:402-408 |
| ISSN: | 1936-8798 |
| Popis: | Objectives This study sought to compare increasing doses of intracoronary (IC) adenosine or IC sodium nitroprusside versus intravenous (IV) adenosine for fractional flow reserve (FFR) assessment. Background Maximal hyperemia is the critical prerequisite for FFR assessment. Despite IV adenosine currently representing the recommended approach, IC administration of adenosine or other coronary vasodilators constitutes a valuable alternative in everyday practice. However, it is surprisingly unclear which IC strategy allows the achievement of FFR values comparable to IV adenosine. Methods Fifty intermediate coronary stenoses (n = 45) undergoing FFR measurement were prospectively and consecutively enrolled. Hyperemia was sequentially induced by incremental boli of IC adenosine (ADN) (60 μg ADN60, 300 μg ADN300, 600 μg ADN600), by IC sodium nitroprusside (NTP) (0.6 μg/kg bolus) and by IV adenosine infusion (IVADN) (140 μg/kg/min). FFR values, symptoms, and development of atrioventricular block were recorded. Results Incremental doses of IC adenosine and NTP were well tolerated and associated with fewer symptoms than IVADN. Intracoronary adenosine doses (0.881 ± 0.067, 0.871 ± 0.068, and 0.868 ± 0.070 with ADN60, ADN300, and ADN600, respectively) and NTP (0.892 ± 0.072) induced a significant decrease of FFR compared with baseline levels (p Conclusions Intracoronary adenosine, at doses higher than currently suggested, allows obtaining FFR values similar to IV adenosine. Intravenous adenosine, which remains the gold standard, might thus be reserved for those lesions with equivocal FFR values after high (up to 600 μg) IC adenosine doses. |
| Databáze: | OpenAIRE |
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