Comparing invasive hemodynamic responses in adenosine hyperemia versus physical exercise stress in chronic coronary syndromes
Autor: | Konstantinos Stathogiannis, Firas Al-Janabi, Paul A. Kelly, Justin E. Davies, Jamil Mayet, Shah Mohdnazri, Ricardo Petraco, Sukhjinder Nijjer, Matthew J. Shun-Shin, Reto Gamma, Yousif Ahmad, Amarjit Sethi, Thomas R. Keeble, Iqbal S. Malik, Darrel P. Francis, Christopher Cook, Raffi Kaprielian, John R. Davies, Guus A. de Waard, Rasha Al-Lamee, Takayuki Warisawa, James P. Howard, Gerald J. Clesham, Sayan Sen, Grigoris V. Karamasis, Kare H. Tang, Ghada Mikhail |
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Jazyk: | angličtina |
Rok vydání: | 2021 |
Předmět: |
medicine.medical_specialty
Cardiac Catheterization Adenosine medicine.medical_treatment Vasodilator Agents Hemodynamics Physical exercise Hyperemia Fractional flow reserve Coronary artery disease Internal medicine medicine Humans Exercise Cardiac catheterization Aged business.industry Microcirculation Coronary Stenosis Syndrome Middle Aged medicine.disease Coronary Vessels Fractional Flow Reserve Myocardial Stenosis Rate pressure product Aortic pressure Cardiology Cardiology and Cardiovascular Medicine business |
ISSN: | 1874-1754 |
Popis: | Objectives-\ud 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.\ud Methods-\ud 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.\ud Results-\ud 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).\ud Conclusions-\ud 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. |
Databáze: | OpenAIRE |
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