Is heart rate response a reliable marker of adenosine-induced coronary hyperemia?

Autor: Haseeb Rahman, Divaka Perera, Howard Ellis, Bhavik Modi, Sara Abou Sherif, Amedeo Chiribiri, Kseniia Eruslanova
Rok vydání: 2018
Předmět:
Male
Adenosine
Vasodilator Agents
Myocardial Ischemia
Coronary Disease
Fractional flow reserve
030204 cardiovascular system & hematology
Chest pain
Coronary artery disease
030218 nuclear medicine & medical imaging
0302 clinical medicine
Heart Rate
Tachycardia
Cardiac imaging
Middle Aged
Coronary Vessels
Magnetic Resonance Imaging
Catheter
cardiovascular system
Cardiology
Female
medicine.symptom
Cardiology and Cardiovascular Medicine
Perfusion
Echocardiography
Stress
circulatory and respiratory physiology
medicine.medical_specialty
Hyperemia
03 medical and health sciences
Predictive Value of Tests
Coronary Circulation
Internal medicine
Heart rate
medicine
Humans
Radiology
Nuclear Medicine and imaging
cardiovascular diseases
Aged
Retrospective Studies
Original Paper
business.industry
Stress perfusion cardiac MRI
medicine.disease
Echocardiography
Doppler
Color
body regions
Cardiac Imaging Techniques
Blood pressure
business
Biomarkers
Zdroj: The International Journal of Cardiovascular Imaging
ISSN: 1573-0743
1569-5794
DOI: 10.1007/s10554-018-1309-1
Popis: Introduction Growing evidence supports ischemia-guided management of chest pain, with invasive and non-invasive tests reliant upon achieving adenosine-induced coronary hyperemia (defined as increased blood flow to an organ’s perfusion bed). In the non-invasive setting, surrogate markers of hyperemia, such as increases in heart rate, are often used, despite not being formally validated. We tested whether heart rate and other non-invasive indices are reliable markers of coronary hyperemia. Methods The first part involved Doppler flow-based validation of the best pressure-wire markers of hyperemia in 53 patients. Subsequently, using these validated pressure-derived parameters, 265 pressure-wire traces were analysed to determine whether heart rate and other non-invasive parameters correlated with hyperemia. Results In the flow derivation cohort, the best determinant of hyperemia came from having 2 out of 3 of: (1) Ventriculisation of the distal pressure waveform, (2) disappearance of distal dicrotic pressure notch, (3) separation of mean aortic and distal pressures. Within the 244 patients demonstrating hyperemia, non-invasive markers of hyperemia, such as change in heart rate (p = 0.77), blood pressure (p = 0.60) and rate-pressure product (p = 0.86), were poor correlates of coronary hyperemia, with only 37.3% demonstrating a ≥ 10% increase in heart rate that is commonly used to adjudge adenosine-induced hyperemia in the non-invasive setting. Conclusions We demonstrate, by correlation with Doppler-flow data, a validated method of identifying coronary hyperemia within the catheter laboratory using the pressure-wire. We subsequently show that non-invasive parameters, such as heart rate change, are poor predictors of coronary hyperemia during stress imaging protocols that rely upon achieving adenosine-induced hyperemia.
Databáze: OpenAIRE
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