Adequacy of intracoronary versus intravenous adenosine-induced maximal coronary hyperemia for fractional flow reserve measurements
Adequacy of intracoronary versus intravenous adenosine-induced maximal coronary hyperemia for fractional flow reserve measurements
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DOI：
10.1067/mhj.2000.109920
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发表时间：
2000-10-01
影响因子：
4.8
通讯作者：
Yock, PG
中科院分区：
文献类型：
--
作者：
Jeremias, A;Whitbourn, RJ;Yock, PG
背景血流储备分数（FFR）是基于最大充血时获得的压力测量值来衡量冠状动脉狭窄严重程度的指标。用于最大冠状动脉充血的最广泛使用的药理学刺激是腺苷，以连续静脉内（IV）输注或冠状动脉内（IC）推注给药。IV腺苷有更多的副作用，是更昂贵的IC腺苷，但有一个更稳定，更长的充血effect.Methods我们比较了IC和IV腺苷管理的多中心试验中的血流储备分数的测量的疗效。52例患者的60处病变接受了IV和IC腺苷FFR测定。以140 μ g/ka的速率连续输注IV腺苷。直到达到稳态充血。在右冠状动脉中以15至20 μ g的剂量和在左冠状动脉中以18至24 μ g的剂量给予IC腺苷推注。FFR计算为最大充血时远端冠状动脉压力（来自压力导丝）与主动脉压力（引导导管）的比值。结果共评价了26支左前降支、23支右冠状动脉、9支左回旋支和3支左主干冠状动脉。两组的平均狭窄百分比为55.8% ± 23.6%（范围0%至95%），平均FFR为0.78 ± 0.15（范围0.41至0.98）。FFR测量值与IV和IC腺苷之间存在强线性相关性（R = 0.978，y = 0.032 + 0.964x，P <0.001）。2组测量值之间的一致性也很高，FFR的平均差异为-0.004 +/- 0.03。然而，在5处病变（8.3%）的FFR测量结果的两个方向上观察到一个小的随机分散，其中IC腺苷的FFR比IV输注高0.05或更多，表明这些患者的充血反应不佳。静脉注射腺苷后，心率和血压的变化明显更高。两名患者IV，但没有与IC腺苷，有严重的副作用（支气管痉挛酸严重恶心）。结论这些结果表明，IC腺苷相当于IV输注的血流储备分数的测定在大多数患者。然而，在一小部分病例中，IC腺苷的冠状动脉充血效果不佳。
Background Fractional flow reserve (FFR) is a measure of coronary stenosis severity that is based on pressure measurements obtained at maximal hyperemia. The most widely used pharmacologic stimulus for maximal coronary hyperemia is adenosine, administered either as a continuous intravenous (IV) infusion or intracoronary (IC) bolus. IV adenosine has more side effects and is more costly than IC adenosine but has a more stable and prolonged hyperemic effect.Methods We compared the efficacy of IC and IV adenosine administration for the measurement of FFR in a multicenter trial. Fifty-two patients with 60 lesions underwent determination of FFR with both IV and IC adenosine. IV adenosine was administered as a continuous infusion at a rate of 140 mu g/ka. per minute until a steady state hyperemia was achieved. IC adenosine boluses were administered at a dose of 15 to 20 mu g in the right and 18 to 24 mu g in the left coronary artery. FFR was calculated as the ratio of the distal coronary pressure (from pressure guide wire) to the aortic pressure (guide catheter) at maximal hyperemia.Results A total of 26 left anterior descending, 23 right, 9 left circumflex, and 3 left main coronary arteries were evaluated. Mean percent stenosis for both groups was 55.8% +/- 23.6% (range 0% to 95%), and mean FFR was 0.78 +/- 0.15 (range 0.41 to 0.98). There was a strong and linear correlation between FFR measurements with IV and IC adenosine (R = 0,978, y = 0.032 + 0.964x, P < .001). The agreement between the 2 sets of measurements was also high, with a mean difference in FFR of -0.004 +/- 0.03. However, a small random scatter in both directions of FFR measurements was noted with 5 lesions (8.3%) where FFR with IC adenosine was higher by 0.05 or more compared with IV infusions, suggesting a suboptimal hyperemic response in these patients. Changes in heart rate and blood pressure were significantly higher with IV adenosine. Two patients with IV, but none with IC adenosine, had severe side effects (bronchospasm acid severe nausea).Conclusion These results suggest that IC adenosine is equivalent to IV infusion for the determination of FFR in the majority of patients. However, in a small percentage of cases, coronary hyperemia was suboptimal with IC adenosine.