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Variability in IV Adenosine‐Induced Coronary Microvascular Resistance and Systemic Pressure Compromises FFR Determination despite Stable Stenosis Hemodynamics
Author(s) -
Casadonte Lorena,
Marques Koen,
Spaan Jos,
Siebes Maria
Publication year - 2015
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.29.1_supplement.953.9
Subject(s) - adenosine , hemodynamics , medicine , cardiology , stenosis , fractional flow reserve , vascular resistance , bolus (digestion) , reactive hyperemia , anesthesia , blood flow , coronary angiography , myocardial infarction
Aim To investigate the effect of intracoronary (IC) and intravenous (IV) adenosine administration on variability in coronary and stenosis hemodynamics. Methods In 12 diseased coronary vessels (25‐56% DS), aortic pressure (Pa), distal pressure (Pd) and flow velocity (v) were simultaneously measured at baseline and hyperemia induced by IC (40 μg bolus) and IV adenosine administration (140 μg/kg/min). At baseline and throughout the hyperemic response we obtained cycle‐averaged pressure and velocity signals to derive microvascular resistance (MR = Pd/v) and FFR= Pd/Pa. From fitted stenosis pressure gradient‐velocity (ΔP‐v) relations, we determined ΔP at v= 30 cm/s (dPv30). Results Maximal v was similar for IC and IV adenosine (50 ± 4 vs. 54 ± 5 cm/s) with no difference in MR (1.73 ± 0.10 vs. 1.74 ± 0.13 mmHg/cm/s). However, MR during IV hyperemia rose between 9 and 135% in the post‐peak period, with concomitant fluctuations in v (13 to 61% decline) and pressures (up to 34% decline). Minimal FFR coincided with peak v for IC adenosine, but occurred 21 ± 8 s after peak v for IV adenosine, when Pa had decreased by 13% and HR increased by 25% vs. baseline. IV and IC derived stenosis ΔP‐v relations followed a stable common quadratic relationship, with no difference in dPv30. Conclusion IV adenosine caused persistent systemic and coronary hemodynamic variability. IC adenosine yielded comparable hyperemia with minor effects on systemic hemodynamics. Consistent ΔP‐v relations and dPv30 provide reliable means for stenosis evaluation free from maximal vasodilation.