Comparison of intravenous adenosine to intracoronary papaverine for calculation of pressure-derived fractional flow reserve
✍ Scribed by van der Voort, Pepijn H. ;van Hagen, Eduard ;Hendrix, Gert ;van Gelder, Berry ;Bech, Jan Willem ;Pijls, Nico H. J.
- Publisher
- John Wiley and Sons
- Year
- 1996
- Tongue
- English
- Weight
- 514 KB
- Volume
- 39
- Category
- Article
- ISSN
- 0098-6569
No coin nor oath required. For personal study only.
✦ Synopsis
For calculation of fractional flow reserve (FFR), simultaneous registration of both aortic pressure (P. ) and transstenotic distal coronary pressure (Pd) is necessary at steady-state maximum coronary hyperemia. The aim of the present study was to compare the maximum transstenotic gradient (APmax) and pressurederived myocardial fractional flow reserve (FFR,,,), observed during intravenous adenosine infusion, to APmax and F F R , , induced by intracoronary papaverine, which is considered to be the gold standard for induction of coronary hyperemia, but acts too short for steady-state hyperemic pressure recordings and is associated with QT-prolongation.
in 24 patients with coronary stenoses of various degrees, Pa and Pd were measured simultaneously by the diagnostic catheter and a high fidelity 0.018" flberoptic pressure monitoring guide wire, respectively. Excellent steady-state phasic intracoronary pressure recordings were obtained in ail patients within 1 min after start of intravenous adenosine infusion at a rate of 140 pglkglmin, and compared to APmax obtained 30 sec after intracoronary administration of papaverine (12 mg LCA, 10 mg RCA).
APmax was 24 2 15 mmHg during adenosine infusion and 24 f 15 mmHg after papaverine administration. Myocardial fractional flow reserve, calculated from these pressure recordings, was 0.75 f 0.16 and 0.75 0.15, respectively, with an individual difference of 0.02 2 0.01 between both values (r = 0.99). No important side effects by intravenous infusion of adenosine were observed.
Thus intravenous adenosine infusion at a rate of 140 pglkglmin is an excellent and safe alternative for induction of steady-state maximum coronary hyperemla and therefore is an ideal vasodliator for determination of fractional flow reserve based upon pressure recordings.