Hemodynamic Response to Intravenous Adenosine and Its Effect on Fractional Flow Reserve Assessment: Results of the Adenosine for the Functional Evaluation of Coronary Stenosis Severity (AFFECTS) Study

TY - JOUR

T1 - Hemodynamic Response to Intravenous Adenosine and Its Effect on Fractional Flow Reserve Assessment

T2 - Results of the Adenosine for the Functional Evaluation of Coronary Stenosis Severity (AFFECTS) Study

AU - Tarkin, Jason M.

AU - Nijjer, Sukhjinder

AU - Sen, Sayan

AU - Petraco, Ricardo

AU - Echavarria-Pinto, Mauro

AU - Asress, Kaleab N.

AU - Lockie, Tim

AU - Khawaja, Muhammed Z.

AU - Mayet, Jamil

AU - Hughes, Alun D.

AU - Malik, Iqbal S.

AU - Mikhail, Ghada W.

AU - Baker, Christopher S.

AU - Foale, Rodney A.

AU - Redwood, Simon

AU - Francis, Darrel P.

AU - Escaned, Javier

AU - Davies, Justin E.

PY - 2013/12

Y1 - 2013/12

N2 - Background - We studied the hemodynamic response to intravenous adenosine on calculation of fractional flow reserve (FFR). Intravenous adenosine is widely used to achieve conditions of stable hyperemia for measurement of FFR. However, intravenous adenosine affects both systemic and coronary vascular beds differentially.Methods and Results - A total of 283 patients (310 coronary stenoses) underwent coronary angiography with FFR using intravenous adenosine 140 mcg/kg per minute via a central femoral vein. Offline analysis was performed to calculate aortic (Pa), distal intracoronary (Pd), and reservoir (Pr) pressure at baseline, peak, and stable hyperemia. Seven different hemodynamic patterns were observed according to Pa and Pd change at peak and stable hyperemia. The average time from baseline to stable hyperemia was 68.238.5 seconds, when both Pa and Pd were decreased (Pa, -10.2 +/- 10.5 mmHg; Pd, -18.2 +/- 10.8 mmHg; PConclusions - Intravenous adenosine results in variable changes in systemic blood pressure, which can lead to alterations in FFR lesion classification. Attention is required to ensure FFR is measured under conditions of stable hyperemia, although the FFR value at this point may be numerically higher.

AB - Background - We studied the hemodynamic response to intravenous adenosine on calculation of fractional flow reserve (FFR). Intravenous adenosine is widely used to achieve conditions of stable hyperemia for measurement of FFR. However, intravenous adenosine affects both systemic and coronary vascular beds differentially.Methods and Results - A total of 283 patients (310 coronary stenoses) underwent coronary angiography with FFR using intravenous adenosine 140 mcg/kg per minute via a central femoral vein. Offline analysis was performed to calculate aortic (Pa), distal intracoronary (Pd), and reservoir (Pr) pressure at baseline, peak, and stable hyperemia. Seven different hemodynamic patterns were observed according to Pa and Pd change at peak and stable hyperemia. The average time from baseline to stable hyperemia was 68.238.5 seconds, when both Pa and Pd were decreased (Pa, -10.2 +/- 10.5 mmHg; Pd, -18.2 +/- 10.8 mmHg; PConclusions - Intravenous adenosine results in variable changes in systemic blood pressure, which can lead to alterations in FFR lesion classification. Attention is required to ensure FFR is measured under conditions of stable hyperemia, although the FFR value at this point may be numerically higher.

KW - adenosine

KW - angiography

KW - blood pressure

KW - coronary disease

KW - fractional flow reserve

KW - myocardial

KW - hemodynamics

KW - INTERVENTION

KW - INTRACORONARY

KW - ANGIOGRAPHY

KW - PAPAVERINE

U2 - 10.1161/CIRCINTERVENTIONS.113.000591

DO - 10.1161/CIRCINTERVENTIONS.113.000591

M3 - Article

SN - 1941-7640

VL - 6

SP - 654

EP - 661

JO - Circulation-Cardiovascular Interventions

JF - Circulation-Cardiovascular Interventions

IS - 6

ER -