Intracoronary and intravenous adenosine 5'-triphosphate, adenosine, papaverine, and contrast medium to assess fractional flow reserve in humans.
BACKGROUND
Inducing both maximal and steady-state coronary hyperemia is of clinical importance to take full advantage of fractional flow reserve measurements. The present study compares different dosages and routes of administration of adenosine 5'-triphosphate (ATP), adenosine, contrast medium, and papaverine regarding their potential to achieve both maximal and steady-state hyperemia.


RESULTS
In 21 patients with an isolated coronary stenosis, coronary vasodilation was induced successively by papaverine (20 mg intracoronary), adenosine (20 and 40 microg intracoronary), ATP (20 and 40 microg intracoronary), iohexol (6 mL intracoronary), adenosine or ATP through an antecubital vein (140 and 180 microg x kg(-1) x min(-1)), or adenosine or ATP through a femoral vein (140 and 180 microg x kg(-1) x min(-1)). Because vessel dimensions did not change, the ratio of distal coronary pressure (Pd) to aortic pressure (Pa) was used as an index of myocardial resistance. Pd/Pa was 0.77+/-0.21 at rest and decreased to 0.61+/-0.21 after papaverine. Pd/Pa decreased to a similar level with all other vasodilators, except with contrast medium (0.68+/-0.21; P<0.01 versus papaverine). Steady-state hyperemia could only be obtained by intracoronary papaverine and by intravenous ATP or adenosine. In another 23 patients, an intravenous infusion of ATP was varied from 0 to 280 microg x kg(-1) x min(-1). At doses >140 microg x kg(-1) x min(-1), there was neither a further decrease in Pd/Pa ratio nor a further increase in coronary flow velocities.


CONCLUSIONS
Provided sufficient dosages are used, ATP, adenosine, and papaverine (but not contrast medium) induce maximal hyperemia and are therefore suitable to assess fractional flow reserve. Only intracoronary papaverine and intravenous ATP or adenosine induce steady-state hyperemia enabling a pressure pullback maneuver that is useful in assessing diffuse coronary atherosclerosis.
De Bruyne
Bernard
B
Cardiovascular Center Aalst, Moorselbaan, 164 B-9300 Aalst, Belgium. bernard.de.bruyne@olvz-aalst.be
Pijls
Nico H J
NH
Barbato
Emanuele
E
Bartunek
Jozef
J
Bech
Jan-Willem
JW
Wijns
William
W
Heyndrickx
Guy R
GR
D000241:Adenosine / Q000008:administration & dosage / Q000494:pharmacology; D000255:Adenosine Triphosphate / Q000008:administration & dosage / Q000494:pharmacology; D003287:Contrast Media; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000187:drug effects*; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000000981:diagnostic imaging; D004305:Dose-Response Relationship, Drug; D004562:Electrocardiography; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006940:Hyperemia / Q000139:chemically induced; D007262:Infusions, Intravenous; D007472:Iohexol / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009206:Myocardium; D010208:Papaverine / Q000008:administration & dosage / Q000494:pharmacology; D014665:Vasodilator Agents / Q000008:administration & dosage* / Q000494:pharmacology
D003287:Contrast Media; D014665:Vasodilator Agents; D007472:Iohexol; D000255:Adenosine Triphosphate; D010208:Papaverine; D000241:Adenosine