Comparison of hyperemic efficacy between central and peripheral venous adenosine infusion for fractional flow reserve measurement.
BACKGROUND
Maximal hyperemia is a prerequisite for the accurate measurement of fractional flow reserve (FFR). Although continuous infusion of adenosine via the femoral vein is considered to be the gold standard, this requires an additional invasive procedure for femoral vein access and is difficult to use during transradial coronary catheterization. We performed this prospective study to evaluate the feasibility and efficacy of peripheral intravenous infusion of adenosine for FFR measurement.


RESULTS
Seventy-one patients were prospectively enrolled, and FFR was measured using a 0.014-inch coronary pressure wire. Hyperemic efficacy of adenosine was compared among intracoronary bolus injection and continuous IV infusion (140 μg/min/kg) via the femoral and via the forearm vein. In 20 patients, hyperemic mean transit time and index of microcirculatory resistance were also measured. Mean FFR after bolus administration of adenosine was 0.81±0.10. As compared with femoral vein infusion (FFR: 0.80±0.10), hyperemic efficacy of forearm vein infusion of adenosine (FFR: 0.80±0.11) was not inferior (P for noninferiority=0.01). The number of functionally significant stenoses (FFR <0.75) was also not different between the 2 methods (femoral vein versus forearm vein; 17 (25.0%) versus 17 (25.0%), P=1.0). Both hyperemic mean transit time and index of microcirculatory resistance were not different between the 2 routes of adenosine infusion. Additional bolus injection of adenosine during IV infusion did not improve the hyperemic efficacy but increased the risk of atrioventricular block.


CONCLUSIONS
This study suggests that continuous intravenous infusion of adenosine via the forearm vein is a convenient and effective way to induce steady-state hyperemia for invasive physiological measurements.


BACKGROUND
URL: http://www.clinicaltrials.gov. Unique identifier: NCT01070420.
Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea.
Myung-Ki
MK
Seo
Bon-Kwon
BK
Koo
Ji-Hyun
JH
Kim
Dong-Ho
DH
Shin
Han-Mo
HM
Yang
Kyung-Woo
KW
Park
Hae-Young
HY
Lee
Hyun-Jae
HJ
Kang
Hyo-Soo
HS
Kim
Byung-Hee
BH
Oh
Young-Bae
YB
Park
D000241:Adenosine / Q000008:administration & dosage* / Q000009:adverse effects; D000368:Aged; D000704:Analysis of Variance; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D005240:Feasibility Studies; D005260:Female; D005268:Femoral Vein; D005542:Forearm / Q000098:blood supply; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D006940:Hyperemia / Q000503:physiopathology*; D007262:Infusions, Intravenous; D007269:Injections, Intra-Arterial; D016014:Linear Models; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D056910:Republic of Korea; D012720:Severity of Illness Index; D014655:Vascular Resistance; D014665:Vasodilator Agents / Q000008:administration & dosage* / Q000009:adverse effects
D014665:Vasodilator Agents; D000241:Adenosine