title: 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.
abstract: 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.
  
  
  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 68.2±38.5 seconds, when both ΔPa and ΔPd were decreased (ΔPa, -10.2±10.5 mm Hg; ΔPd, -18.2±10.8 mm Hg; P<0.001 for both). The fall in Pa closely correlated with the reduction in peripheral Pr (ΔPr, -12.9±15.7 mm Hg; P<0.001; r=0.9; P<0.001). ΔPa and ΔPd were closely related under conditions of peak (r=0.75; P<0.001) and stable hyperemia (r=0.83; P<0.001). On average, 56% (10.2 mm Hg) of the reduction in Pd was because of fall in Pa. FFR lesion classification changed in 9% using an FFR threshold of ≤0.80 and 5.2% with FFR threshold <0.75 when comparing Pd/Pa at peak and stable hyperemia.
  
  
  CONCLUSIONS
  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.
authors.affiliation: From the International Centre for Circulatory Health, National Heart and Lung Institute, NIHR Imperial College Biomedical Research Centre, and Imperial College NHS Trust, London, United Kingdom (J.M.T., S.N., S.S., R.P., J.M., A.D.H., I.S.M., G.W.M., C.S.B., R.A.F., D.P.F., J.E.D.); King's College London BHF Centre of Research Excellence and the NIHR Biomedical Research Centre at Guy's and St Thomas' Hospital NHS Foundation Trust, the Rayne Institute, St Thomas' Hospital, London, United Kingdom (K.N.A., T.L., M.Z.K., S.R.); and Cardiovascular Institute, Hospital Clinico San Carlos, Madrid, Spain (M.E.-P., J.E.).
authors.forename: Jason M
authors.initials: JM
authors.lastname: Tarkin
authors.forename: Sukhjinder
authors.initials: S
authors.lastname: Nijjer
authors.forename: Sayan
authors.initials: S
authors.lastname: Sen
authors.forename: Ricardo
authors.initials: R
authors.lastname: Petraco
authors.forename: Mauro
authors.initials: M
authors.lastname: Echavarria-Pinto
authors.forename: Kaleab N
authors.initials: KN
authors.lastname: Asress
authors.forename: Tim
authors.initials: T
authors.lastname: Lockie
authors.forename: Muhammed Z
authors.initials: MZ
authors.lastname: Khawaja
authors.forename: Jamil
authors.initials: J
authors.lastname: Mayet
authors.forename: Alun D
authors.initials: AD
authors.lastname: Hughes
authors.forename: Iqbal S
authors.initials: IS
authors.lastname: Malik
authors.forename: Ghada W
authors.initials: GW
authors.lastname: Mikhail
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Baker
authors.forename: Rodney A
authors.initials: RA
authors.lastname: Foale
authors.forename: Simon
authors.initials: S
authors.lastname: Redwood
authors.forename: Darrel P
authors.initials: DP
authors.lastname: Francis
authors.forename: Javier
authors.initials: J
authors.lastname: Escaned
authors.forename: Justin E
authors.initials: JE
authors.lastname: Davies
mesh_terms: D000241:Adenosine / Q000008:administration & dosage* / Q000494:pharmacology*; D061605:Administration, Intravenous; D000368:Aged; D001011:Aorta / Q000187:drug effects / Q000502:physiology; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000187:drug effects / Q000502:physiology; D005260:Female; D053805:Fractional Flow Reserve, Myocardial / Q000187:drug effects* / Q000502:physiology; D006439:Hemodynamics / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index
chemical_list: D000241:Adenosine
keywords: adenosine; angiography; blood pressure; coronary disease; fractional flow reserve, myocardial; hemodynamics