title: Effects of intracoronary sodium nitroprusside compared with adenosine on fractional flow reserve measurement.
abstract: The purpose of this study was to compare the efficacy and safety of intracoronary (IC) sodium nitroprusside (SNP) and IC adenosine (AD) for fractional flow reserve (FFR) measurement. We compared the FFR response and side effect profiles of IC AD and IC SNP in 40 patients with a combined total of 53 moderate coronary stenoses. Boluses of AD at doses of 40 μg (A1) and 60 μg (A2), and SNP at doses of 0.3 μg/kg (S1), 0.6 μg/kg (S2), and 0.9 μg/kg (S3) were used to achieve coronary hyperemia. The mean FFR value decreased significantly by 7.96% (A1), 10.51% (A2), 8.74% (S1), 10.58% (S2), and 10.73% (S3) compared with the baseline distal coronary pressure/aortic pressure. IC SNP delayed the mean time to peak value of FFR by 87.5%, 79.0%, and 88.6% in S1, S2, and S3, respectively, compared with A2 (P<.001). The mean duration of the plateau phase was longer in S1 (50.47 ± 14.25 s), S2 (51.33 ± 16.41 s) and S3 (57.60 ± 18.07 s) compared with A2 (27.93 ± 11.90 s; P<.01). IC AD caused shortness of breath in 11 patients (27.5%), flushing in 4 patients (10%), headache in 8 patients (20%), and transient second-degree atrioventricular block (AVB) in 6 patients (15%). IC SNP may be used as a hyperemic agent in FFR measurements. It may be preferable to IC AD as a routine clinical stimulus and has the additional advantage of showing a longer plateau phase.
authors.affiliation: Department of Cardiology, Cardiovascular Research Institute of People's Liberation Army, Shenyang Northern Hospital, Shenyang, Liaoning 110016, China. Hanyl@medmail.com.cn.
authors.forename: Xiaozeng
authors.initials: X
authors.lastname: Wang
authors.forename: Shaosheng
authors.initials: S
authors.lastname: Li
authors.forename: Xin
authors.initials: X
authors.lastname: Zhao
authors.forename: Jie
authors.initials: J
authors.lastname: Deng
authors.forename: Yaling
authors.initials: Y
authors.lastname: Han
mesh_terms: D000241:Adenosine / Q000008:administration & dosage / Q000009:adverse effects; D000328:Adult; D000368:Aged; D017023:Coronary Angiography / Q000379:methods; D023921:Coronary Stenosis / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D004417:Dyspnea / Q000139:chemically induced / Q000453:epidemiology; D005483:Flushing / Q000139:chemically induced / Q000453:epidemiology; D053805:Fractional Flow Reserve, Myocardial / Q000502:physiology*; D006261:Headache / Q000139:chemically induced / Q000453:epidemiology; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006940:Hyperemia / Q000503:physiopathology; D015994:Incidence; D007269:Injections, Intra-Arterial; D008875:Middle Aged; D009599:Nitroprusside / Q000008:administration & dosage / Q000009:adverse effects; D012720:Severity of Illness Index
chemical_list: D009599:Nitroprusside; D000241:Adenosine