title: Fractional Flow Reserve in the Transradial Era: Will Hand Vein Adenosine Infusion Suffice?: A Comparative Study of the Extent, Rapidity, and Stability of Hyperemia From Hand and Femoral Venous Routes of Adenosine Administration.
abstract: OBJECTIVE
  The aim of this study was to assess adenosine infusion via a cannula in the back of the hand compared with central venous access to achieve peak hyperemia during fractional flow reserve (FFR).
  
  
  BACKGROUND
  Adenosine is often used to induce maximal hyperemia when measuring FFR. The gold standard is continuous infusion via a large central vein; however, the increasing use of the transradial route for angiography makes it desirable to have an alternative route for adenosine. Peripheral venous access is frequently obtained in the hand, but concern exists as to whether adenosine delivery from this site can achieve adequate vasodilation for accurate FFR measurement. Our aim was to address this.
  
  
  METHODS
  Subjects were selected from patients presenting for coronary angiography/intervention who required a pressure-wire study. Subjects received intravenous adenosine infusion sequentially via 2 routes: first, via a 20-gauge hand cannula, and then, after a washout period, via a 5- or 6-F femoral venous sheath. Adenosine was administered at 140 μg/kg/min from each site. Data interpretation was blinded. Minimal FFR achieved with intravenous adenosine from each infusion site was recorded as was the time to peak hyperemia.
  
  
  RESULTS
  Paired (hand and femoral adenosine) recordings taken from 84 vessels in 61 patients were suitable for blinded analysis. The mean FFR measured using adenosine administered via hand and femoral routes was 0.85 with an SD of 0.08 (intraclass correlation=0.986). Time to peak hyperemia was longer on average with hand-administered adenosine compared with femoral adenosine administration (63 s vs. 43 s; mean difference, 22 s with a 95% confidence interval: 18 s to 27 s; p<0.0001). Formal comparison of FFR stability using Mann-Whitney analysis (2 tailed) gives p=0.43, indicating no significant evidence of a difference in stability between the 2 routes.
  
  
  CONCLUSIONS
  Hand vein adenosine infusion produced FFR values very similar to those obtained using central femoral vein adenosine administration, with no systematic bias toward higher or lower reading from 1 site. This has important practical implications for radial access cases involving pressure-wire studies.
authors.affiliation: King's College Hospital, London, United Kingdom. Electronic address: peterscott75@hotmail.com.
authors.forename: Peter
authors.initials: P
authors.lastname: Scott
authors.affiliation: King's College Hospital, London, United Kingdom.
authors.forename: Alex
authors.initials: A
authors.lastname: Sirker
authors.affiliation: King's College Hospital, London, United Kingdom.
authors.forename: Rafal
authors.initials: R
authors.lastname: Dworakowski
authors.affiliation: University Hospital of North Staffordshire, North Staffordshire, United Kingdom.
authors.forename: Gideon
authors.initials: G
authors.lastname: Paul
authors.affiliation: King's College Hospital, London, United Kingdom.
authors.forename: Luciano
authors.initials: L
authors.lastname: Candilio
authors.affiliation: King's College Hospital, London, United Kingdom.
authors.forename: Nishat
authors.initials: N
authors.lastname: Jahagirdar
authors.affiliation: King's College Hospital, London, United Kingdom.
authors.forename: Narbeh
authors.initials: N
authors.lastname: Melikian
authors.affiliation: King's College Hospital, London, United Kingdom.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Byrne
mesh_terms: D000241:Adenosine / Q000008:administration & dosage*; D000368:Aged; D002406:Catheterization, Peripheral / Q000379:methods; D062905:Central Venous Catheters; D015331:Cohort Studies; D017023:Coronary Angiography / Q000379:methods; D003326:Coronary Circulation / Q000187:drug effects; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D005260:Female; D005268:Femoral Vein / Q000000981:diagnostic imaging; D053805:Fractional Flow Reserve, Myocardial / Q000187:drug effects*; D006225:Hand / Q000098:blood supply*; D006801:Humans; D006940:Hyperemia / Q000139:chemically induced* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage
chemical_list: D014665:Vasodilator Agents; D000241:Adenosine
keywords: FFR; access site; adenosine; coronary intervention; fractional flow reserve