Comparison of standard- and high-dose intracoronary adenosine for the measurement of coronary fractional flow reserve (FFR).
BACKGROUND
Measurement of fractional flow reserve (FFR) by intravenous infusion or intracoronary injection of adenosine is the reference method to determine the hemodynamic relevance of coronary artery stenoses. The goal of this prospective study was to compare standard (40 µg adenosine for the right and 80 µg for the left coronary artery) to high doses of intracoronary adenosine for FFR measurement.


RESULTS
In 130 intermediate coronary artery stenoses, two sequential FFR measurements were performed with standard-dose intracoronary application of adenosine (40 µg for the right and 80 μg for the left coronary artery), followed by one FFR measurement with a bolus of 200 μg for the right and 400 μg for the left coronary artery. There was strong correlation (r = 0.97, p < 0.001) between FFR values determined with standard-dose adenosine (0.86 ± 0.08) versus high-dose adenosine (0.85 ± 0.08). High-dose adenosine did not yield FFR values ≤0.80 or ≤0.75 significantly more frequently than standard-dose adenosine. Patients reported more discomfort after high-dose adenosine application compared to standard-dose adenosine (p < 0.001).


CONCLUSIONS
For FFR measurements with intracoronary adenosine injection, results achieved with doses of 40 µg adenosine for the right and 80 µg for the left coronary artery display no clinically relevant difference to doses of 200 and 400 µg, respectively.
Department of Cardiology, University of Erlangen, Ulmenweg 18, 91054, Erlangen, Germany. jens.roether@uk-erlangen.de.
Jens
J
Röther
Department of Cardiology, University of Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.
Stephan
S
Achenbach
Department of Cardiology, University of Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.
Monique
M
Tröbs
Department of Cardiology, University of Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.
Florian
F
Blachutzik
Department of Cardiology, University of Giessen, Giessen, Germany.
Holger
H
Nef
Department of Cardiology, University of Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.
Mohamed
M
Marwan
Department of Cardiology, University of Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.
Christian
C
Schlundt
D000241:Adenosine / Q000008:administration & dosage* / Q000009:adverse effects; D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000503:physiopathology; D003331:Coronary Vessels / Q000503:physiopathology*; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D005858:Germany; D006801:Humans; D007269:Injections, Intra-Arterial; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D014160:Transducers, Pressure; D014665:Vasodilator Agents / Q000008:administration & dosage* / Q000009:adverse effects
D014665:Vasodilator Agents; D000241:Adenosine
Coronary intervention; Fractional flow reserve; Intracoronary adenosine