title: Effect of High (200 μg/kg per Minute) Adenosine Dose Infusion on Fractional Flow Reserve Variability.
abstract: Variations in distal coronary pressure (Pd)/aortic pressure (Pa) ratio during steady-state hyperemia with standard (140 μg/kg per minute) adenosine dose may hamper accurate fractional flow reserve assessment. This study investigated to what extent an increased adenosine dose can overcome Pd/Pa variation.
  
  
  
  In a prospective, single-arm study, out of 95 prospectively screened patients, 38 (40.0%) exhibited significant (≥0.05 difference of max Pd/Pa minus min Pd/Pa) variations in Pd/Pa from 15 s post Pd/Pa dip and until the end of a 3-minute adenosine (140 μg/kg per minute) infusion. Thirty patients agreed to participate in a post 5-minute repeat fractional flow reserve assessment using 200 μg/kg per minute 3-minute adenosine infusion. The study's co-primary end point of Pd/Pa coefficient of dispersion was lower for the high versus standard adenosine dose: 1.31 (1.13-2.72) versus 2.76 (2.38-5.60), P=0.002. The study's co-primary end point of ΔPd/Pa was also lower for the high versus standard adenosine dose: 0.065 (0.038-0.10) versus 0.08 (0.06-0.11), P=0.002. This difference was mainly driven by the lowering effect of the high adenosine dose on the maximum Pd/Pa compared to the standard dose: 0.84 (0.81-0.93) versus 0.90 (0.83-0.95), P=0.007, while minimum Pd/Pa remained unaffected. High adenosine dose was adequately tolerated by all patients, without requiring infusion discontinuation in any case.
  
  
  
  Pd/Pa variability is frequently observed during standard adenosine infusion and is significantly decreased following a high (200 μg/kg per minute) adenosine dose. This is achieved without a significant difference in the minimum Pd/Pa.
  
  
  
  URL: https://www.clinicaltrials.gov. Unique identifier: NCT02350439.
authors.affiliation: Department of Cardiology, Patras University Hospital, Rion Patras, Greece dalex@med.uoa.gr.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Alexopoulos
authors.affiliation: Department of Cardiology, Patras University Hospital, Rion Patras, Greece.
authors.forename: Ioanna
authors.initials: I
authors.lastname: Xanthopoulou
authors.affiliation: Department of Cardiology, Patras University Hospital, Rion Patras, Greece.
authors.forename: Grigorios
authors.initials: G
authors.lastname: Tsigkas
authors.affiliation: Department of Cardiology, Patras University Hospital, Rion Patras, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Koutsogiannis
authors.affiliation: Department of Cardiology, Patras University Hospital, Rion Patras, Greece.
authors.forename: Paraskevi
authors.initials: P
authors.lastname: Salata
authors.affiliation: Department of Cardiology, Patras University Hospital, Rion Patras, Greece.
authors.forename: Stylianos
authors.initials: S
authors.lastname: Armylagos
authors.affiliation: Department of Cardiology, Patras University Hospital, Rion Patras, Greece.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Moulias
authors.affiliation: Department of Cardiology, Patras University Hospital, Rion Patras, Greece.
authors.forename: Periklis
authors.initials: P
authors.lastname: Davlouros
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000503:physiopathology; D000241:Adenosine / Q000008:administration & dosage*; D000368:Aged; D062186:Arterial Pressure; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000503:physiopathology; D023921:Coronary Stenosis / Q000188:drug therapy* / Q000503:physiopathology; D003331:Coronary Vessels / Q000503:physiopathology; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin / Q000627:therapeutic use; D011446:Prospective Studies; D014665:Vasodilator Agents / Q000008:administration & dosage* / Q000627:therapeutic use
chemical_list: D014665:Vasodilator Agents; D005996:Nitroglycerin; D000241:Adenosine
keywords: adenosine; fractional flow reserve; hemodynamics