title: Assessment of increasing intravenous adenosine dose in fractional flow reserve.
abstract: Effects of increased adenosine dose in the assessment of fractional flow reserve (FFR) were studied in relation to FFR results, hemodynamic effects and patient discomfort. FFR require maximal hyperemia mediated by adenosine. Standard dose is 140 μg/kg/min administrated intravenously. Higher doses are commonly used in clinical practice, but an extensive comparison between standard intravenous dose and a high dose (220 μg/kg/min) has previously not been performed.
  
  
  
  Seventy-five patients undergoing FFR received standard dose adenosine, followed by high dose adenosine. FFR, mean arterial pressure (MAP) and heart rate (HR) were analyzed. Patient discomfort measured by Visual Analogue Scale (VAS) was assessed.
  
  
  
  No significant difference was found between the doses in FFR value (0.85 [0.79-0.90] vs 0.85 [0.79-0.89], p = 0.24). The two doses correlated well irrespective of lesion severity (r = 0.86, slope = 0.89, p = <0.001). There were no differences in MAP or HR. Patient discomfort was more pronounced using high dose adenosine (8.0 [5.0-9.0]) versus standard dose (5.0 [2.0-7.0]), p = <0.001.
  
  
  
  Increased dose adenosine does not improve hyperemia and is associated with increased patient discomfort. Our findings do not support the use of high dose adenosine.
  
  
  
  Retrospective Trial registration: Current Controlled Trials ISRCTN14618196 . Registered 15 December 2016.
authors.affiliation: Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden. David.Sparv@med.lu.se.|Department of Coronary Heart Disease, Skane University Hospital, Lund, Sweden. David.Sparv@med.lu.se.
authors.forename: David
authors.identifier: 0000-0002-6540-6090
authors.initials: D
authors.lastname: Sparv
authors.affiliation: Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.|Department of Coronary Heart Disease, Skane University Hospital, Lund, Sweden.
authors.forename: Matthias
authors.initials: M
authors.lastname: Götberg
authors.affiliation: Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.
authors.forename: Jan
authors.initials: J
authors.lastname: Harnek
authors.affiliation: Department of Coronary Heart Disease, Skane University Hospital, Lund, Sweden.
authors.forename: Tobias
authors.initials: T
authors.lastname: Persson
authors.affiliation: Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.
authors.forename: Bjarne
authors.initials: B
authors.lastname: Madsen Hardig
authors.affiliation: Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.|Department of Coronary Heart Disease, Skane University Hospital, Lund, Sweden.
authors.forename: David
authors.initials: D
authors.lastname: Erlinge
mesh_terms: D000241:Adenosine / Q000008:administration & dosage*; D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000503:physiopathology*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D053805:Fractional Flow Reserve, Myocardial / Q000187:drug effects*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D011446:Prospective Studies; D014664:Vasodilation / Q000187:drug effects / Q000502:physiology*; D014665:Vasodilator Agents / Q000008:administration & dosage
chemical_list: D014665:Vasodilator Agents; D000241:Adenosine
keywords: Adenosine; Coronary heart disease; Fractional flow reserve; Visual analogue scale