title: Temporal dissociation between the minimal distal-to-aortic pressure ratio and peak hyperemia during intravenous adenosine infusion.
abstract: The present study sought to compare the temporal relation between maximal coronary flow (peak hyperemia) and minimal coronary-to-aortic pressure ratio (Pd/Pa) for intracoronary (IC) and intravenous (IV) adenosine administration. Peak hyperemia is assumed to coincide with the minimal Pd/Pavalue. However, this has not been confirmed for systemic hemodynamic variations during IV adenosine infusion. Hemodynamic responses to IV and IC adenosine administration were obtained in 12 patients (14 lesions) using combined IC pressure and flow velocity measurements. A fluid dynamic model was used to predict the change in Pd/Pafor different stenosis severities and varying PaHemodynamic variability during IV adenosine hyperemia was greater than during IC adenosine, as assessed by the coefficient of variation. During IV adenosine, flow velocity peaked 28 ± 4 (SE) s after the onset of hyperemia, while Pd/Pareached a minimum (0.82 ± 0.01) 22 ± 7 s later (P< 0.05), when Pahad declined by 6.1% and hyperemic velocity by 4.5% (P< 0.01). Model outcomes corroborated the role of variable Pain this dissociation. In contrast, maximal flow and minimal Pd/Pacoincided for IC adenosine, with IV-equivalent peak velocities and a higher Pd/Paratio (0.86 ± 0.01,P< 0.01). Hemodynamic variability during continuous IV adenosine infusion can lead to temporal dissociation of minimal Pd/Paand peak hyperemia, in contrast to IC adenosine injection, where maximal velocity and minimal Pd/Pacoincide. Despite this variability, stenosis hemodynamics remained stable with both ways of adenosine administration. Our findings suggest advantages of IC over IV adenosine to identify maximal hyperemia from pressure-only measurements.NEW & NOTEWORTHYSystemic hemodynamic variability during intravenous adenosine infusion produces substantial temporal dissociation between peak hyperemia appraised by coronary flow velocity and the minimal distal-to-aortic pressure ratio commonly used to determine functional stenosis severity. This dissociation was absent for intracoronary adenosine administration and tended to be mitigated in patients receiving Ca2+antagonists.
authors.affiliation: Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; and.
authors.forename: Lorena
authors.initials: L
authors.lastname: Casadonte
authors.affiliation: Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Koen M
authors.initials: KM
authors.lastname: Marques
authors.affiliation: Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; and.
authors.forename: Jos A E
authors.initials: JAE
authors.lastname: Spaan
authors.affiliation: Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; and m.siebes@amc.uva.nl.
authors.forename: Maria
authors.identifier: http://orcid.org/0000-0002-7034-5843
authors.initials: M
authors.lastname: Siebes
mesh_terms: D000241:Adenosine / Q000008:administration & dosage / Q000494:pharmacology*; D000368:Aged; D001011:Aorta; D062186:Arterial Pressure / Q000187:drug effects; D001794:Blood Pressure / Q000502:physiology*; D002317:Cardiovascular Agents / Q000008:administration & dosage / Q000494:pharmacology*; D015331:Cohort Studies; D003331:Coronary Vessels; D005260:Female; D053805:Fractional Flow Reserve, Myocardial / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006940:Hyperemia / Q000139:chemically induced* / Q000503:physiopathology*; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D002317:Cardiovascular Agents; D000241:Adenosine
keywords: adenosine; coronary artery disease; coronary blood flow; fractional flow reserve; hemodynamics