Rzeczuch Krzysztof, Jankowska Ewa, Kaczmarek Agnieszka, Telichowski Artur, Porada Adam, Banasiak Waldemar, Ponikowski Piotr
Department of Cardiology, 4th Military Clinical Hospital, Wrocław, Poland.
Kardiol Pol. 2003 Apr;58(4):269-74.
Induction of maximal hyperaemia is a prerequisite for a reliable estimation of fractional flow reserve (FFR) in a moderate coronary artery stenosis. Intracoronary adenosine is the most frequently used agent to achieve maximal hyperaemia. However, an insufficient dose of adenosine may induce only partial hyperaemia, thus artificially increasing the FFR values.
To assess the tolerability and effects on FFR value of increased doses of adenosine.
FFR was measured in 36 patients with 53 moderate coronary lesions. In order to induce maximal hyperaemia and assess FFR in the targeted coronary artery, intracoronary adenosine in a dose of 30 micro g was administered twice (FFR30). Next, 60 micro g of adenosine was tested twice (FFR60). In addition, in some patients with left coronary artery stenosis, 90 micro g of adenosine was also injected (FFR90).
No significant side effects were noted except a transient, self-terminating episode of a second degree atrio-ventricular block in one patient. The mean value of FFR30 was significantly higher than FFR60 (0.854+/-0.152 vs 0.836+/-0.162, p<0.001), and the mean difference between these two measurements was 0.018+/-0.036. In 29 (54.7%) evaluated lesions, FFR30 values were higher than FFR60; in 12 (22.6%) measurements the difference exceeded 0.02, and in 8 (15%) cases - 0.05. The use of 90 micro g of adenosine did not further decrease FFR in any of the cases.
An increase of the adenosine dose from 30 micro g to 60 micro g was well tolerated and caused further decrease in the FFR values which may be of clinical importance in some patients. The use of 90 micro g of adenosine did not further decrease FFR.
诱导最大充血是可靠评估中度冠状动脉狭窄时血流储备分数（FFR）的前提条件。冠状动脉内注射腺苷是实现最大充血最常用的药物。然而，腺苷剂量不足可能仅诱导部分充血，从而人为地提高FFR值。
评估增加腺苷剂量后的耐受性及其对FFR值的影响。
对36例患者的53处中度冠状动脉病变进行FFR测量。为了诱导最大充血并评估目标冠状动脉的FFR，冠状动脉内注射30μg腺苷两次（FFR30）。接下来，对60μg腺苷进行两次测试（FFR60）。此外，在一些左冠状动脉狭窄患者中，还注射了90μg腺苷（FFR90）。
除1例患者出现一度房室传导阻滞的短暂、自行终止发作外，未观察到明显副作用。FFR30的平均值显著高于FFR60（0.854±0.152对0.836±0.162，p<0.001），这两次测量的平均差值为0.018±0.036。在29处（54.7%）评估病变中，FFR30值高于FFR60；在12次（22.6%）测量中，差值超过0.02，在8例（15%）中超过0.05。在任何病例中，使用90μg腺苷均未进一步降低FFR。
将腺苷剂量从30μg增加到60μg耐受性良好，并导致FFR值进一步降低，这在一些患者中可能具有临床意义。使用90μg腺苷未进一步降低FFR。
