Parham Walter A, Bouhasin Andre, Ciaramita Jeffrey P, Khoukaz Souheil, Herrmann Steven C, Kern Morton J
J. Gerard Mudd Cardiac Catheterization Laboratory, St Louis University Health Sciences Center, St Louis, Mo, USA.
Circulation. 2004 Mar 16;109(10):1236-43. doi: 10.1161/01.CIR.0000118470.52908.D9. Epub 2004 Mar 1.
Sodium nitroprusside is one of several agents considered effective for treating the no-reflow phenomenon during acute coronary interventions. However, the coronary hyperemic dose responses and systemic hemodynamic effects of intracoronary nitroprusside have yet to be determined in humans. The purpose of this study was to compare the hyperemic and hemodynamic responses of intracoronary nitroprusside to intracoronary adenosine in patients during cardiac catheterization with angiographically normal anterior descending arteries.
In 21 patients, coronary blood flow velocity (0.014-inch Doppler flow wire), heart rate, and blood pressure were measured in unobstructed left anterior descending coronary arteries at rest, after intracoronary adenosine (30- to 50-microg boluses), and after 3 serial doses (0.3-, 0.6-, and 0.9-microg/kg boluses) of intracoronary nitroprusside. Coronary reserve was calculated as hyperemia/basal coronary flow velocity. In an additional 9 patients with intermediate stenoses (53+/-7%), 14 fractional flow reserve (FFR) measurements (using 0.014-inch pressure wire) were performed with both intracoronary adenosine and nitroprusside (0.6 microg/kg). Intracoronary nitroprusside produced equivalent coronary hyperemia with a longer duration ( approximately 25%) compared with intracoronary adenosine. Intracoronary nitroprusside (0.9 microg/kg) decreased systolic blood pressure by <20%, with minimal change in heart rate, whereas intracoronary adenosine had no effect on these parameters. FFR measurements with intracoronary nitroprusside were identical to those obtained with intracoronary adenosine (r=0.97).
Compared with adenosine, intracoronary nitroprusside produces an equivalent but more prolonged coronary hyperemic response in normal coronary arteries. Intracoronary nitroprusside, in doses commonly used for the treatment of the no-reflow phenomenon, can produce sustained coronary hyperemia without detrimental systemic hemodynamics. On the basis of FFR measurements compared with adenosine, sodium nitroprusside also appears to be a suitable hyperemic stimulus for coronary physiological measurements.
硝普钠是几种被认为对治疗急性冠状动脉介入治疗期间的无复流现象有效的药物之一。然而，冠状动脉内硝普钠的冠状动脉充血剂量反应和全身血流动力学效应在人体中尚未确定。本研究的目的是比较冠状动脉造影显示前降支正常的患者在心脏导管检查期间冠状动脉内硝普钠与冠状动脉内腺苷的充血和血流动力学反应。
在21例患者中，于静息状态下、冠状动脉内注射腺苷（30至50微克推注）后以及冠状动脉内注射3次连续剂量（0.3、0.6和0.9微克/千克推注）的硝普钠后，使用0.014英寸多普勒血流导线测量无阻塞的左前降支冠状动脉中的冠状动脉血流速度、心率和血压。冠状动脉储备以充血期/基础冠状动脉血流速度计算。在另外9例中度狭窄（53±7%）的患者中，使用冠状动脉内腺苷和硝普钠（0.6微克/千克）进行了14次血流储备分数（FFR）测量（使用0.014英寸压力导丝）。与冠状动脉内腺苷相比，冠状动脉内硝普钠产生的冠状动脉充血相当，但持续时间更长（约25%）。冠状动脉内硝普钠（0.9微克/千克）使收缩压降低<20%，心率变化最小，而冠状动脉内腺苷对这些参数无影响。冠状动脉内硝普钠的FFR测量结果与冠状动脉内腺苷的测量结果相同（r = 0.97）。
与腺苷相比，冠状动脉内硝普钠在正常冠状动脉中产生等效但更持久的冠状动脉充血反应。用于治疗无复流现象的常用剂量的冠状动脉内硝普钠可产生持续的冠状动脉充血，而不会对全身血流动力学产生不利影响。基于与腺苷相比的FFR测量结果，硝普钠似乎也是用于冠状动脉生理测量的合适充血刺激剂。
