Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy.
JACC Cardiovasc Interv. 2012 Apr;5(4):402-8. doi: 10.1016/j.jcin.2011.12.014.
This study sought to compare increasing doses of intracoronary (i.c.) adenosine or i.c. sodium nitroprusside versus intravenous (i.v.) adenosine for fractional flow reserve (FFR) assessment.
Maximal hyperemia is the critical prerequisite for FFR assessment. Despite i.v. adenosine currently representing the recommended approach, i.c. administration of adenosine or other coronary vasodilators constitutes a valuable alternative in everyday practice. However, it is surprisingly unclear which i.c. strategy allows the achievement of FFR values comparable to i.v. adenosine.
Fifty intermediate coronary stenoses (n = 45) undergoing FFR measurement were prospectively and consecutively enrolled. Hyperemia was sequentially induced by incremental boli of i.c. adenosine (ADN) (60 μg ADN60, 300 μg ADN300, 600 μg ADN600), by i.c. sodium nitroprusside (NTP) (0.6 μg/kg bolus) and by i.v. adenosine infusion (IVADN) (140 μg/kg/min). FFR values, symptoms, and development of atrioventricular block were recorded.
Incremental doses of i.c. adenosine and NTP were well tolerated and associated with fewer symptoms than IVADN. Intracoronary adenosine doses (0.881 ± 0.067, 0.871 ± 0.068, and 0.868 ± 0.070 with ADN60, ADN300, and ADN600, respectively) and NTP (0.892 ± 0.072) induced a significant decrease of FFR compared with baseline levels (p < 0.001). Notably, ADN600 only was associated with FFR values similar to IVADN (0.867 ± 0.072, p = 0.28). Among the 10 patients with FFR values ≤0.80 with IVADN, 5 were correctly identified also by ADN60, 6 by ADN300, 7 by ADN600, and 6 by NTP.
Intracoronary adenosine, at doses higher than currently suggested, allows obtaining FFR values similar to i.v. adenosine. Intravenous adenosine, which remains the gold standard, might thus be reserved for those lesions with equivocal FFR values after high (up to 600 μg) i.c. adenosine doses.
本研究旨在比较冠状动脉内（i.c.）腺苷或 i.c. 硝普钠与静脉内（i.v.）腺苷递增剂量在评估血流储备分数（FFR）方面的作用。
最大充血是评估 FFR 的关键前提。尽管静脉内腺苷目前被推荐为首选方法，但 i.c. 给予腺苷或其他冠状动脉扩张剂在日常实践中是一种有价值的替代方法。然而，令人惊讶的是，目前尚不清楚哪种 i.c. 策略可以实现与 i.v. 腺苷相当的 FFR 值。
前瞻性连续纳入 50 例接受 FFR 测量的中等程度冠状动脉狭窄患者（n=45）。通过递增剂量的 i.c. 腺苷（ADN）（60μg ADN60、300μg ADN300、600μg ADN600）、i.c. 硝普钠（NTP）（0.6μg/kg 推注）和 i.v. 腺苷输注（IVADN）（140μg/kg/min）依次诱导充血。记录 FFR 值、症状和房室传导阻滞的发生情况。
递增剂量的 i.c. 腺苷和 NTP 耐受良好，且与 IVADN 相比症状更少。与基线水平相比，冠状动脉内腺苷剂量（分别为 0.881±0.067、0.871±0.068 和 0.868±0.070 用 ADN60、ADN300 和 ADN600）和 NTP（0.892±0.072）显著降低了 FFR（p<0.001）。值得注意的是，仅 ADN600 与 IVADN 相关的 FFR 值相似（0.867±0.072，p=0.28）。在 10 例 FFR 值≤0.80 的 IVADN 患者中，5 例通过 ADN60 正确识别，6 例通过 ADN300 识别，7 例通过 ADN600 识别，6 例通过 NTP 识别。
高于目前建议剂量的冠状动脉内腺苷可获得与静脉内腺苷相似的 FFR 值。静脉内腺苷仍然是金标准，因此可以保留用于那些在高剂量（高达 600μg）i.c. 腺苷后 FFR 值存在疑问的病变。
