Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea.
Circ Cardiovasc Interv. 2012 Jun;5(3):401-5. doi: 10.1161/CIRCINTERVENTIONS.111.965392. Epub 2012 May 29.
Maximal hyperemia is a prerequisite for the accurate measurement of fractional flow reserve (FFR). Although continuous infusion of adenosine via the femoral vein is considered to be the gold standard, this requires an additional invasive procedure for femoral vein access and is difficult to use during transradial coronary catheterization. We performed this prospective study to evaluate the feasibility and efficacy of peripheral intravenous infusion of adenosine for FFR measurement.
Seventy-one patients were prospectively enrolled, and FFR was measured using a 0.014-inch coronary pressure wire. Hyperemic efficacy of adenosine was compared among intracoronary bolus injection and continuous IV infusion (140 μg/min/kg) via the femoral and via the forearm vein. In 20 patients, hyperemic mean transit time and index of microcirculatory resistance were also measured. Mean FFR after bolus administration of adenosine was 0.81±0.10. As compared with femoral vein infusion (FFR: 0.80±0.10), hyperemic efficacy of forearm vein infusion of adenosine (FFR: 0.80±0.11) was not inferior (P for noninferiority=0.01). The number of functionally significant stenoses (FFR <0.75) was also not different between the 2 methods (femoral vein versus forearm vein; 17 (25.0%) versus 17 (25.0%), P=1.0). Both hyperemic mean transit time and index of microcirculatory resistance were not different between the 2 routes of adenosine infusion. Additional bolus injection of adenosine during IV infusion did not improve the hyperemic efficacy but increased the risk of atrioventricular block.
This study suggests that continuous intravenous infusion of adenosine via the forearm vein is a convenient and effective way to induce steady-state hyperemia for invasive physiological measurements.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT01070420.
最大充血是测量血流储备分数（FFR）的前提条件。尽管通过股静脉持续输注腺苷被认为是金标准，但这需要进行额外的股静脉入路侵入性操作，并且在经桡动脉冠状动脉导管插入术中难以使用。我们进行了这项前瞻性研究，以评估通过外周静脉输注腺苷进行 FFR 测量的可行性和疗效。
71 例患者前瞻性入组，使用 0.014 英寸冠状动脉压力导丝测量 FFR。通过冠状动脉内推注和通过股静脉及前臂静脉以 140μg/min/kg 的速度持续静脉输注两种方式比较腺苷的充血效果。在 20 例患者中，还测量了充血平均通过时间和微循环阻力指数。腺苷推注后的平均 FFR 为 0.81±0.10。与股静脉输注相比（FFR：0.80±0.10），前臂静脉输注腺苷的充血效果（FFR：0.80±0.11）并不差（非劣效性 P=0.01）。两种方法的功能性显著狭窄数量（FFR<0.75）也无差异（股静脉与前臂静脉；17（25.0%）与 17（25.0%），P=1.0）。两种腺苷输注途径的充血平均通过时间和微循环阻力指数均无差异。在静脉输注期间进行额外的腺苷推注并不能改善充血效果，但会增加房室传导阻滞的风险。
这项研究表明，通过前臂静脉持续静脉输注腺苷是一种方便有效的诱导稳定充血状态进行有创生理测量的方法。
