Khashaba Ahmed, Mortada Ayman, Omran Azza
Ain Shams University, Cardiology Department Cairo, Egypt.
Clin Med Insights Cardiol. 2014 Feb 12;8:17-21. doi: 10.4137/CMC.S11535. eCollection 2014.
Maximal hyperemia is the critical prerequisite for fractional flow reserve (FFR) assessment. Despite intravenous (IV) adenosine currently being the recommended approach, intracoronary (IC) administration of adenosine constitutes a valuable alternative in everyday practice. However, it is surprisingly unclear which IC strategy allows the achievement of FFR values that are comparable to IV adenosine.
This study sought to compare increasing doses of IC adenosine versus IV adenosine for FFR.
30 intermediate coronary stenoses undergoing FFR measurement were prospectively and consecutively enrolled. Hyperemia was sequentially induced by bolus of IC adenosine (ADN; 150 μg) followed by IV adenosine (IVADN) infusion over 3 minutes at dose of (140 μg/kg/min). FFR values, symptoms, and development of atrioventricular block were recorded.
150 μg doses of IC adenosine were well tolerated and associated with fewer symptoms than IV adenosine. Intracoronary adenosine doses induced a significant decrease of FFR compared with baseline levels (P < 0.01). Among the 6 patients with FFR values less than 0.80 identified by IVADN, 4 were correctly identified also by 150 μg bolus IC adenosine. Larger randomized studies with cross-over design are necessary to verify the results.
This small pilot study suggests that IC adenosine might be an alternative to IV adenosine. Larger randomized studies with a cross-over design are necessary.
最大充血是血流储备分数（FFR）评估的关键前提条件。尽管目前推荐静脉注射腺苷，但在日常实践中，冠状动脉内注射腺苷也是一种有价值的替代方法。然而，令人惊讶的是，目前尚不清楚哪种冠状动脉内注射策略能够获得与静脉注射腺苷相当的FFR值。
本研究旨在比较递增剂量的冠状动脉内注射腺苷与静脉注射腺苷用于FFR测定的效果。
前瞻性连续纳入30例接受FFR测量的中度冠状动脉狭窄患者。先通过冠状动脉内注射腺苷（ADN；150μg）推注诱导充血，随后在3分钟内以（140μg/kg/min）的剂量静脉输注腺苷（IVADN）。记录FFR值、症状及房室传导阻滞的发生情况。
150μg剂量的冠状动脉内注射腺苷耐受性良好，且与静脉注射腺苷相比症状更少。冠状动脉内注射腺苷剂量与基线水平相比，FFR显著降低（P<0.01）。在静脉注射腺苷确定的6例FFR值小于0.80的患者中，4例也被150μg推注的冠状动脉内注射腺苷正确识别。需要更大规模的交叉设计随机研究来验证结果。
这项小型初步研究表明，冠状动脉内注射腺苷可能是静脉注射腺苷的一种替代方法。需要更大规模的交叉设计随机研究。
