Schlundt Christian, Bietau Christian, Klinghammer Lutz, Wiedemann Ricarda, Rittger Harald, Ludwig Josef, Achenbach Stephan
From the Department of Internal Medicine 2-Cardiology and Angiology, University Hospital Erlangen, Erlangen, Germany.
Circ Cardiovasc Interv. 2015 May;8(5). doi: 10.1161/CIRCINTERVENTIONS.114.001781.
Measurement of fractional flow reserve (FFR) constitutes the current gold standard to evaluate the hemodynamic significance of coronary stenoses. Limited data validate the intracoronary application of adenosine against standard intravenous infusion. We systematically compared FFR measurements during intracoronary and intravenous application of adenosine about agreement and reproducibility.
We included 114 patients with an intermediate degree of stenosis in coronary angiography. Two FFR measurements were performed during intracoronary bolus injection (40 μg for the right and 80 μg for the left coronary artery, FFRic), and 2 FFR measurements during continuous intravenous infusion of adenosine (140 μg/kg per minute, FFRiv). FFR value, the time to reach FFR and patient discomfort (on a subjective scale from 0 for no symptoms to 5 for maximal discomfort) were recorded for each measurement. Mean time to FFR was 100 ± 27 s for continuous intravenous infusion versus 23 ± 14 s for intracoronary bolus administration of adenosine (P < 0.001). Reported discomfort after intracoronary application was significantly lower compared with intravenous adenosine (subjective scale > 0 in 35.1% versus 87.7% of the patients; P < 0.001). Correlation between FFRiv and FFRic was extremely close (r = 0.99; P < 0.001) with no systematic bias in Bland-Altman analysis (bias 0.002 [confidence interval, -0.001 to 0.005]) and low intermethod variability (1.56%). Intramethod variability was not different between intravenous and intracoronary administration (1.47% versus 1.33%; P=0.5).
Intracoronary bolus injection of adenosine (40 μg for the right and 80 μg for the left coronary artery) yields identical FFR results compared with intravenous infusion (140 μg/kg per minute), while requiring less time and offering superior patient comfort.
血流储备分数（FFR）测量是目前评估冠状动脉狭窄血流动力学意义的金标准。仅有有限的数据验证了冠状动脉内应用腺苷与标准静脉输注相比的情况。我们系统地比较了冠状动脉内和静脉应用腺苷时FFR测量结果的一致性和可重复性。
我们纳入了114例冠状动脉造影显示为中度狭窄的患者。在冠状动脉内推注腺苷（右冠状动脉40μg，左冠状动脉80μg，FFRic）期间进行了两次FFR测量，在持续静脉输注腺苷（140μg/kg每分钟，FFRiv）期间进行了两次FFR测量。记录每次测量的FFR值、达到FFR的时间以及患者不适程度（主观评分从无症状的0分到极度不适的5分）。持续静脉输注腺苷时达到FFR的平均时间为100±27秒，而冠状动脉内推注腺苷时为23±14秒（P<0.001）。冠状动脉内应用腺苷后报告的不适程度明显低于静脉应用腺苷（患者主观评分>0分的比例分别为35.1%和87.7%；P<0.001）。FFRiv和FFRic之间的相关性非常紧密（r = 0.99；P<0.001），Bland-Altman分析中无系统偏差（偏差0.002[置信区间，-0.001至0.005]）且方法间变异性低（1.56%）。静脉和冠状动脉内给药的方法内变异性无差异（1.47%对1.33%；P = 0.5）。
冠状动脉内推注腺苷（右冠状动脉40μg，左冠状动脉80μg）与静脉输注（140μg/kg每分钟）产生的FFR结果相同，同时所需时间更短且患者舒适度更高。
