Stanojevic Dusan, Gunasekaran Prasad, Tadros Peter, Wiley Mark, Earnest Matthew, Mehta Ashwani, Lippmann Matthew, Levine Micah, Dawn Buddhadeb, Gupta Kamal
Division of Cardiovascular Diseases, University of Kansas Medical Center, Mail Stop 3006, 3901 Rainbow Boulevard, Kansas City, KS 66160 USA.
J Invasive Cardiol. 2016 Sep;28(9):357-61. Epub 2016 Jun 15.
This study assessed the safety of intravenous adenosine infusion during fractional flow reserve (FFR) evaluation of intermediate coronary lesions in severe aortic stenosis (AS). In severe AS, the extent of underlying coronary artery disease (CAD) can be an important determinant for deciding between surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR). Hemodynamic assessment of coronary lesion severity using FFR may reduce the extent of revascularization needed and make TAVR more feasible in higher-risk patients (compared with coronary artery bypass surgery with SAVR).
We retrospectively analyzed the demographic, clinical, and hemodynamic parameters of 72 patients with severe AS who underwent FFR procedure with intravenous adenosine infusion for hemodynamic assessment of intermediate coronary artery lesions. Severe AS patients were elderly, predominantly male, and had a high prevalence of peripheral arterial disease, prior myocardial infarction, left ventricular hypertrophy, and chronic kidney disease. Mean aortic valve area in these patients was 0.71 ± 0.24 cm². No patient with severe AS required discontinuation of the adenosine and all patients tolerated the infusion well. We observed a statistically significant reduction in systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) during adenosine infusion compared with the baseline values. However, no clinically significant adverse events occurred.
In elderly patients with severe AS, adenosine infusion is safe and well tolerated during FFR evaluation of intermediate coronary lesions. There was a significantly greater drop in SBP, DBP, MAP, and HR with adenosine infusion as compared with baseline values. This, however, was not associated with clinically significant adverse events.
本研究评估了在严重主动脉瓣狭窄（AS）患者的中等程度冠状动脉病变的血流储备分数（FFR）评估过程中静脉输注腺苷的安全性。在严重AS患者中，潜在冠状动脉疾病（CAD）的程度可能是决定进行外科主动脉瓣置换术（SAVR）和经导管主动脉瓣置换术（TAVR）的重要决定因素。使用FFR对冠状动脉病变严重程度进行血流动力学评估可能会减少所需的血运重建范围，并使TAVR在高危患者中更可行（与SAVR联合冠状动脉搭桥手术相比）。
我们回顾性分析了72例严重AS患者的人口统计学、临床和血流动力学参数，这些患者接受了静脉输注腺苷的FFR程序，以对中等程度冠状动脉病变进行血流动力学评估。严重AS患者年龄较大，以男性为主，外周动脉疾病、既往心肌梗死、左心室肥厚和慢性肾脏病的患病率较高。这些患者的平均主动脉瓣面积为0.71±0.24cm²。没有严重AS患者需要停用腺苷，所有患者对输注耐受性良好。与基线值相比，我们观察到腺苷输注期间收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）和心率（HR）有统计学意义的降低。然而，没有发生具有临床意义的不良事件。
在患有严重AS的老年患者中，在中等程度冠状动脉病变的FFR评估期间，腺苷输注是安全的且耐受性良好。与基线值相比，腺苷输注导致SBP、DBP、MAP和HR有明显更大幅度的下降。然而，这与具有临床意义的不良事件无关。
