Legutko Jacek, Kleczyński Paweł, Dziewierz Artur, Rzeszutko Lukasz, Dudek Dariusz
Institute of Cardiology, Jagiellonian University, Krakow, Poland.
Postepy Kardiol Interwencyjnej. 2019;15(1):52-58. doi: 10.5114/aic.2019.83652. Epub 2019 Mar 27.
Intravenous infusion of adenosine via the femoral vein is commonly used to achieve maximum hyperemia for fractional flow reserve (FFR) assessment in the catheterization laboratory. In the era of transradial access for coronary interventions, obtaining additional venous access with sheath insertion in the groin is unpractical and may be associated with a higher risk of bleeding complications. In a vast majority of cases, patients scheduled for the catheterization laboratory are already equipped with peripheral vein access in antecubital fossa vein. However, only limited data exist to support non-central vein infusion of adenosine instead of the femoral vein for FFR assessment.
To compare infusion of adenosine via a central versus a peripheral vein for the assessment of peak FFR.
We enrolled 50 consecutive patients with 125 borderline coronary lesions that were assessed by FFR using adenosine femoral and antecubital vein infusion of 140 µg/kg/min.
Physiological severity assessed with femoral vein adenosine infusion at 140 µg/kg/min was mean 0.82 ±0.09, and with antecubital vein adenosine infusion at 140 µg/kg/min was 0.82 ±0.09. The mean time from initiation of adenosine infusion to maximal stable hyperemia was significantly shorter for 140 µg/kg/min femoral vein infusion as compared to antecubital vein infusion (49 ±19 s vs. 68 ±23 s; < 0.001). There was a strong correlation between FFR values obtained from 140 µg/kg/min femoral and antecubital vein infusion ( = 0.99; < 0.001).
Antecubital vein adenosine infusion achieved FFR values are very similar to those obtained using femoral vein adenosine administration. However, time to maximal hyperemia is longer with infusion via the antecubital vein.
在导管实验室中，经股静脉静脉输注腺苷通常用于实现最大充血状态，以进行血流储备分数（FFR）评估。在冠状动脉介入治疗采用经桡动脉途径的时代，在腹股沟处插入鞘管以获得额外的静脉通路并不实际，且可能与更高的出血并发症风险相关。在绝大多数情况下，计划进行导管实验室检查的患者已经在前臂肘窝静脉建立了外周静脉通路。然而，仅有有限的数据支持在FFR评估中使用非中心静脉输注腺苷替代股静脉输注。
比较经中心静脉与外周静脉输注腺苷对FFR峰值的评估效果。
我们连续纳入了50例患者，这些患者共有125处临界冠状动脉病变，通过经股静脉和前臂肘窝静脉以140μg/kg/min的速度输注腺苷来进行FFR评估。
以140μg/kg/min的速度经股静脉输注腺苷时评估的生理严重程度平均为0.82±0.09，以140μg/kg/min的速度经前臂肘窝静脉输注腺苷时为0.82±0.09。与经前臂肘窝静脉输注相比，140μg/kg/min的股静脉输注从开始输注腺苷到达到最大稳定充血状态的平均时间显著更短（49±19秒对68±23秒；P<0.001）。从140μg/kg/min的股静脉和前臂肘窝静脉输注获得的FFR值之间存在很强的相关性（r = 0.99；P<0.001）。
经前臂肘窝静脉输注腺苷获得的FFR值与经股静脉输注腺苷获得的值非常相似。然而，通过前臂肘窝静脉输注达到最大充血的时间更长。
