冠状动脉内腺苷评估血流储备分数与热稀释法检测微血管功能障碍的可行性及诊断效能的改善。
Feasibility and Improved Diagnostic Yield of Intracoronary Adenosine to Assess Microvascular Dysfunction With Bolus Thermodilution.
机构信息
Cardiology Department, Hospital Clínico San Carlos, IDISSC Universidad Complutense de Madrid Spain.
出版信息
J Am Heart Assoc. 2024 Nov 19;13(22):e035404. doi: 10.1161/JAHA.124.035404. Epub 2024 Nov 7.
BACKGROUND
Bolus thermodilution and intravenous adenosine are established methods for coronary microcirculatory assessment. Yet, its adoption remains low, partly due to procedural time and patient discomfort associated with intravenous adenosine. We investigated differences between intracoronary and intravenous adenosine using bolus thermodilution in terms of microcirculatory indices, procedural time, and side effects associated with adenosine in patients with myocardial ischemia and nonobstructive coronary arteries.
METHODS AND RESULTS
In this prospective, observational study, 102 patients with suspected myocardial ischemia and nonobstructive coronary arteries underwent measurements of mean transit time, coronary flow reserve, index of microcirculatory resistance, procedure time and patient tolerability with low-dose intracoronary adenosine, high-dose intracoronary adenosine (HDIC), and intravenous adenosine. HDIC induced greater hyperemia compared with low-dose intracoronary IC adenosine and intravenous adenosine with a shorter hyperemic mean transit time, <0.0001. Coronary flow reserve was higher and index of microcirculatory resistance lowest with HDIC, compared with low-dose intracoronary IC adenosine and intravenous adenosine, <0.05. Low coronary flow reserve was downgraded from 21% with intravenous adenosine to 10% with HDIC adenosine (=0.031); high index of microcirculatory resistance was downgraded from 23% with intravenous adenosine to 14% with HDIC (=0.098). Intracoronary adenosine was associated with lower procedural times (<0.0001). More patients experienced chest pain with intravenous adenosine (<0.01) and the chest pain intensity was higher compared with intracoronary adenosine (<0.0001).
CONCLUSIONS
In patients with suspected myocardial ischemia and nonobstructive coronary arteries undergoing coronary microcirculatory assessment with bolus thermodilution, the use of HDIC compared with intravenous adenosine was associated with enhanced induction of hyperemia. The use of intracoronary adenosine allowed for a shorter procedure time and was better tolerated.
REGISTRATION+: URL: clinicaltrials.gov; Unique Identifier: NCT04827498.
背景
弹丸式热稀释和静脉内腺苷已被确立为冠状动脉微循环评估的方法。然而，其应用仍然很低，部分原因是与静脉内腺苷相关的程序时间和患者不适。我们研究了冠状动脉内和静脉内腺苷在心肌缺血和非阻塞性冠状动脉患者中使用弹丸式热稀释时的微循环指数、程序时间和腺苷相关副作用的差异。
方法和结果
在这项前瞻性观察研究中，102 例疑似心肌缺血和非阻塞性冠状动脉患者接受了平均传输时间、冠状动脉血流储备、微血管阻力指数、程序时间和患者对低剂量冠状动脉内腺苷、高剂量冠状动脉内腺苷（HDIC）和静脉内腺苷的耐受性测量。HDIC 诱导的充血比低剂量冠状动脉内 IC 腺苷和静脉内腺苷更强，充血平均传输时间更短，<0.0001。与低剂量冠状动脉内 IC 腺苷和静脉内腺苷相比，HDIC 时冠状动脉血流储备更高，微血管阻力指数更低，<0.05。低冠状动脉血流储备从静脉内腺苷的 21%降级为 HDIC 腺苷的 10%（=0.031）；高微血管阻力指数从静脉内腺苷的 23%降级为 HDIC 的 14%（=0.098）。冠状动脉内腺苷与较短的程序时间相关（<0.0001）。更多的患者在静脉内腺苷时出现胸痛（<0.01），且胸痛强度高于冠状动脉内腺苷（<0.0001）。
结论
在接受弹丸式热稀释冠状动脉微循环评估的疑似心肌缺血和非阻塞性冠状动脉患者中，与静脉内腺苷相比，使用 HDIC 与增强充血诱导相关。冠状动脉内腺苷的使用允许更短的程序时间，且耐受性更好。
注册
URL：clinicaltrials.gov；独特标识符：NCT04827498。
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