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Hemodynamic response to intravenous adenosine and its effect on fractional flow reserve assessment: results of the Adenosine for the Functional Evaluation of Coronary Stenosis Severity (AFFECTS) study.

AbstractBACKGROUND:
We studied the hemodynamic response to intravenous adenosine on calculation of fractional flow reserve (FFR). Intravenous adenosine is widely used to achieve conditions of stable hyperemia for measurement of FFR. However, intravenous adenosine affects both systemic and coronary vascular beds differentially.
METHODS AND RESULTS:
A total of 283 patients (310 coronary stenoses) underwent coronary angiography with FFR using intravenous adenosine 140 mcg/kg per minute via a central femoral vein. Offline analysis was performed to calculate aortic (Pa), distal intracoronary (Pd), and reservoir (Pr) pressure at baseline, peak, and stable hyperemia. Seven different hemodynamic patterns were observed according to Pa and Pd change at peak and stable hyperemia. The average time from baseline to stable hyperemia was 68.2±38.5 seconds, when both ΔPa and ΔPd were decreased (ΔPa, -10.2±10.5 mm Hg; ΔPd, -18.2±10.8 mm Hg; P<0.001 for both). The fall in Pa closely correlated with the reduction in peripheral Pr (ΔPr, -12.9±15.7 mm Hg; P<0.001; r=0.9; P<0.001). ΔPa and ΔPd were closely related under conditions of peak (r=0.75; P<0.001) and stable hyperemia (r=0.83; P<0.001). On average, 56% (10.2 mm Hg) of the reduction in Pd was because of fall in Pa. FFR lesion classification changed in 9% using an FFR threshold of ≤0.80 and 5.2% with FFR threshold <0.75 when comparing Pd/Pa at peak and stable hyperemia.
CONCLUSIONS:
Intravenous adenosine results in variable changes in systemic blood pressure, which can lead to alterations in FFR lesion classification. Attention is required to ensure FFR is measured under conditions of stable hyperemia, although the FFR value at this point may be numerically higher.
AuthorsJason M Tarkin, Sukhjinder Nijjer, Sayan Sen, Ricardo Petraco, Mauro Echavarria-Pinto, Kaleab N Asress, Tim Lockie, Muhammed Z Khawaja, Jamil Mayet, Alun D Hughes, Iqbal S Malik, Ghada W Mikhail, Christopher S Baker, Rodney A Foale, Simon Redwood, Darrel P Francis, Javier Escaned, Justin E Davies
JournalCirculation. Cardiovascular interventions (Circ Cardiovasc Interv) Vol. 6 Issue 6 Pg. 654-61 (Dec 2013) ISSN: 1941-7632 [Electronic] United States
PMID24254709 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
Chemical References
  • Adenosine
Topics
  • Adenosine (administration & dosage, pharmacology)
  • Administration, Intravenous
  • Aged
  • Aorta (drug effects, physiology)
  • Blood Pressure (drug effects, physiology)
  • Coronary Angiography
  • Coronary Stenosis (diagnostic imaging, physiopathology)
  • Coronary Vessels (diagnostic imaging, drug effects, physiology)
  • Female
  • Fractional Flow Reserve, Myocardial (drug effects, physiology)
  • Hemodynamics (drug effects, physiology)
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Severity of Illness Index

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