Abstract
BackgroundEffects of increased adenosine dose in the assessment of fractional flow reserve (FFR) were studied in relation to FFR results, hemodynamic effects and patient discomfort. FFR require maximal hyperemia mediated by adenosine. Standard dose is 140 μg/kg/min administrated intravenously. Higher doses are commonly used in clinical practice, but an extensive comparison between standard intravenous dose and a high dose (220 μg/kg/min) has previously not been performed.MethodsSeventy-five patients undergoing FFR received standard dose adenosine, followed by high dose adenosine. FFR, mean arterial pressure (MAP) and heart rate (HR) were analyzed. Patient discomfort measured by Visual Analogue Scale (VAS) was assessed.ResultsNo significant difference was found between the doses in FFR value (0.85 [0.79–0.90] vs 0.85 [0.79–0.89], p = 0.24). The two doses correlated well irrespective of lesion severity (r = 0.86, slope = 0.89, p = <0.001). There were no differences in MAP or HR. Patient discomfort was more pronounced using high dose adenosine (8.0 [5.0–9.0]) versus standard dose (5.0 [2.0–7.0]), p = <0.001.ConclusionsIncreased dose adenosine does not improve hyperemia and is associated with increased patient discomfort. Our findings do not support the use of high dose adenosine.Trial registrationRetrospective Trial registration: Current Controlled Trials ISRCTN14618196. Registered 15 December 2016.
Highlights
Effects of increased adenosine dose in the assessment of fractional flow reserve (FFR) were studied in relation to FFR results, hemodynamic effects and patient discomfort
The use of FFR-guidance in percutaneous coronary intervention (PCI) has been shown to identify which lesions that benefit from revascularization [2]
Patient admitted for coronary angiography were considered eligible for inclusion if the following criteria were fulfilled: Age ≥18 years, borderline-significant coronary stenosis [6] and signed informed consent prior to enrollment
Summary
Effects of increased adenosine dose in the assessment of fractional flow reserve (FFR) were studied in relation to FFR results, hemodynamic effects and patient discomfort. FFR require maximal hyperemia mediated by adenosine. Standard dose is 140 μg/kg/min administrated intravenously. Higher doses are commonly used in clinical practice, but an extensive comparison between standard intravenous dose and a high dose (220 μg/kg/min) has previously not been performed. Fractional Flow Reserve (FFR) is the most validated diagnostic method to determine physiologically significance of stenosis in the epicardial arteries [1,2,3,4]. FFR is defined as the ratio of pressure difference across a coronary lesion during hyperemia [5]. The use of FFR-guidance in percutaneous coronary intervention (PCI) has been shown to identify which lesions that benefit from revascularization [2]. The use of FFR in PCI reduces the need of repeat interventions, enhances quality of life and demonstrates cost effectiveness [3]. The diagnostic accuracy of FFR in terms of identification of stenosis with inducible ischemia is 85–93% [7,8,9]
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