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
BACKGROUND—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 b...
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| Veröffentlicht in: | Circulation. Cardiovascular interventions 2013-12, Vol.6 (6), p.654-661 |
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| creator | Tarkin, Jason M Nijjer, Sukhjinder Sen, Sayan Petraco, Ricardo Echavarria-Pinto, Mauro Asress, Kaleab N Lockie, Tim Khawaja, Muhammed Z Mayet, Jamil Hughes, Alun D Malik, Iqbal S Mikhail, Ghada W Baker, Christopher S Foale, Rodney A Redwood, Simon Francis, Darrel P Escaned, Javier Davies, Justin E |
| description | BACKGROUND—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 |
| doi_str_mv | 10.1161/CIRCINTERVENTIONS.113.000591 |
| format | Article |
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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.]]></description><identifier>ISSN: 1941-7640</identifier><identifier>EISSN: 1941-7632</identifier><identifier>DOI: 10.1161/CIRCINTERVENTIONS.113.000591</identifier><identifier>PMID: 24254709</identifier><language>eng</language><publisher>United States: American Heart Association, Inc</publisher><subject>Adenosine - administration & dosage ; Adenosine - pharmacology ; Administration, Intravenous ; Aged ; Aorta - drug effects ; Aorta - physiology ; Blood Pressure - drug effects ; Blood Pressure - physiology ; Coronary Angiography ; Coronary Stenosis - diagnostic imaging ; Coronary Stenosis - physiopathology ; Coronary Vessels - diagnostic imaging ; Coronary Vessels - drug effects ; Coronary Vessels - physiology ; Female ; Fractional Flow Reserve, Myocardial - drug effects ; Fractional Flow Reserve, Myocardial - physiology ; Hemodynamics - drug effects ; Hemodynamics - physiology ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Severity of Illness Index</subject><ispartof>Circulation. Cardiovascular interventions, 2013-12, Vol.6 (6), p.654-661</ispartof><rights>2013 American Heart Association, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3090-35cbfd8be6c800cb4fbd27a90e1a09098d123f02d8fdad6e753e890764cb8ead3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,3687,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24254709$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tarkin, Jason M</creatorcontrib><creatorcontrib>Nijjer, Sukhjinder</creatorcontrib><creatorcontrib>Sen, Sayan</creatorcontrib><creatorcontrib>Petraco, Ricardo</creatorcontrib><creatorcontrib>Echavarria-Pinto, Mauro</creatorcontrib><creatorcontrib>Asress, Kaleab N</creatorcontrib><creatorcontrib>Lockie, Tim</creatorcontrib><creatorcontrib>Khawaja, Muhammed Z</creatorcontrib><creatorcontrib>Mayet, Jamil</creatorcontrib><creatorcontrib>Hughes, Alun D</creatorcontrib><creatorcontrib>Malik, Iqbal S</creatorcontrib><creatorcontrib>Mikhail, Ghada W</creatorcontrib><creatorcontrib>Baker, Christopher S</creatorcontrib><creatorcontrib>Foale, Rodney A</creatorcontrib><creatorcontrib>Redwood, Simon</creatorcontrib><creatorcontrib>Francis, Darrel P</creatorcontrib><creatorcontrib>Escaned, Javier</creatorcontrib><creatorcontrib>Davies, Justin E</creatorcontrib><title>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</title><title>Circulation. Cardiovascular interventions</title><addtitle>Circ Cardiovasc Interv</addtitle><description><![CDATA[BACKGROUND—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.]]></description><subject>Adenosine - administration & dosage</subject><subject>Adenosine - pharmacology</subject><subject>Administration, Intravenous</subject><subject>Aged</subject><subject>Aorta - drug effects</subject><subject>Aorta - physiology</subject><subject>Blood Pressure - drug effects</subject><subject>Blood Pressure - physiology</subject><subject>Coronary Angiography</subject><subject>Coronary Stenosis - diagnostic imaging</subject><subject>Coronary Stenosis - physiopathology</subject><subject>Coronary Vessels - diagnostic imaging</subject><subject>Coronary Vessels - drug effects</subject><subject>Coronary Vessels - physiology</subject><subject>Female</subject><subject>Fractional Flow Reserve, Myocardial - drug effects</subject><subject>Fractional Flow Reserve, Myocardial - physiology</subject><subject>Hemodynamics - drug effects</subject><subject>Hemodynamics - physiology</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Retrospective Studies</subject><subject>Severity of Illness Index</subject><issn>1941-7640</issn><issn>1941-7632</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNplUV1v0zAUjRCIjcFfQH7gYXvIsON8GfFSRQmLNHVSW3iNHPtGDTh2sZ1W_Yf8LNx1m5B4sO71ueccy_dE0SeCbwnJyeeqXVXtclOvftTLTfuwXAeY3mKMM0ZeRZeEpSQucpq8fulTfBG9c-4nxgHOk7fRRZImWVpgdhn9uYPJyKPm0yjQCtzOaAfIG9Rqb_ketJkdWshQ3agBcS1R6x2qhwGER0ajxnLhR6O5Qo0yh5MH2D2ghXPg3ATafzlhswoqMyC_hX_sBmMfkWbWzyb1nquZny4nemVsQO0Rrf2jxqE17MGO_oiuF01TV5v1TZjN8vg-ejNw5eDDU72Kvjf1prqL7x--tdXiPhYUMxzTTPSDLHvIRYmx6NOhl0nBGQbCw5yVkiR0wIksB8llDkVGoWQ4LFH0JXBJr6Lrs-_Omt8zON9NoxOgFNcQdtWRNGd5VhQ5C9SvZ6qwxjkLQ7ez4xR-0xHcnbLs_ssywLQ7ZxnkH59emvsJ5Iv4ObxASM-Eg1EerPul5gPYbgtc-W2HCaVFyrI4CR1JgmkcDsH0LwpHsSc</recordid><startdate>201312</startdate><enddate>201312</enddate><creator>Tarkin, Jason M</creator><creator>Nijjer, Sukhjinder</creator><creator>Sen, Sayan</creator><creator>Petraco, Ricardo</creator><creator>Echavarria-Pinto, Mauro</creator><creator>Asress, Kaleab N</creator><creator>Lockie, Tim</creator><creator>Khawaja, Muhammed Z</creator><creator>Mayet, Jamil</creator><creator>Hughes, Alun D</creator><creator>Malik, Iqbal S</creator><creator>Mikhail, Ghada W</creator><creator>Baker, Christopher S</creator><creator>Foale, Rodney A</creator><creator>Redwood, Simon</creator><creator>Francis, Darrel P</creator><creator>Escaned, Javier</creator><creator>Davies, Justin E</creator><general>American Heart Association, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201312</creationdate><title>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</title><author>Tarkin, Jason M ; Nijjer, Sukhjinder ; Sen, Sayan ; Petraco, Ricardo ; Echavarria-Pinto, Mauro ; Asress, Kaleab N ; Lockie, Tim ; Khawaja, Muhammed Z ; Mayet, Jamil ; Hughes, Alun D ; Malik, Iqbal S ; Mikhail, Ghada W ; Baker, Christopher S ; Foale, Rodney A ; Redwood, Simon ; Francis, Darrel P ; Escaned, Javier ; Davies, Justin E</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3090-35cbfd8be6c800cb4fbd27a90e1a09098d123f02d8fdad6e753e890764cb8ead3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adenosine - administration & dosage</topic><topic>Adenosine - pharmacology</topic><topic>Administration, Intravenous</topic><topic>Aged</topic><topic>Aorta - drug effects</topic><topic>Aorta - physiology</topic><topic>Blood Pressure - drug effects</topic><topic>Blood Pressure - physiology</topic><topic>Coronary Angiography</topic><topic>Coronary Stenosis - diagnostic imaging</topic><topic>Coronary Stenosis - physiopathology</topic><topic>Coronary Vessels - diagnostic imaging</topic><topic>Coronary Vessels - drug effects</topic><topic>Coronary Vessels - physiology</topic><topic>Female</topic><topic>Fractional Flow Reserve, Myocardial - drug effects</topic><topic>Fractional Flow Reserve, Myocardial - physiology</topic><topic>Hemodynamics - drug effects</topic><topic>Hemodynamics - physiology</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Retrospective Studies</topic><topic>Severity of Illness Index</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tarkin, Jason M</creatorcontrib><creatorcontrib>Nijjer, Sukhjinder</creatorcontrib><creatorcontrib>Sen, Sayan</creatorcontrib><creatorcontrib>Petraco, Ricardo</creatorcontrib><creatorcontrib>Echavarria-Pinto, Mauro</creatorcontrib><creatorcontrib>Asress, Kaleab N</creatorcontrib><creatorcontrib>Lockie, Tim</creatorcontrib><creatorcontrib>Khawaja, Muhammed Z</creatorcontrib><creatorcontrib>Mayet, Jamil</creatorcontrib><creatorcontrib>Hughes, Alun D</creatorcontrib><creatorcontrib>Malik, Iqbal S</creatorcontrib><creatorcontrib>Mikhail, Ghada W</creatorcontrib><creatorcontrib>Baker, Christopher S</creatorcontrib><creatorcontrib>Foale, Rodney A</creatorcontrib><creatorcontrib>Redwood, Simon</creatorcontrib><creatorcontrib>Francis, Darrel P</creatorcontrib><creatorcontrib>Escaned, Javier</creatorcontrib><creatorcontrib>Davies, Justin E</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation. Cardiovascular interventions</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tarkin, Jason M</au><au>Nijjer, Sukhjinder</au><au>Sen, Sayan</au><au>Petraco, Ricardo</au><au>Echavarria-Pinto, Mauro</au><au>Asress, Kaleab N</au><au>Lockie, Tim</au><au>Khawaja, Muhammed Z</au><au>Mayet, Jamil</au><au>Hughes, Alun D</au><au>Malik, Iqbal S</au><au>Mikhail, Ghada W</au><au>Baker, Christopher S</au><au>Foale, Rodney A</au><au>Redwood, Simon</au><au>Francis, Darrel P</au><au>Escaned, Javier</au><au>Davies, Justin E</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>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</atitle><jtitle>Circulation. Cardiovascular interventions</jtitle><addtitle>Circ Cardiovasc Interv</addtitle><date>2013-12</date><risdate>2013</risdate><volume>6</volume><issue>6</issue><spage>654</spage><epage>661</epage><pages>654-661</pages><issn>1941-7640</issn><eissn>1941-7632</eissn><abstract><![CDATA[BACKGROUND—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.]]></abstract><cop>United States</cop><pub>American Heart Association, Inc</pub><pmid>24254709</pmid><doi>10.1161/CIRCINTERVENTIONS.113.000591</doi><tpages>8</tpages></addata></record> |
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| ispartof | Circulation. Cardiovascular interventions, 2013-12, Vol.6 (6), p.654-661 |
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| source | MEDLINE; American Heart Association Journals; EZB-FREE-00999 freely available EZB journals |
| subjects | Adenosine - administration & dosage Adenosine - pharmacology Administration, Intravenous Aged Aorta - drug effects Aorta - physiology Blood Pressure - drug effects Blood Pressure - physiology Coronary Angiography Coronary Stenosis - diagnostic imaging Coronary Stenosis - physiopathology Coronary Vessels - diagnostic imaging Coronary Vessels - drug effects Coronary Vessels - physiology Female Fractional Flow Reserve, Myocardial - drug effects Fractional Flow Reserve, Myocardial - physiology Hemodynamics - drug effects Hemodynamics - physiology Humans Male Middle Aged Retrospective Studies Severity of Illness Index |
| title | 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 |
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