Adequacy of intracoronary versus intravenous adenosine-induced maximal coronary hyperemia for fractional flow reserve measurements

Jeremias, Allen; Whitbourn, Robert; Filardo, Steven D.; Fitzgerald, Peter J.; Cohen, David J.; Tuzcu, E M; Anderson, William D.; Abizaid, Alexandre; Mintz, Gary S.; Yeung, Alan C.; Kern, Morton J.; Yock, Paul G.

doi:10.1067/mhj.2000.109920

Cited by 129 publications

(66 citation statements)

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“…Unknown factors, including individual variability in Ado dose-responses or the microvascular effects of individual risk conditions, could potentially affect CFVR Ado . While similar doses of intracoronary Ado provide near-maximal increase in coronary flow in 90-92% of cases, 28 the 18 mcg dose may not have achieved maximal hyperemia in every patient. 29 Also, no systematic assessment of left ventricular hypertrophy was undertaken.…”

Section: Study Limitationsmentioning

confidence: 99%

Coronary microvascular reactivity is only partially predicted by atherosclerosis risk factors or coronary artery disease in women evaluated for suspected ischemia: results from the NHLBI Women's Ischemia Syndrome Evaluation (WISE)

Wessel

Arant

McGorray

et al. 2007

Clinical Cardiology

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Section: Study Limitationsmentioning

confidence: 99%

Coronary microvascular reactivity is only partially predicted by atherosclerosis risk factors or coronary artery disease in women evaluated for suspected ischemia: results from the NHLBI Women's Ischemia Syndrome Evaluation (WISE)

Wessel

Arant

McGorray

et al. 2007

Clinical Cardiology

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“…23 The reasons include avoiding the need for additional femoral punctures or infusion pumps, increased cost efficiencies and lower incidence of side-effects. 24 Intracoronary dosing may avoid hemodynamic confounding because central aortic pressure is less likely to change, 21 even when intracoronary infusions are used. 25 Although classification agreement is good across a wide spectrum of stenoses, 24 in more clinical populations the classification match between intracoronary and intravenous dosing can fall to 78%, near the 0.80 threshold.…”

Section: Altering the Doses Of Hyperemic Agentsmentioning

confidence: 99%

“…24 Intracoronary dosing may avoid hemodynamic confounding because central aortic pressure is less likely to change, 21 even when intracoronary infusions are used. 25 Although classification agreement is good across a wide spectrum of stenoses, 24 in more clinical populations the classification match between intracoronary and intravenous dosing can fall to 78%, near the 0.80 threshold. 14 Therefore, Current Developments in Pressure-Only Indices…”

Section: Altering the Doses Of Hyperemic Agentsmentioning

confidence: 99%

Advances in Coronary Physiology

Nijjer

Sen

Petraco

et al. 2015

Circ J

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Pressure-wire technology, most typically fractional flow reserve (FFR), has provided interventional cardiologists with a means of determining the physiological importance of a stenosis during angiography. There has been renewed interest in coronary physiology in the light of guideline recognition, ongoing clinical research and new technologies changing the paradigm of how assessment is performed in the catheter laboratory. We reflect on FFR, with regards the potential effects of changing hemodynamics on FFR and the latest evidence with regards to outcomes. We also review the instantaneous wave-free ratio (iFR), a new pressure-only index, measured at rest, that is under active evaluation in several international randomized controlled trials. We review the accumulated evidence and discuss the important physiological concepts between pressure and flow that underlie the approach to using resting indices. Finally we investigate future developments, including physiological mapping with iFR-Pullback and the potential to predict the hemodynamic effect of stenting. (Circ J 2015; 79: 1172 -1184

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“…This glycocalyx insensitivity should be taken into account when using adenosine-induced coronary hyperemia as a marker for vasodilating capacity to an ischemic stimulus. coronary circulation; hyaluronidase; dogs TO ASSESS the functional severity of coronary stenoses in the clinic, use of adenosine for inducing maximal coronary hyperemia in patients has been well established (8,10,17,34). Clinical decision-making to intervene is based on intracoronary parameters that are derived during hyperemia, and it is therefore critical that the adenosine-induced hyperemia accurately reflects the coronary hyperemia that can be attained by endogenous stimuli (7).…”

mentioning

confidence: 99%

Hyaluronidase treatment of coronary glycocalyx increases reactive hyperemia but not adenosine hyperemia in dog hearts

VanTeeffelen

Dekker

Fokkema

et al. 2005

American Journal of Physiology-Heart and Circulatory Physiology

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. Hyaluronidase treatment of coronary glycocalyx increases reactive hyperemia but not adenosine hyperemia in dog hearts. Am J Physiol Heart Circ Physiol 289: H2508 -H2513, 2005. First published July 22, 2005; doi:10.1152/ajpheart.00446.2005.-Because adenosine is commonly used for inducing maximal coronary hyperemia in the clinic, it is imperative that adenosine-induced hyperemia (AH) resembles coronary hyperemia that can be attained by endogenous stimuli. In the present study we hypothesized that coronary reactive hyperemia (RH) is limited compared with AH due to the presence of the glycocalyx and that the AH response is therefore unable to detect glycocalyx modifications. In anesthetized open-chest dogs, blood flow and pressure were measured in the left circumflex artery. RH after 15-s occlusion was compared with an intracoronary infusion of adenosine (650 g; AH) during control conditions and after intracoronary treatment of the glycocalyx with hyaluronidase (20.000 U, 2 ϫ 20 min; n ϭ 6) or heat-inactivated hyaluronidase (n ϭ 5). During control, coronary conductance during RH was 1.49 Ϯ 0.15 ml ⅐ mmHg Ϫ1 ⅐ min Ϫ1 and 76 Ϯ 7% of coronary conductance during AH (P Ͻ 0.05). After hyaluronidase, RH conductance increased (P Ͻ 0.01) by 43 Ϯ 13% and became 93 Ϯ 4% of AH conductance (P ϭ NS). Heatinactivated hyaluronidase had no effect on RH and AH conductance. Our results demonstrate that adenosine-induced coronary hyperemia profoundly exceeds RH and that the difference is virtually abolished on selective removal of the glycocalyx. It is concluded that, compared with RH, adenosine-induced coronary hyperemia is not affected by modification of the glycocalyx. This glycocalyx insensitivity should be taken into account when using adenosine-induced coronary hyperemia as a marker for vasodilating capacity to an ischemic stimulus. coronary circulation; hyaluronidase; dogs TO ASSESS the functional severity of coronary stenoses in the clinic, use of adenosine for inducing maximal coronary hyperemia in patients has been well established (8,10,17,34). Clinical decision-making to intervene is based on intracoronary parameters that are derived during hyperemia, and it is therefore critical that the adenosine-induced hyperemia accurately reflects the coronary hyperemia that can be attained by endogenous stimuli (7). Intravital microscopic studies of cremaster tissue have suggested that adenosine affects capillary perfusion by limiting the effect of the glycocalyx on vascular resistance (3,12,21). The glycocalyx is the carbohydrate-rich matrix that lines the luminal surface of blood vessels and forms the true interface between the endothelium and flowing blood (6,24,26,30). Normally, flowing red blood cells and large dextrans are excluded from the glycocalyx in cremaster capillaries (6, 30, 31). However, it was shown that adenosine superfusion impaired glycocalyx exclusion properties (21). Because an intact glycocalyx strongly reduces the volume available for flow of plasma and red blood cells in capillaries (3,22,30), an impaired g...

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Adequacy of intracoronary versus intravenous adenosine-induced maximal coronary hyperemia for fractional flow reserve measurements

Cited by 129 publications

References 0 publications

Coronary microvascular reactivity is only partially predicted by atherosclerosis risk factors or coronary artery disease in women evaluated for suspected ischemia: results from the NHLBI Women's Ischemia Syndrome Evaluation (WISE)

Coronary microvascular reactivity is only partially predicted by atherosclerosis risk factors or coronary artery disease in women evaluated for suspected ischemia: results from the NHLBI Women's Ischemia Syndrome Evaluation (WISE)

Advances in Coronary Physiology

Hyaluronidase treatment of coronary glycocalyx increases reactive hyperemia but not adenosine hyperemia in dog hearts

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