Comparison of standard- and high-dose intracoronary adenosine for the measurement of coronary fractional flow reserve (FFR)

Röther, Jens; Achenbach, Stephan; Tröbs, Monique; Blachutzik, Florian; Nef, Holger; Marwan, Mohamed; Schlundt, Christian

doi:10.1007/s00392-016-1010-0

Cited by 13 publications

(6 citation statements)

References 28 publications

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“…However, hypotension and resulting tachycardia often prevent further drug initiation and up-titration. Along with pharmacological approaches, surgical implantable electrical devices for the treatment of HF patients with reduced ejection fraction (HFrEF) improve symptoms, reduce the risk of death and all-cause mortality in primary and secondary prevention [10, 28–30]. Nevertheless, in HFrEF patient outcomes remain unsatisfactory high with an increased risk for sudden death, worsening HF, frequent hospitalization for CV events and recurrent decompensation [31–33].…”

Section: Introductionmentioning

confidence: 99%

Long-term effects of device-guided slow breathing in stable heart failure patients with reduced ejection fraction

et al. 2018

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Section: Introductionmentioning

confidence: 99%

Long-term effects of device-guided slow breathing in stable heart failure patients with reduced ejection fraction

et al. 2018

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“…On the other hand, other studies using similar doses of IC adenosine documented significantly higher FFR values in comparison with standard IV adenosine . This discrepancy has been previously reported in dose–response studies . There are multiple explanations for this discrepancy.…”

Section: Discussionmentioning

confidence: 61%

“…[15][16][17] This discrepancy has been previously reported in dose-response studies. [21][22][23] There are multiple explanations for this discrepancy. The differences in the administered doses could explain the variability of hyperemic between the methods of administration.…”

Section: The Lowest Ffr Value Achieved With Ic Adenosine Bolus Variedmentioning

confidence: 99%

Comparison of intracoronary versus intravenous adenosine‐induced maximal hyperemia for fractional flow reserve measurement: A systematic review and meta‐analysis

Abo-Aly

Lolay

Adams

et al. 2019

Cathet Cardio Intervent

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Objective We sought to perform a systematic review and meta‐analysis of the available literature comparing fractional flow reserve (FFR) measurements after administration of adenosine using intracoronary (IC) bolus versus standard continuous intravenous (IV) infusion. Background FFR is considered the gold standard for invasive assessment of coronary lesions of intermediate severity. IV adenosine is recommended to induce hyperemia; however, IC adenosine is widely used for convenience. The difference between IV and IC administration in lesions assessment is not well studied. Methods We systematically searched MEDLINE and relevant databases for studies comparing IV with IC adenosine administration for FFR measurement. We reviewed data pertaining to adenosine doses, side effects, and FFR values. Results Eight studies addressing the primary question were identified. Dose of IC adenosine varied between 36 and 600 μg. Compared to IV adenosine infusion, the sensitivity of IC administration is 0.805 (95% confidence interval [95% CI]: 0.664–0.896; p < .001), specificity is 0.965 (95% CI: 0.932–0.983; p < .001), positive likelihood ratio is 24.218 (95% CI: 12,263–47.830; p < .001), negative likelihood ratio is 0.117 (95% CI: 0.033–0.411; p < .01), and diagnostic odds ratio is 274.225 [95% CI: 92.731–810.946; p < .001]. Overall, hemodynamic side effects and symptoms were reported more frequently with IV adenosine. Conclusions The available literature suggests that IC adenosine is well tolerated and may provide equivalent diagnostic accuracy compared to IV administration. However, variability in dosing regimens does not allow definitive conclusions regarding noninferiority of IC approach compared to IV administration.

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“…3 In fact, the measurement of fractional flow reserve (FFR), after the induction of maximum hyperemia with adenosine, has been indicated as the first-line strategy, 4 providing an outcome advantage for the guidance of percutaneous coronary interventions (PCIs). However, the protocol for hyperemia induction with adenosine still lacks standardization, 5,6 being additionally weighted by interindividual variability of response and poor tolerance. Among adenosine-free measurements, the instantaneous wave-free ratio (iFR) is a nonhyperemic pressurederived ratio that is obtained as a diastolic resting measure, 7 recently incorporated in guidelines as a tool for the functional evaluation of coronary stenoses based on the noninferiority data of randomized trials.…”

Section: Introductionmentioning

confidence: 99%

Impact of Age on the Functional Evaluation of Intermediate Coronary Stenoses With Instantaneous Wave-Free Ratio and Fractional Flow Reserve

Verdoia

Gioscia²,

Nardin

et al. 2020

Angiology

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The optimal strategy for assessing the ischemic significance of intermediate coronary stenoses with adenosine-induced fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) is still debated. Few studies have previously assessed the impact of age on FFR and iFR, which was the aim of our study. Patients undergoing FFR and iFR evaluation for intermediate (40%-70%) coronary lesions were included and divided according to age. Fractional flow reserve was performed by intracoronary boluses of adenosine (60-1440 μg). Instantaneous wave-free ratio was automatically calculated. Among 148 patients undergoing FFR measurement of 166 lesions, 45.3% were ≥70 years. Elderly patients had higher minimal lumen diameter ( P = .03). We also observed a linear relationship between iFR and FFR independently of age. Fractional flow reserve values were higher in the elderly patients, whereas iFR was not related to age. A total of 33 lesions had a positive iFR with no difference for age (17.3% vs 22%, P = .56), while FFR <0.80 was more infrequent in the elderly patients (17.1% vs 34.8%, P = .02). In intermediate coronary stenoses, iFR and FFR correlation is unaffected by age. Fractional flow reserve is higher in the elderly patients, whereas iFR is less affected by age. Future large-scale studies are needed to define whether iFR should be the preferred choice in elderly patients.

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Comparison of standard- and high-dose intracoronary adenosine for the measurement of coronary fractional flow reserve (FFR)

Abstract: For FFR measurements with intracoronary adenosine injection, results achieved with doses of 40 µg adenosine for the right and 80 µg for the left coronary artery display no clinically relevant difference to doses of 200 and 400 µg, respectively.

Cited by 13 publications

References 28 publications

Long-term effects of device-guided slow breathing in stable heart failure patients with reduced ejection fraction

Long-term effects of device-guided slow breathing in stable heart failure patients with reduced ejection fraction

Comparison of intracoronary versus intravenous adenosine‐induced maximal hyperemia for fractional flow reserve measurement: A systematic review and meta‐analysis

Impact of Age on the Functional Evaluation of Intermediate Coronary Stenoses With Instantaneous Wave-Free Ratio and Fractional Flow Reserve

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