Effects of Intravenous and Intracoronary Adenosine 5′-Triphosphate as Compared With Adenosine on Coronary Flow and Pressure Dynamics

Jeremias, Allen; Filardo, Steven D.; Whitbourn, Robert; Kernoff, Robert S.; Yeung, Alan C.; Fitzgerald, Peter J.; Yock, Paul G.

doi:10.1161/01.cir.101.3.318

Cited by 104 publications

(65 citation statements)

References 27 publications

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“…14 -16 In canines, ATP seems to be slightly more potent than adenosine, and it was shown that coronary blood flow could be further augmented with an increase of the dosage. 10 However, in humans, the present data indicate equipotency of ATP and adenosine and do not confirm a longer lasting effect. Increasing the dosages of ATP beyond the recommended dosage of 140 g · kg Ϫ1 · min Ϫ1 did not induce a further decline of the resistance index but induced a marked decline in systemic blood pressure in some patients.…”

Section: Atpcontrasting

confidence: 89%

“…9 Animal experiments also suggest that higher dosages than commonly proposed might be needed to achieve complete hyperemia. 10 In certain patient subsets, the different vasodilators were reported to exert different effects on myocardial resistances. 11 In addition, in animals, maximal hyperemic response, as observed after coronary occlusion, was not achieved by the pharmacological stimuli.…”

mentioning

confidence: 99%

“…11 In addition, in animals, maximal hyperemic response, as observed after coronary occlusion, was not achieved by the pharmacological stimuli. 10 In addition, a recent study established the usefulness of more prolonged vasodilation required for pressure wire pullback procedure in assessing diffuse coronary atherosclerosis. 12 The aim of the present study was to compare, side-by-side, the effects of different dosages and routes of administrations of adenosine 5Ј-triphosphate (ATP) and adenosine with intracoronary administration of contrast medium and papaverine regarding their potential for inducing maximal and steady-state hyperemia.…”

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confidence: 99%

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Intracoronary and Intravenous Adenosine 5′-Triphosphate, Adenosine, Papaverine, and Contrast Medium to Assess Fractional Flow Reserve in Humans

et al. 2003

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Background-Inducing both maximal and steady-state coronary hyperemia is of clinical importance to take full advantage of fractional flow reserve measurements. The present study compares different dosages and routes of administration of adenosine 5Ј-triphosphate (ATP), adenosine, contrast medium, and papaverine regarding their potential to achieve both maximal and steady-state hyperemia. Methods and Results-In 21 patients with an isolated coronary stenosis, coronary vasodilation was induced successively by papaverine (20 mg intracoronary), adenosine (20 and 40 g intracoronary), ATP (20 and 40 g intracoronary), iohexol (6 mL intracoronary), adenosine or ATP through an antecubital vein (140 and 180 g · kg Ϫ1 · min

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Section: Atpcontrasting

confidence: 89%

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confidence: 99%

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confidence: 99%

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Intracoronary and Intravenous Adenosine 5′-Triphosphate, Adenosine, Papaverine, and Contrast Medium to Assess Fractional Flow Reserve in Humans

et al. 2003

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“…Several previous studies in dogs have compared peak coronary hyperemia after occlusion vs. hyperemia induced by intravenous or intracoronary administration of pharmacological agents. These studies have reported similar results between the two interventions (4,19), as well as higher values during RH (9) or higher values with vasodilators (1,11,33). Differences in agents, concentrations, and route of administration seem to underlie the reported disparity.…”

Section: Rh Vs Ahmentioning

confidence: 60%

“…Comparison of concentrations between human and animal studies is ambiguous, however, because it is suggested that humans are more sensitive to the vasodilator properties of adenosine or have a slower rate of elimination of adenosine than dogs (34). Indeed, intracoronary administration of adenosine at doses used in humans was found to elicit only submaximal hyperemia in dogs (9). Although the use of milligram doses of adenosine in the clinic has been advocated (14), our data suggest that application of such high adenosine concentrations might increase the discrepancy between pharmacologically induced dilation vs. ischemia-induced hyperemia.…”

Section: Rh Vs Ahmentioning

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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Coronary flow reserve correlates left ventricular diastolic dysfunction in patients with dilated cardiomyopathy

Teragaki

Yanagi

Toda

et al. 2002

Cathet Cardio Intervent

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The relationship between altered coronary circulation and left ventricular (LV) function in dilated cardiomyopathy (DCM) remains unclear. We used the Doppler guidewire and transthoracic echo Doppler in 24 DCM patients to investigate the relationship between coronary flow reserve (CFR) and LV systolic/diastolic function, trying to predict diastolic dysfunction and evaluate DCM severity with CFR. CFR correlated better with the deceleration time (DT) of the E-wave and the ratio of E-wave peak value to that of the A-wave (E/A) than with LV ejection fraction (EF). The optimal CFR cutoff value for predicting the restrictive pattern of transmitral flow velocity (DT = 120 msec) was 2.6 (sensitivity 91%, specificity 100%). Dividing patients into two groups around the CFR = 2.6 cutoff, differences in DT and E/A between groups were more prominent than those for EF. CFR correlates better with LV diastolic than systolic function and may be useful for predicting diastolic dysfunction in DCM patients.

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Effects of Intravenous and Intracoronary Adenosine 5′-Triphosphate as Compared With Adenosine on Coronary Flow and Pressure Dynamics

Cited by 104 publications

References 27 publications

Intracoronary and Intravenous Adenosine 5′-Triphosphate, Adenosine, Papaverine, and Contrast Medium to Assess Fractional Flow Reserve in Humans

Intracoronary and Intravenous Adenosine 5′-Triphosphate, Adenosine, Papaverine, and Contrast Medium to Assess Fractional Flow Reserve in Humans

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

Coronary flow reserve correlates left ventricular diastolic dysfunction in patients with dilated cardiomyopathy

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