Intracoronary versus Intravenous Adenosine-Induced Maximal Coronary Hyperemia for Fractional Flow Reserve Measurements

Abstract

BACKGROUNDMaximal hyperemia is the critical prerequisite for fractional flow reserve (FFR) assessment. Despite intravenous (IV) adenosine currently being the recommended approach, intracoronary (IC) administration of adenosine constitutes a valuable alternative in everyday practice. However, it is surprisingly unclear which IC strategy allows the achievement of FFR values that are comparable to IV adenosine.OBJECTIVESThis study sought to compare increasing doses of IC adenosine versus IV adenosine for FFR.METHODS30 intermediate coronary stenoses undergoing FFR measurement were prospectively and consecutively enrolled. Hyperemia was sequentially induced by bolus of IC adenosine (ADN; 150 μg) followed by IV adenosine (IVADN) infusion over 3 minutes at dose of (140 μg/kg/min). FFR values, symptoms, and development of atrioventricular block were recorded.RESULTS150 μg doses of IC adenosine were well tolerated and associated with fewer symptoms than IV adenosine. Intracoronary adenosine doses induced a significant decrease of FFR compared with baseline levels (P < 0.01). Among the 6 patients with FFR values less than 0.80 identified by IVADN, 4 were correctly identified also by 150 μg bolus IC adenosine. Larger randomized studies with cross-over design are necessary to verify the results.CONCLUSIONSThis small pilot study suggests that IC adenosine might be an alternative to IV adenosine. Larger randomized studies with a cross-over design are necessary.

Myocardial Fractional Flow Reserve Measurement Using Contrast Media as a First-Line Assessment of Coronary Lesions in Current Practice

“…Recent studies did not find significant differences of hyperemic response between IC and intravenous administration. 23,24 As already previously mentioned, the degree of contrast-induced hyperemia depends on the biophysical properties of the contrast medium. Thus, as our study was performed with iodixanol, we cannot generalize our findings to other protocols of cFFR.…”

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

“…The lowest FFR value achieved with IC adenosine bolus varied according to the dose used. Two studies demonstrated no statistically significant difference in FFR values measured with IC adenosine at a dose of the 150 μg and IV adenosine . Other studies reported the same conclusion but with significantly lower IC adenosine dose of 40 and 80 μg in the RCA and left coronary artery, respectively .…”

“…Continuous intravenous (IV) adenosine is considered the standard method to induce maximal hyperemia, but its use in the catheterization laboratory is time‐consuming and expensive. Intracoronary (IC) bolus administration is an alternative to IV adenosine in inducing maximal hyperemia . Multiple studies have been carried out to compare the diagnostic accuracy, tolerability, and costs of IV and IC adenosine administrations in intermediate coronary lesions.…”

Simplifying the Assessment of Coronary Artery Stenosis by Enhancing Instantaneous Wave Free Ratio

“…The former is the established gold standard and is calculated during hyperaemia, originally obtained with adenosine, and averaged through several cardiac cycles. In order to facilitate FFR adoption, two different approaches have been proposed: intra coronary adenosine administration (13), and more recently introduction of contrast medium as an alternative hyperemic agent. Contrast medium induced FFR, studies have shown a good correlation between contrast induced Pd/Pa and adenosine mediated FFR (14)(15)(16)(17).…”