The haemodynamic response to intravenous adenosine and its impact on fractional flow reserve: results of the AFFECTS (Adenosine For the Functional assEssment of Coronary sTenosis Severity) study

Repeatability of Fractional Flow Reserve Despite Variations in Systemic and Coronary Hemodynamics

“…Recent work proposed 7 patterns of response to IV adenosine infusion, but with an emphasis on Pa and Pd separately and without repeated, paired tracings for the same lesion (11). However, as clarified in our Figure 4, Pa and Pd responses vary markedly even for the same patient when repeating an FFR measurement.…”

“…However, some investigators have recently questioned the validity of FFR measurements made during IV adenosine infusion (11,12). Specifically, some investigators proposed that only the FFR measured during "stable hyperemia" should be used to guide treatment, even if lower values had been observed (11).…”

“…Specifically, some investigators proposed that only the FFR measured during "stable hyperemia" should be used to guide treatment, even if lower values had been observed (11). Other investigators noted common FFR instability during IV adenosine infusion, but still recommended always using the lowest observed value (12).…”

Pre-Angioplasty Instantaneous Wave-Free Ratio Pullback Provides Virtual Intervention and Predicts Hemodynamic Outcome for Serial Lesions and Diffuse Coronary Artery Disease

“…However, it remains a limitation that the interventionalist must commit to balloon dilation of at least 1 lesion before repeating that pullback as the values will have changed and the outcome of removing 1 stenosis on the others cannot be predicted. A further limitation is that prolonged infusions of adenosine can have unexpected consequences with changing pressure ratios, which may go unnoticed during a pullback and affect its interpretation (20)(21)(22)(23).…”

Differences between automatically detected and steady-state fractional flow reserve

“…When FFR was detected automatically before achievement of steady-state hyperemia, Pd was decreased significantly by -10.4 % already when compared with baseline Pd, whereas Pa was merely unchanged. FFR values are known to vary and fluctuate during adenosine-dependent induction of hyperemia [14,15]. Different aspects might explain this phenomenon.…”