Comparison of Intracoronary Versus Intravenous Administration of Adenosine for Measurement of Coronary Fractional Flow Reserve

Schlundt, Christian; Bietau, Christian; Klinghammer, Lutz; Wiedemann, Ricarda; Rittger, Harald; Ludwig, Josef; Achenbach, Stephan

doi:10.1161/circinterventions.114.001781

Cited by 48 publications

(56 citation statements)

References 37 publications

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“…The phenomenon reported in our study highlights the possibility of false low FFR values with overestimation of hemodynamic significance when automatic FFR detection occurs during the induction phase of hyperemia. Correspondingly, detailed analysis of BlandAltman plots from previously published studies revealed substantial differences C0.05 to both directions in single patients [26,28,29], and the rate of classification mismatch between automatically detected and steady-state FFR in our study was comparable with rates of overestimation of functional significance after IC adenosine administration. Our results question accuracy of the concept of IC bolus injection for induction of maximum hyperemia for intracoronary pressure measurements, because identification of steady-state hyperemia is difficult if even possible.…”

Section: Classification Mismatch Analysissupporting

confidence: 79%

“…Two recently published studies reported no significant differences between FFR measurements following IC injection or IV infusion of adenosine [26,27]. However, the authors did not precisely report whether they used automatically detected or true steady-state FFR, and FFR was continuously averaged during five cardiac cycles in one trial [26]. The phenomenon reported in our study highlights the possibility of false low FFR values with overestimation of hemodynamic significance when automatic FFR detection occurs during the induction phase of hyperemia.…”

Section: Classification Mismatch Analysiscontrasting

confidence: 56%

“…Considering these findings, it might be assumed that lower FFR values after high dose IC adenosine injection are caused by the falsely low automatic FFR measurement phenomenon reported in our study, rather than representing more effective hyperemia. Two recently published studies reported no significant differences between FFR measurements following IC injection or IV infusion of adenosine [26,27]. However, the authors did not precisely report whether they used automatically detected or true steady-state FFR, and FFR was continuously averaged during five cardiac cycles in one trial [26].…”

Section: Classification Mismatch Analysismentioning

confidence: 98%

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Differences between automatically detected and steady-state fractional flow reserve

et al. 2015

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Section: Classification Mismatch Analysissupporting

confidence: 79%

Section: Classification Mismatch Analysiscontrasting

confidence: 56%

Section: Classification Mismatch Analysismentioning

confidence: 98%

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Differences between automatically detected and steady-state fractional flow reserve

et al. 2015

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“…39,40 However, the chances of securing the same dichotomous treatment recommendation by each method of adenosine administration falls to 78 % at FFR values of approximately 0.80 41 and there is a hyperaemic dose-response relationship seen with intracoronary doses of >60 μg. 42 The route of adenosine administration differs from centre to centre, 43 and while FFR measurement with central administration of intravenous adenosine is considered the gold standard, in the era of transradial PCI, intracoronary or peripheral intravenous administration of adenosine is more practical, although this does give similar FFR results to centrally administered adenosine.…”

Section: Routes and Doses Of Adenosine Administrationmentioning

confidence: 99%

Fractional Flow Reserve: Does a Cut-off Value add Value?

Mohdnazri

Sharp

2016

Interventional Cardiology Review

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CoronaryFractional flow reserve (FFR) is an index used to describe the physiological significance of a coronary stenosis. It measures the pressure drop under conditions of maximal hyperaemia between the aorta and a selected vessel location distal to an angiographic lesion. 1 Several FFR studies have identified patient groups in whom coronary stenting is associated with improved outcomes when compared with medical therapy (and vice versa). FFR-guided treatment prevents unnecessary stenting and therefore coronary physiology has been associated with improved outcomes at reduced cost, a rare combination in a new technology.2-7 Coronary physiological assessment is now an integral part of the modern catheterisation laboratory, with a level 1A recommendation by the European Society of Cardiology (ESC) for use in stable patients in whom evidence of ischaemia is not already available. Ischaemic Heart Disease and Coronary RevascularisationAngina is the clinical manifestation of myocardial ischaemia in patients with stable coronary artery disease (CAD). It is caused by transient imbalance between blood supply and metabolic demand. The myocardial ischemia that causes angina is, however, not simply a question of a 'blocked pipe'; rather, ischaemia is a result of complex pathophysiological mechanisms that include obstructive epicardial CAD, inflammation, microvascular coronary dysfunction, endothelial dysfunction, thrombosis and angiogenesis (see Figure 1). 10Obstructive epicardial CAD is only one of the factors that contributes to myocardial ischaemia and yet, in the treatment of ischaemic heart disease (IHD), great (some would say overwhelming) emphasis is given to identifying and eliminating obstructive epicardial CAD over other potential causes of ischaemia, some of which may have key therapeutic roles in treating patients with IHD. The reason for this emphasis is obvious -obstructive epicardial CAD is easily identified, easily understood and relatively easily treated by angiography and stenting or bypass grafting. Doing so, however, does not always relieve ischaemia. Concept and Validation of Fractional Flow ReserveWhen FFR is used to identify a potentially ischaemia-causing lesion, the aim is to identify deficient blood flow distal to a coronary lesion.However, unlike coronary pressure, measurement of coronary blood flow in the catheter laboratory is not technically straightforward. positive non-invasive test may still occur, but sensitivity and specificity were sub-optimal. Clinical judgement was therefore advised for values in this range. The FAME studies then moved the FFR cut-off point to ≤0.80, with a view to predicting outcomes. The ≤0.80 cut-off point has been adopted into clinical practice guidelines, whereas the lower value of ≤0.75 is no longer widely used. Here, the authors discuss the data underpinning these cut-off values and the practical implications for their use when using FFR guidance in PCI. KeywordsCoronary physiology, fractional flow reserve, pressure wire Disclosure: SRM and TRK have received rese...

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“…injection (typically at a dose of 140 lg/kg/min) or as an intracoronary (i.c.) bolus [11]. For that purpose, use of doses between 6 lg and 720 lg has been reported [1,[5][6][7].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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Comparison of Intracoronary Versus Intravenous Administration of Adenosine for Measurement of Coronary Fractional Flow Reserve

Abstract: Background-Measurement

Cited by 48 publications

References 37 publications

Differences between automatically detected and steady-state fractional flow reserve

Differences between automatically detected and steady-state fractional flow reserve

Fractional Flow Reserve: Does a Cut-off Value add Value?

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

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