Comparison of regadenoson and nitroprusside to adenosine for measurement of fractional flow reserve: A systematic review and meta-analysis

Lee, Justin Z.; Singh, Nirmal; Nyotowidjojo, Iwan; Howe, Carol; Low, See Wei; Nguyen, Thach; Pinto, Duane S.; Kumar, Gautam; Lee, Kwan S.

doi:10.1016/j.carrev.2017.07.004

Cited by 7 publications

(4 citation statements)

References 24 publications

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“…This study provides more evidence regarding the usefulness of IC NTP for the assessment of FFR, as other authors have shown, having the largest metanalysis evaluated only 173 patients 23 …”

Section: Discussionsupporting

confidence: 56%

Safety and efficacy of intracoronary sodium nitroprusside for the assessment of coronary fractional flow reserve

Pedroni

Sarmiento

Solernó

et al. 2018

Indian Heart Journal

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BackgroundCoronary fractional flow reserve (FFR) determination is a valuable tool for the assessment of stenosis significance in intermediate coronary obstructions. Maximal hyperemia is mandatory for this determination. Although intravenous (IV) Adenosine is the standard agent used, its use carries an elevated incidence of side effects. Intracoronary sodium nitroprusside (IC NTP) is a very well-known coronary vasodilator, but it is not routinely used for FFR determinations.ObjectivesThe purpose of the present study was to compare FFR determinations and side effect profile of IC NTP with IV Adenosine.MethodsWe prospectively assessed FFR determinations in a total of 20 intermediate coronary artery stenotic lesions in 18 consecutive patients with the administration of IV Adenosine (140 μg/kg/min) and IC NTP (100 μg). The appearance of side effects was registered.ResultsThe mean age was 55.5 ± 7.5 years. Fifteen (83%) of the patients were male. Mean FFR values with IC NTP were similar to those obtained with IV Adenosine (0.82 ± 0.07 vs 0.82 ± 0.06, respectively, r = 0.775, p < 0.0001). Intravenous Adenosine induced side effects in 45% of patients (shortness of breath 30%, flushing 5%, headache 5%, angina pectoris 5%, and transient conduction disturbances 10%). No side effects were reported with IC NTP.ConclusionsIC NTP at a dose of 100 μg is as effective as IV Adenosine for FFR assessment. Besides, it is better tolerated and should be consider as a vasodilator agent in the assessment of FFR.

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“…This study provides more evidence regarding the usefulness of IC NTP for the assessment of FFR, as other authors have shown, having the largest metanalysis evaluated only 173 patients 23 …”

Section: Discussionsupporting

confidence: 56%

Safety and efficacy of intracoronary sodium nitroprusside for the assessment of coronary fractional flow reserve

Pedroni

Sarmiento

Solernó

et al. 2018

Indian Heart Journal

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“…Measurement of FFR requires maximal hyperemia with measurement of IC artery pressure proximal and distal to the stenotic lesion in question. 23 The infusion of IV adenosine is the reference method for measurement of FFR, but IC boluses frequently are used for convenience and to save time, but effectiveness needs to be better established. 24 Multiple studies have been carried out to compare the diagnostic accuracy, tolerability, and costs of IV and IC adenosine administrations in intermediate coronary lesions.…”

Section: Medications To Enhance Ffrmentioning

confidence: 99%

“…24 Regadenoson administered by the IV route and the IC administration of nitroprusside have both been shown to be appropriate alternatives to IV adenosine for determination of FFR, but additional validation and standardization of the clinical methodology are necessary. 23…”

Section: Medications To Enhance Ffrmentioning

confidence: 99%

Use and Value of Fractional Flow Reserve in Coronary Arteriography

2019

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“…Varios estudios han comparado el regadenosón y la adenosina intravenosa 8 , pero a los autores de este artículo no les consta ningún trabajo que haya comparado el regadenosón con adenosina intracoronaria en la valoración de la RFF.…”

Section: Introductionunclassified

Regadenosón intravenoso frente a adenosina intracoronaria para la medida de la reserva fraccional de flujo

Zaragoza¹,

Urbina²,

Viguer³

et al. 2019

RECIC

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Introducción y objetivos: El regadenosón, un agonista selectivo de los receptores A2a de la adenosina, se ha propuesto como una alternativa para el cálculo de la reserva fraccional de flujo (RFF). El objetivo de este estudio fue evaluar la utilidad del regadenosón en comparación con el uso de adenosina intracoronaria. Métodos: Se incluyeron de forma prospectiva y consecutiva 41 lesiones coronarias intermedias (30-70%) en las que se indicó valoración funcional con guía de presión. A cada paciente se le administró de forma secuencial adenosina intracoronaria y regadenosón intravenoso, y se registraron los datos hemodinámicos y los efectos adversos con la hiperemia inducida mediante ambos fármacos. Las diferencias en la RFF final se analizaron mediante regresión lineal y se identificaron las discrepancias clínicamente relevantes asumiendo como punto de corte el valor de 0,80. Resultados: La media de la RFF fue significativamente menor con regadenosón que con adenosina (0,838 ± 0,072 frente a 0,852 ± 0,073; p = 0,002), y en 4 casos (9,8%) se encontraron diferencias clínicamente relevantes. El análisis de regresión mostró una fuerte correlación lineal entre los valores individuales (r = 0,925; p < 0,001). Tanto la adenosina como el regadenosón redujeron de forma significativa la presión arterial media, y solo el regadenosón incrementó significativamente la frecuencia cardiaca basal. En 2 casos (4,9%) se registró asistolia > 3 s tras recibir adenosina y no se observó ninguna complicación con regadenosón. Conclusiones: La administración de regadenosón en bolo único intravenoso mostró una significativa reducción en el valor de RFF en comparación con la administración de bolos de adenosina intracoronaria, y las diferencias observadas podrían resultar relevantes en la toma de decisiones clínicas.

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Comparison of regadenoson and nitroprusside to adenosine for measurement of fractional flow reserve: A systematic review and meta-analysis

Cited by 7 publications

References 24 publications

Safety and efficacy of intracoronary sodium nitroprusside for the assessment of coronary fractional flow reserve

Safety and efficacy of intracoronary sodium nitroprusside for the assessment of coronary fractional flow reserve

Use and Value of Fractional Flow Reserve in Coronary Arteriography

Regadenosón intravenoso frente a adenosina intracoronaria para la medida de la reserva fraccional de flujo

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