Impact of increasing dose of intracoronary adenosine on peak hyperemia duration during fractional flow reserve assessment

Verdoia, Monica; Erbetta, Riccardo; Sagazio, Emanuele; Barbieri, Lucia; Negro, Federica; Suryapranata, Harry; Kedhi, Elvin; Luca, Giuseppe De

doi:10.1016/j.ijcard.2018.09.088

Cited by 7 publications

(5 citation statements)

References 26 publications

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“…The Fractional flow reserve (FFR), measuring physiologic parameters, as the fall in coronary pressure across a stenosis, after the achievement of maximal hyperemia, has emerged as an accurate and reliable method for the assessment of hemodynamically relevant coronary stenoses [2,3]. However, despite several trials pointing at the prognostic benefits of limiting coronary revascularization only to those lesions with FFR < 0.80 [4,5], the strategy for achieving maximum hyperemia is still debated, with several protocols and dosing for adenosine administration reported in literature [6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Impact of aging on the effects of intracoronary adenosine, peak hyperemia and its duration during fractional flow reserve assessment

Verdoia

Gioscia

Suryapranata³

et al. 2021

Coronary Artery Disease

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Introduction Functional assessment of coronary stenoses is crucial for determining the correct therapeutic strategy. Age-related modifications in cardiovascular function could alter the functional significance of an intermediate coronary lesion. Therefore, the aim of the present study was to investigate the impact of age on fractional flow reserve (FFR) measurements in patients with intermediate coronary artery disease. Methods We included patients undergoing coronary angiography at our Division of Cardiology from June 2008 to February 2019 for elective indication or recent acute coronary syndrome and receiving FFR assessment for an intermediate coronary stenosis (angiographic 40–70% stenoses). FFR measurement was performed by pressure-recording guidewire (Prime Wire; Volcano Imaging System Philips Healthcare, San Diego, California, USA), after induction of hyperemia with intracoronary boluses of adenosine (from 60 to 720 μg, with dose doubling at each step). Results We included in our study 276 patients, undergoing FFR evaluation on 314 lesions, that were divided according to age (< or ≥70 years). Elderly patients displayed a higher cardiovascular risk profile and received more often specific therapy. We found significantly higher FFR values and lower Delta FFR and time to recovery in patients with age ≥70 years old even with high-dose adenosine. Elderly patients showed a trend in lower percentage of positive FFRs, especially with high-dose (P = 0.09). Overall, any FFR ≤ 0.80 was observed in 33.5% of younger patients and 21.1% of patients ≥70 years (P = 0.02). Results were confirmed after correction for baseline differences [adjusted odds ratio (95% confidence interval) = 0.60 (0.33–1.09), P = 0.08]. Conclusion This is one of the first studies investigating the impact of age on the measurement of FFR with high-dose adenosine. Patients with age >70 years old with intermediate CAD are more likely to have higher FFR values and lower duration of hyperemia after adenosine boluses, as compared with younger patients.

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Section: Introductionmentioning

confidence: 99%

Impact of aging on the effects of intracoronary adenosine, peak hyperemia and its duration during fractional flow reserve assessment

Verdoia

Gioscia

Suryapranata³

et al. 2021

Coronary Artery Disease

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“…Early invasive studies using intracoronary Doppler assessment of coronary blood flow velocity and total coronary resistance showed that intravenous adenosine at doses of 140 µg/kg/min resulted in maximal hyperaemia, defined by papaverine response, in 84% of subjects [ 3 ]. Several invasive studies have assessed the effect of adenosine dose on FFR with higher doses showing no significant change in FFR compared with lower doses [ 19 – 21 ]. In a CMR study, Karamitsos et al showed that a stepwise increase in the adenosine dose from 140 μg/kg/min to 210 μg/kg/min is safe and increases the rate of patients with an adequate haemodynamic response [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

A comparison of standard and high dose adenosine protocols in routine vasodilator stress cardiovascular magnetic resonance: dosage affects hyperaemic myocardial blood flow in patients with severe left ventricular systolic impairment

Brown

Saunderson

Das

et al. 2021

Journal of Cardiovascular Magnetic Resonance

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Background Adenosine stress perfusion cardiovascular magnetic resonance (CMR) is commonly used in the assessment of patients with suspected ischaemia. Accepted protocols recommend administration of adenosine at a dose of 140 µg/kg/min increased up to 210 µg/kg/min if required. Conventionally, adequate stress has been assessed using change in heart rate, however, recent studies have suggested that these peripheral measurements may not reflect hyperaemia and can be blunted, in particular, in patients with heart failure. This study looked to compare stress myocardial blood flow (MBF) and haemodynamic response with different dosing regimens of adenosine during stress perfusion CMR in patients and healthy controls. Methods 20 healthy adult subjects were recruited as controls to compare 3 adenosine perfusion protocols: standard dose (140 µg/kg/min for 4 min), high dose (210 µg/kg/min for 4 min) and long dose (140 µg/kg/min for 8 min). 60 patients with either known or suspected coronary artery disease (CAD) or with heart failure and different degrees of left ventricular (LV) dysfunction underwent adenosine stress with standard and high dose adenosine within the same scan. All studies were carried out on a 3 T CMR scanner. Quantitative global myocardial perfusion and haemodynamic response were compared between doses. Results In healthy controls, no significant difference was seen in stress MBF between the 3 protocols. In patients with known or suspected CAD, and those with heart failure and mild systolic impairment (LV ejection fraction (LVEF) ≥ 40%) no significant difference was seen in stress MBF between standard and high dose adenosine. In those with LVEF < 40%, there was a significantly higher stress MBF following high dose adenosine compared to standard dose (1.33 ± 0.46 vs 1.10 ± 0.47 ml/g/min, p = 0.004). Non-responders to standard dose adenosine (defined by an increase in heart rate (HR) < 10 bpm) had a significantly higher stress HR following high dose (75 ± 12 vs 70 ± 14 bpm, p = 0.034), but showed no significant difference in stress MBF. Conclusions Increasing adenosine dose from 140 to 210 µg/kg/min leads to increased stress MBF in patients with significantly impaired LV systolic function. Adenosine dose in clinical perfusion assessment may need to be increased in these patients.

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“…Adenosine is a natural mediator with a short half-life in the bloodstream, displaying a broad spectrum of effects in several districts and tissues, mediated by the family of the four ADA receptors. In particular, the A2A receptor is responsible for antiplatelet effects, as well as vasodilatory effects [20][21] , by improving endothelial function and vasomotion. Therefore, previous studies have raised the hypothesis that ade-genotyping in a sample of consecutive patients and by repeating the analyses on a randomly selected sample encompassing 10% of the entire population.…”

Section: Discussionmentioning

confidence: 99%

Impact of the Polymorphism rs5751876 of the Purinergic Receptor ADORA2A on Periprocedural Myocardial Infarction in Patients Undergoing Percutaneous Coronary Intervention

Negro

Verdoia

Nardin

et al. 2021

JAT

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Aim: Periprocedural myocardial infarction (PMI), a severe complication of Percutaneous Coronary Intervention (PCI) procedures, has a negative prognostic effect, both at short and long-term follow-up. So far, adenosine's role in preventing PMI has shown contrasting results. A genetic variant of ADORA2A receptor, 1976 C > T, has been suggested as a potential determinant of the interindividual response to adenosine, thus conditioning its potential benefits on PMI. In our study, we investigated whether the ADORA2A 1976 C > T polymorphism is associated with PMI occurrence in patients undergoing coronary stenting. Methods: The study included consecutive patients undergoing PCI at the Azienda Ospedaliera-Universitaria “Maggiore della Carità,” Novara, Italy, between January 2010 and January 2016. Their genetic status was assessed using polymerase chain reaction (PCR) and restriction-fragment-length-polymorphism technique. Myonecrosis biomarkers were measured at intervals from 6 to 48 hours. PMI was defined as CKMB increased 3 times over the Upper Limit of Normal (ULN), or 50% of pre-PCI value; periprocedural myonecrosis was defined as troponin I increased 3 times over the ULN or by 50% of the baseline value. Results: We included 1,104 patients undergoing PCI, 863 (78.2%) of whom carried the ADORA2A T-allele. No difference was found for the main demographic, clinical features, or biochemistry parameters. However, C-carriers had lower statin therapy use ( p = 0.008) and lower HDL-cholesterol levels ( p = 0.01). Homozygous C/C patients had more frequent multivessel disease ( p = 0.03), longer lesions ( p = 0.01) and Type C lesions ( p = 0.01), thus requiring more complex procedures. After correction for baseline confounding factors at multivariate analysis, there was no difference in myocardial necrosis according to the ADORA2A genotype ( p = 0.40). In contrast, PMI tended to increase in the homozygous C/C population ( p = 0.06), but this trend was attenuated at multivariate analysis after correction for baseline confounding factors (C/C: OR[95%CI]= 1.52 [0.88–2.6], p = 0.14). Conclusions: Our study showed that the polymorphism rs5751876 of the ADORA2A receptor is associated with a higher prevalence of complex coronary lesions and multivessel disease. However, it does not significantly influence the occurrence of periprocedural MI or myonecrosis.

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Impact of increasing dose of intracoronary adenosine on peak hyperemia duration during fractional flow reserve assessment

Cited by 7 publications

References 26 publications

Impact of aging on the effects of intracoronary adenosine, peak hyperemia and its duration during fractional flow reserve assessment

Impact of aging on the effects of intracoronary adenosine, peak hyperemia and its duration during fractional flow reserve assessment

A comparison of standard and high dose adenosine protocols in routine vasodilator stress cardiovascular magnetic resonance: dosage affects hyperaemic myocardial blood flow in patients with severe left ventricular systolic impairment

Impact of the Polymorphism rs5751876 of the Purinergic Receptor ADORA2A on Periprocedural Myocardial Infarction in Patients Undergoing Percutaneous Coronary Intervention

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