Low Coronary Microcirculatory Resistance Associated With Profound Hypotension During Intravenous Adenosine Infusion

Echavarría‐Pinto, Mauro; Gonzalo, Nieves; Ibáñez, Borja; Petraco, Ricardo; Jimenez-Quevedo, Pilar; Sen, Sayan; Nijjer, Sukhjinder; Tarkin, Jason M.; Alfonso, Fernándo; Núñez‐Gil, Iván J.; Bañuelos, Camino; Quirós, Alicia; Fernández‐Ortíz, Antonio; Macaya, Carlos; Koo, Bon‐Kwon; Davies, Justin E.; Escaned, Javier

doi:10.1161/circinterventions.113.000659

Cited by 32 publications

(17 citation statements)

References 51 publications

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“…In such scenarios, high-dose intravenous administration of adenosine may lead to false-positive FFR results in addition to an acute and undesirable deterioration in haemodynamics. 42 When making an assessment in the acute setting, the potential for such undesirable deterioration should always be considered, especially when there is a large myocardial mass and depressed LV function is involved.…”

Section: Potential Limitations Of Ffr In Acsmentioning

confidence: 99%

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Evaluation of intermediate coronary stenoses in acute coronary syndromes using pressure guidewire

2017

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Fractional flow reserve (FFR) is increasingly used to guide myocardial revascularisation. However, supporting evidence regarding its use originates from studies that have enrolled mainly patients with stable angina, while patients with acute coronary syndromes (ACS) have not been included. Notably, multifactorial microvascular dysfunction and an increased sympathetic tone in patients with ACS may lead to blunted response to adenosine and false-negative results of FFR due to submaximal hyperaemia. This may raise the possibility of deferring treatment of stenosis that instead would have needed dilatation, thus leaving a residual risk of preventable cardiac events. In this literature review, we aim at summarising laboratory and clinical investigations concerning the use of FFR in culprit and non-culprit lesions in ACS. Furthermore, we will report recent data on instantaneous wave-free ratio, an adenosine-free index of functional stenosis severity, in stable coronary artery disease and in patients with ACS.

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Section: Potential Limitations Of Ffr In Acsmentioning

confidence: 99%

“…ACS, acute coronary syndrome; CAD, coronary artery disease; FFR, fractional flow reserve; iFR, instantaneous wave-free ratio. (Adapted from Echavarría-Pinto et al) 42. …”

mentioning

confidence: 99%

Evaluation of intermediate coronary stenoses in acute coronary syndromes using pressure guidewire

2017

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“…However, Echavarria-Pinto et al reported a relationship between obesity (defined as body mass index ≥30 kg/ m 2 ), lower IMR corr values, and more frequent hypotensive responses to intravenous adenosine infusion in 79 patients with intermediate stenosis. 23 Likewise, there have been controversies whether common cardiovascular risk factors which have been known to cause macrovascular disease are also risk factors for primary microvascular disease. 24 In our results, conventional risk factors of macrovascular disease, as well as stenosis severity of epicardial coronary stenosis, were not associated with high IMR.…”

Section: Determinants Of High Imrmentioning

confidence: 99%

Integrated Physiologic Assessment of Ischemic Heart Disease in Real-World Practice Using Index of Microcirculatory Resistance and Fractional Flow Reserve

Lee

Layland

Jung

et al. 2015

Circ: Cardiovascular Interventions

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Background-The index of microcirculatory resistance (IMR) is a quantitative and specific index for coronary microcirculation. However, the distribution and determinants of IMR have not been fully investigated in patients with ischemic heart disease (IHD). Methods and Results-Consecutive patients who underwent elective measurement of both fractional flow reserve (FFR) and IMR were enrolled from 8 centers in 5 countries. Patients with acute myocardial infarction were excluded.

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“…Previous research from our group [8] has suggested a more profound vasodilatory effect of adenosine on the microcirculation in patients with obesity and diabetes; these patients may have a greater protective benefit from Ticagrelor during PCI.…”

Section: Rationalementioning

confidence: 99%

“…Additionally, previous research [8] has identified a more pronounced effect of adenosine on microcirculatory resistance in patients with obesity and diabetes. Therefore, a potentially higher protective effect of Ticagrelor during PCI might be expected in this subgroup.…”

Section: Introductionmentioning

confidence: 99%

PRotective Effect on the coronary microcirculation of patients with DIabetes by Clopidogrel or Ticagrelor (PREDICT): study rationale and design. A randomized multicenter clinical trial using intracoronary multimodal physiology

Cerrato

Quirós

Echavarría‐Pinto

et al. 2017

Cardiovasc Diabetol

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BackgroundIn diabetic patients a predisposed coronary microcirculation along with a higher risk of distal particulate embolization during primary percutaneous intervention (PCI) increases the risk of peri-procedural microcirculatory damage. However, new antiplatelet agents, in particular Ticagrelor, may protect the microcirculation through its adenosine-mediated vasodilatory effects.MethodsPREDICT is an original, prospective, randomized, multicenter controlled study designed to investigate the protective effect of Ticagrelor on the microcirculation during PCI in patient with diabetes mellitus type 2 or pre-diabetic status. The primary endpoints of this study aim to test (i) the decrease in microcirculatory resistance with antiplatelet therapy (Ticagrelor > Clopidogrel; mechanistic effect) and (ii) the relative microcirculatory protection of Ticagrelor compared to Clopidogrel during PCI (Ticagrelor < Clopidogrel; protective effect).ConclusionsPREDICT will be the first multicentre clinical trial to test the adenosine-mediated vasodilatory effect of Ticagrelor on the microcirculation during PCI in diabetic patients. The results will provide important insights into the prospective beneficial effect of this drug in preventing microvascular impairment related to PCI (http://www.clinicaltrials.gov No. NCT02698618).Electronic supplementary materialThe online version of this article (doi:10.1186/s12933-017-0543-5) contains supplementary material, which is available to authorized users.

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Low Coronary Microcirculatory Resistance Associated With Profound Hypotension During Intravenous Adenosine Infusion

Cited by 32 publications

References 51 publications

Evaluation of intermediate coronary stenoses in acute coronary syndromes using pressure guidewire

Evaluation of intermediate coronary stenoses in acute coronary syndromes using pressure guidewire

Integrated Physiologic Assessment of Ischemic Heart Disease in Real-World Practice Using Index of Microcirculatory Resistance and Fractional Flow Reserve

PRotective Effect on the coronary microcirculation of patients with DIabetes by Clopidogrel or Ticagrelor (PREDICT): study rationale and design. A randomized multicenter clinical trial using intracoronary multimodal physiology

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