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Impact of Alpha- and Beta-Adrenergic Receptor Blockers on Fractional Flow Reserve and Index of Microvascular Resistance

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Abstract

We investigated the effect of β- and α-adrenergic blockers on fractional flow reserve (FFR) and index of microvascular resistance (IMR). In 43 patients (pts) with intermediate stenoses, we measured FFR and IMR before and after nonselective β-blocker propranolol (30 μg/kg, n = 20) and selective β1-blocker metoprolol (40 μg/kg, n = 23) IC; (b) In additional 21 pts after percutaneous coronary intervention (PCI), FFR and IMR were measured before and after α-blocker phentolamine (3 mg) IC. Neither propranolol nor metoprolol changed values of FFR and IMR. Phentolamine slightly decreased FFR (from 0.88 ± 0.05 to 0.87 ± 0.06, p = 0.025) but did not change IMR. FFR decreased from >0.80 to ≤0.80 in 3 pts (14 %), but in none, the value decreased to <0.75. β-blockers do not affect FFR and IMR in intermediate stenoses. After PCI, a mild decrease in FFR occurs after α-blockers, though of limited clinical impact.

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References

  1. Mangiacapra, F., & Barbato, E. (2011). From SYNTAX to FAME, a paradigm shift in revascularization strategies: the key role of fractional flow reserve in guiding myocardial revascularization. Journal of Cardiovascular Medicine (Hagerstown, Md.), 12, 538–542.

    Article  Google Scholar 

  2. De Bruyne, B., Fearon, W. F., Pijls, N. H., et al. (2014). Fractional flow reserve-guided PCI for stable coronary artery disease. New England Journal of Medicine, 371(13), 1208–1217.

    Article  PubMed  Google Scholar 

  3. Hamilos, M., Muller, O., Cuisset, T., et al. (2009). Long-term clinical outcome after fractional flow reserve-guided treatment in patients with angiographically equivocal left main coronary artery stenosis. Circulation, 120, 1505–1512.

    Article  PubMed  Google Scholar 

  4. Ntalianis, A., Sels, J. W., Davidavicius, G., et al. (2010). Fractional flow reserve for the assessment of nonculprit coronary artery stenosis in patients with acute myocardial infarction. Journal of the American College of Cardiology: Cardiovascular Interventions, 3, 1274–1281.

    Google Scholar 

  5. Muller, O., Mangiacapra, F., Ntalianis, A., et al. (2011). Long-term follow-up after fractional flow reserve-guided treatment strategy in patients with an isolated proximal left anterior descending coronary artery stenosis. Journal of the American College of Cardiology: Cardiovascular Interventions, 4, 1175–1182.

    Google Scholar 

  6. Puymirat, E., Peace, A., Mangiacapra, F., et al. (2012). Long-term clinical outcome after fractional flow reserve-guided percutaneous coronary revascularization in patients with small-vessel disease. Circulation. Cardiovascular Interventions, 5, 62–68.

    Article  PubMed  Google Scholar 

  7. Fearon, W. F., Aarnoudse, W., Pijls, N. H., et al. (2004). Microvascular resistance is not influenced by epicardial coronary artery stenosis severity: experimental validation. Circulation, 109, 2269–2272.

    Article  PubMed  Google Scholar 

  8. Aarnoudse, W., Fearon, W. F., Manoharan, G., et al. (2004). Epicardial stenosis severity does not affect minimal microcirculatory resistance. Circulation, 110, 2137–2142.

    Article  PubMed  Google Scholar 

  9. Melikian, N., Vercauteren, S., Fearon, W. F., et al. (2010). Quantitative assessment of coronary microvascular function in patients with and without epicardial atherosclerosis. EuroIntervention, 5, 939–945.

    Article  PubMed  Google Scholar 

  10. Mangiacapra, F., De Bruyne, B., Peace, A. J., Melikian, N., Wijns, W., & Barbato, E. (2012). High cholesterol levels are associated with coronary microvascular dysfunction. Journal of Cardiovascular Medicine (Hagerstown, Md.), 13, 439–442.

    Article  CAS  Google Scholar 

  11. Pijls, N. H., Klauss, V., Siebert, U., et al. (2002). Fractional Flow Reserve (FFR) Post-Stent Registry Investigators. Coronary pressure measurement after stenting predicts adverse events at follow-up: a multicenter registry. Circulation, 105, 2950–2954.

    Article  PubMed  Google Scholar 

  12. Nam, C. W., Hur, S. H., Cho, Y. K., et al. (2011). Relation of fractional flow reserve after drug-eluting stent implantation to one-year outcomes. American Journal of Cardiology, 107, 1763–1767.

    Article  CAS  PubMed  Google Scholar 

  13. Barbato, E. (2009). Role of adrenergic receptors in human coronary vasomotion. Heart, 120, 1505–1512.

    Google Scholar 

  14. Kern, M. J., Horowitz, J. D., Ganz, P., et al. (1985). Attenuation of coronary vascular resistance by selective alpha 1-adrenergic blockade in patients with coronary artery disease. Journal of the American College of Cardiology, 5, 840–846.

    Article  CAS  PubMed  Google Scholar 

  15. Julius, B. K., Vassalli, G., Mandinov, L., & Hess, O. M. (1999). Alpha-adrenoceptor blockade prevents exercise-induced vasoconstriction of stenotic coronary arteries. Journal of the American College of Cardiology, 33, 1499–1505.

    Article  CAS  PubMed  Google Scholar 

  16. Baumgart, D., Haude, M., Gorge, G., et al. (1999). Augmented α-adrenergic constriction of atherosclerotic human coronary arteries. Circulation, 99, 2090–2097.

    Article  CAS  PubMed  Google Scholar 

  17. Barbato, E., Bartunek, J., Wyffels, E., Wijns, W., Heyndrickx, G. R., & De Bruyne, B. (2003). Effects of intravenous dobutamine on coronary vasomotion in humans. Journal of the American College of Cardiology, 42, 1596–1601.

    Article  CAS  PubMed  Google Scholar 

  18. Barbato, E., Piscione, F., Bartunek, J., et al. (2005). Role of beta2 adrenergic receptors in human atherosclerotic coronary arteries. Circulation, 111, 288–294.

    Article  CAS  PubMed  Google Scholar 

  19. Gregorini, L., Fajadet, J., Robert, G., Cassagneau, B., Bernis, M., & Marco, J. (1994). Coronary vasoconstriction after percutaneous transluminal coronary angioplasty is attenuated by antiadrenergic agents. Circulation, 90, 895–907.

    Article  CAS  PubMed  Google Scholar 

  20. Gregorini, L., Marco, J., Kozàkovà, M., et al. (1999). α-adrenergic blockade improves recovery of myocardial perfusion and function after coronary stenting in patients with acute myocardial infarction. Circulation, 99, 482–490.

    Article  CAS  PubMed  Google Scholar 

  21. Gregorini, L., Marco, J., Farah, B., et al. (2002). Effects of selective α1- and α2-adrenergic blockade on coronary flow reserve after coronary stenting. Circulation, 106, 2901–2907.

    Article  CAS  PubMed  Google Scholar 

  22. Gregorini, L., Marco, J., & Heusch, G. (2012). Peri-interventional coronary vasomotion. Journal of Molecular and Cellular Cardiology, 52, 883–889.

    Article  CAS  PubMed  Google Scholar 

  23. Kern, M. J., Ganz, P., Horowitz, J. D., et al. (1983). Potentiation of coronary vasoconstriction by beta-adrenergic blockade in patients with coronary artery disease. Circulation, 67, 1178–1185.

    Article  CAS  PubMed  Google Scholar 

  24. Kern, M. J., Petru, M. A., Ferry, D. R., et al. (1985). Regional coronary vasoconstriction after combined beta-adrenergic and calcium channel blockade in patients with coronary artery disease. Journal of the American College of Cardiology, 5, 1438–1450.

    Article  CAS  PubMed  Google Scholar 

  25. Hodgson, J. M., Cohen, M. D., Szentpetery, S., & Thames, M. D. (1989). Effects of regional alpha- and beta-blockade on resting and hyperaemic coronary blood flow in conscious, unstressed humans. Circulation, 79, 797–809.

    Article  CAS  PubMed  Google Scholar 

  26. Bortone, A. S., Hess, O. M., Gaglione, A., et al. (1990). Effect of intravenous propranolol on coronary vasomotion at rest and during dynamic exercise in patients with coronary artery disease. Circulation, 81, 1225–1235.

    Article  CAS  PubMed  Google Scholar 

  27. Barbato, E., Bartunek, J., Aarnoudse, W., et al. (2004). Alpha-adrenergic receptor blockade and hyperaemic response in patients with intermediate coronary stenoses. European Heart Journal, 25, 2034–2039.

    Article  CAS  PubMed  Google Scholar 

  28. Aarnoudse, W., Geven, M., Barbato, E., Botman, K.-J., De Bruyne, B., & Pijls, N. H. J. (2005). Effect of phentolamine on the hyperemic response to adenosine in patients with microvascular disease. American Journal of Cardiology, 96, 1627–1630.

    Article  CAS  PubMed  Google Scholar 

  29. Penicka, M., Bartunek, J., Wijns, W., et al. (2004). Tissue doppler imaging predicts recovery of left ventricular function after recanalization of an occluded coronary artery. Journal of the American College of Cardiology, 43(1), 85–91.

    Article  PubMed  Google Scholar 

  30. Zarins, C. K., Taylor, C. A., & Min, J. K. (2013). Computed fractional flow reserve (FFTCT) derived from coronary CT angiography. Journal of Cardiovascular Translational Research, 6(5), 708–714.

    Article  PubMed Central  PubMed  Google Scholar 

  31. De Bruyne, B., Pijls, N. H., Barbato, E., et al. (2003). Intracoronary and intravenous adenosine 5′-triphosphate, adenosine, papaverine, and contrast medium to assess fractional flow reserve in humans. Circulation, 107, 1877–1883.

    Article  PubMed  Google Scholar 

  32. Bottcher, M., Johannes, C., San, K., Phelps, E., & Schelbert, H. (1997). Effect of β1-adrenergic receptor blockade on myocardial blood flow and vasodilatory capacity. Journal of Nuclear Medicine, 38, 442–446.

    CAS  PubMed  Google Scholar 

  33. Billinger, M., Seiler, C., Fleisch, M., Eberli, F. R., Meier, B., & Hess, O. M. (2001). Do beta-adrenergic blocking agents increase coronary flow reserve? Journal of the American College of Cardiology, 38, 1866–1871.

    Article  CAS  PubMed  Google Scholar 

  34. Gan, L. M., Wikström, J., & Fritsche-Danielson, R. (2013). Coronary flow reserve from mouse to man–from mechanistic understanding to future interventions. Journal of Cardiovascular Translational Research, 6(5), 715–728.

    Article  PubMed Central  PubMed  Google Scholar 

  35. Ozdemir, M., Erdem, G., Yazici, I., Turkoglu, S., Timurkaynak, T., & Cengel, A. (2007). Metoprolol does Not Effect Myocardial Fractional Flow Reserve in Patients with Intermediate Coronary Stenoses. International Heart Journal, 48, 477–483.

    Article  CAS  PubMed  Google Scholar 

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Conflicts of Interest

No conflict of interest with the topic investigated.

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Authors and Affiliations

  1. Cardiovascular Center Aalst, OLV Clinic, Moorselbaan, 164, B-9300, Aalst, Belgium

    Emanuele Barbato, Giovanna Sarno, Catalina Trana Berza, Giuseppe Di Gioia, Jozef Bartunek, Marc Vanderheyden, Luigi Di Serafino, William Wijns & Bernard De Bruyne

  2. Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy

    Emanuele Barbato, Giuseppe Di Gioia & Bruno Trimarco

Authors
  1. Emanuele Barbato
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  2. Giovanna Sarno
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  3. Catalina Trana Berza
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  4. Giuseppe Di Gioia
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  5. Jozef Bartunek
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  10. Bernard De Bruyne
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Correspondence to Emanuele Barbato.

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Associate Editor Angela Taylor oversaw the review of this article

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Barbato, E., Sarno, G., Berza, C.T. et al. Impact of Alpha- and Beta-Adrenergic Receptor Blockers on Fractional Flow Reserve and Index of Microvascular Resistance. J. of Cardiovasc. Trans. Res. 7, 803–809 (2014). https://doi.org/10.1007/s12265-014-9599-8

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  • DOI: https://doi.org/10.1007/s12265-014-9599-8

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