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

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Abstract

Background

Measurement of fractional flow reserve (FFR) by intravenous infusion or intracoronary injection of adenosine is the reference method to determine the hemodynamic relevance of coronary artery stenoses. The goal of this prospective study was to compare standard (40 µg adenosine for the right and 80 µg for the left coronary artery) to high doses of intracoronary adenosine for FFR measurement.

Methods and results

In 130 intermediate coronary artery stenoses, two sequential FFR measurements were performed with standard-dose intracoronary application of adenosine (40 µg for the right and 80 μg for the left coronary artery), followed by one FFR measurement with a bolus of 200 μg for the right and 400 μg for the left coronary artery. There was strong correlation (r = 0.97, p < 0.001) between FFR values determined with standard-dose adenosine (0.86 ± 0.08) versus high-dose adenosine (0.85 ± 0.08). High-dose adenosine did not yield FFR values ≤0.80 or ≤0.75 significantly more frequently than standard-dose adenosine. Patients reported more discomfort after high-dose adenosine application compared to standard-dose adenosine (p < 0.001).

Conclusions

For FFR measurements with intracoronary adenosine injection, results achieved with doses of 40 µg adenosine for the right and 80 µg for the left coronary artery display no clinically relevant difference to doses of 200 and 400 µg, respectively.

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Abbreviations

FFR:

Fractional flow reserve

i.v.:

Intravenous

i.c.:

Intracoronary

LAD:

Left anterior descending

LCX:

Left circumflex

p a :

Mean arterial pressures proximal to a coronary lesion

p d :

Mean arterial pressures distal to a coronary lesion

QCA:

Contour-based quantitative coronary analysis

RCA:

Right coronary artery

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Authors and Affiliations

  1. Department of Cardiology, University of Erlangen, Ulmenweg 18, 91054, Erlangen, Germany

    Jens Röther, Stephan Achenbach, Monique Tröbs, Florian Blachutzik, Mohamed Marwan & Christian Schlundt

  2. Department of Cardiology, University of Giessen, Giessen, Germany

    Holger Nef

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  1. Jens Röther
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  2. Stephan Achenbach
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  3. Monique Tröbs
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Correspondence to Jens Röther.

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Röther, J., Achenbach, S., Tröbs, M. et al. Comparison of standard- and high-dose intracoronary adenosine for the measurement of coronary fractional flow reserve (FFR). Clin Res Cardiol 105, 1003–1010 (2016). https://doi.org/10.1007/s00392-016-1010-0

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  • DOI: https://doi.org/10.1007/s00392-016-1010-0

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