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Circ Cardiovasc Interv. 2013 Dec;6(6):654-61. doi: 10.1161/CIRCINTERVENTIONS.113.000591. Epub 2013 Nov 19.

Hemodynamic response to intravenous adenosine and its effect on fractional flow reserve assessment: results of the Adenosine for the Functional Evaluation of Coronary Stenosis Severity (AFFECTS) study.

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1
From the International Centre for Circulatory Health, National Heart and Lung Institute, NIHR Imperial College Biomedical Research Centre, and Imperial College NHS Trust, London, United Kingdom (J.M.T., S.N., S.S., R.P., J.M., A.D.H., I.S.M., G.W.M., C.S.B., R.A.F., D.P.F., J.E.D.); King's College London BHF Centre of Research Excellence and the NIHR Biomedical Research Centre at Guy's and St Thomas' Hospital NHS Foundation Trust, the Rayne Institute, St Thomas' Hospital, London, United Kingdom (K.N.A., T.L., M.Z.K., S.R.); and Cardiovascular Institute, Hospital Clinico San Carlos, Madrid, Spain (M.E.-P., J.E.).

Abstract

BACKGROUND:

We studied the hemodynamic response to intravenous adenosine on calculation of fractional flow reserve (FFR). Intravenous adenosine is widely used to achieve conditions of stable hyperemia for measurement of FFR. However, intravenous adenosine affects both systemic and coronary vascular beds differentially.

METHODS AND RESULTS:

A total of 283 patients (310 coronary stenoses) underwent coronary angiography with FFR using intravenous adenosine 140 mcg/kg per minute via a central femoral vein. Offline analysis was performed to calculate aortic (Pa), distal intracoronary (Pd), and reservoir (Pr) pressure at baseline, peak, and stable hyperemia. Seven different hemodynamic patterns were observed according to Pa and Pd change at peak and stable hyperemia. The average time from baseline to stable hyperemia was 68.2±38.5 seconds, when both ΔPa and ΔPd were decreased (ΔPa, -10.2±10.5 mm Hg; ΔPd, -18.2±10.8 mm Hg; P<0.001 for both). The fall in Pa closely correlated with the reduction in peripheral Pr (ΔPr, -12.9±15.7 mm Hg; P<0.001; r=0.9; P<0.001). ΔPa and ΔPd were closely related under conditions of peak (r=0.75; P<0.001) and stable hyperemia (r=0.83; P<0.001). On average, 56% (10.2 mm Hg) of the reduction in Pd was because of fall in Pa. FFR lesion classification changed in 9% using an FFR threshold of ≤0.80 and 5.2% with FFR threshold <0.75 when comparing Pd/Pa at peak and stable hyperemia.

CONCLUSIONS:

Intravenous adenosine results in variable changes in systemic blood pressure, which can lead to alterations in FFR lesion classification. Attention is required to ensure FFR is measured under conditions of stable hyperemia, although the FFR value at this point may be numerically higher.

KEYWORDS:

adenosine; angiography; blood pressure; coronary disease; fractional flow reserve, myocardial; hemodynamics

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