on March 31, 2003
Published online before print March 31, 2003, doi: 10.1161/01.CIR.0000061950.24940.88
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Submitted on October 28, 2002
From the Cardiovascular Center Aalst, Belgium (B.D.B., E.B., J.B., W.W., G.R.H.); the Department of Physiology, University of Louvain, Brussels, Belgium (G.R.H.); the Catharina Hospital, Eindhoven, the Netherlands (N.H.J.P., J.-W.B.); and the Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands (N.H.J.P.). * To whom correspondence should be addressed. E-mail: bernard.de.bruyne{at}olvz-aalst.be.
Background--Inducing both maximal and steady-state coronary hyperemia is of clinical importance to take full advantage of fractional flow reserve measurements. The present study compares different dosages and routes of administration of adenosine 5`-triphosphate (ATP), adenosine, contrast medium, and papaverine regarding their potential to achieve both maximal and steady-state hyperemia. Methods and Results--In 21 patients with an isolated coronary stenosis, coronary vasodilation was induced successively by papaverine (20 mg intracoronary), adenosine (20 and 40 µg intracoronary), ATP (20 and 40 µg intracoronary), iohexol (6 mL intracoronary), adenosine or ATP through an antecubital vein (140 and 180 µg · kg-1 · min-1), or adenosine or ATP through a femoral vein (140 and 180 µg · kg-1 · min-1). Because vessel dimensions did not change, the ratio of distal coronary pressure (Pd) to aortic pressure (Pa) was used as an index of myocardial resistance. Pd/Pa was 0.77±0.21 at rest and decreased to 0.61±0.21 after papaverine. Pd/Pa decreased to a similar level with all other vasodilators, except with contrast medium (0.68±0.21; P<0.01 versus papaverine). Steady-state hyperemia could only be obtained by intracoronary papaverine and by intravenous ATP or adenosine. In another 23 patients, an intravenous infusion of ATP was varied from 0 to 280 µg · kg-1 · min-1. At doses >140 µg · kg-1 · min-1, there was neither a further decrease in Pd/Pa ratio nor a further increase in coronary flow velocities. Conclusion--Provided sufficient dosages are used, ATP, adenosine, and papaverine (but not contrast medium) induce maximal hyperemia and are therefore suitable to assess fractional flow reserve. Only intracoronary papaverine and intravenous ATP or adenosine induce steady-state hyperemia enabling a pressure pullback maneuver that is useful in assessing diffuse coronary atherosclerosis.
Revised on January 21, 2003
Accepted on January 28, 2003
Intracoronary and Intravenous Adenosine 5'-Triphosphate, Adenosine, Papaverine, and Contrast Medium to Assess Fractional Flow Reserve in Humans
Bernard De Bruyne MD, PhD*,
Key words: adenosine • angioplasty • pressure • vasodilation
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