Abstract 10246: Comparison of Low and High Dose Intracoronary Adenosine and Acetylcholine in Women Undergoing Coronary Reactivity Testing
Background: Macro- and microvascular coronary dysfunction is a mechanism of ischemia in patients without obstructive coronary artery disease (CAD). Coronary reactivity testing (CRT) with intra-coronary adenosine and acetylcholine (ACH) is used to identify non-endothelial and endothelial dependent vascular dysfunction, yet repeated and ascending dosing is time-consuming for clinical practice application. Accordingly, we compared low versus high dose intra-coronary adenosine and acetylcholine for coronary flow reserve (CFR), coronary cross-sectional area (CSA), and coronary blood flow (CBF).
Methods: Women with evidence of ischemia and no obstructive CAD underwent CRT using a Doppler transducer-tipped guide wire (Volcano ®FloWire 300cm) in the proximal left anterior descending artery. CFR was recorded in response to low dose (18mcg) and high dose (36mcg) intra-coronary adenosine. Change in CSA and CBF were determined after low dose (0.364mcg ) and high dose ACH (36.4mcg).
Results: Among the 85 women studied, the mean age was 56 years, 41% were dyslipidemic, 33% hypertensive, 49% had history of smoking, and 6% were diabetic. CFR with low versus high dose adenosine was not different. However, change in CSA and CBF were different between high and low dose ACH (Table).
Conclusions: Among women with evidence of ischemia and no CAD, low and high dose adenosine produced similar augmentation in coronary flow velocity, but low and high dose ACH produced different results. For clinically indicated CRT, low dose adenosine but higher dose ACH appears indicated.
- © 2011 by American Heart Association, Inc.