COMPARISON OF INTRAVENOUS ADENOSINE TO INTRACORONARY PAPAVERINE FOR CALCULATION OF PRESSURE-DERIVED FRACTIONAL FLOW RESERVE

For calculation of fractional flow reserve (FFR), simultaneous registr ation of both aortic pressure (P-a) and transstenotic distal coronary pressure (P-d) is necessary at steady-state maximum coronary hyperemia . The aim of the present study was to compare the maximum transstenoti c gradient (Delta Pmax) and pressure-derived myocardial fractional flo w reserve (FFR(myo)), observed during intravenous adenosine infusion, to Delta Pmax and FFR(myo) induced by intracoronary papaverine, which is considered to be the gold standard for induction of coronary hypere mia, but acts too short for steady-state hyperemic pressure recordings and is associated with QT-prolongation. In 24 patients with coronary stenoses of various degrees, P-a and P-d were measured simultaneously by the diagnostic catheter and a high fidelity 0.018 '' fiberoptic pre ssure monitoring guide wire, respectively. Excellent steady-state phas ic intracoronary pressure recordings were obtained in all patients wit hin 1 min after start of intravenous adenosine infusion at a rate of 1 40 mu g/kg/min, and compared to Delta Pmax obtained 30 sec after intra coronary administration of papaverine (12 mg LCA, 10 mg RCA). Delta Pm ax was 24 +/- 15 mmHg during adenosine infusion and 24 +/- 15 mmHg aft er papaverine administration. Myocardial fractional flow reserve, calc ulated from these pressure recordings, was 0.75 +/- 0.16 and 0.75 +/- 0.15, respectively, with an individual difference of 0.02 +/- 0.01 bet ween both values (r = 0.99). No important side effects by intravenous infusion of adenosine were observed. Thus intravenous adenosine infusi on at a rate of 140 mu g/kg/min is an excellent and safe alternative f or induction of steady-state maximum coronary hyperemia and therefore is an ideal vasodilator for determination of fractional flow reserve b ased upon pressure recordings. (C) 1996 Wiley-Liss, Inc.