Comparison of Efficacy Between the Intracoronary Continuous Infusion Method and the Intravenous Continuous Infusion Method of Adenosine to Induce the Maximal Hyperemia for Fractional Flow Reserve Measurement.

초록

Background: Inducing steady-state and maximal coronary hyperemia without adverse effects is essential to measure the fractional flow reserve (FFR). We compared the efficacy among the methods of intracoronary (IC) bolus infusion (ICB), intravenous continuous infusion (IVC), and IC continuous infusion (ICC) of adenosine during measurement of the FFR, which was newly developed for inducing hyperemia in our laboratory without additional procedures. Methods: In 29 patients with 30 intermediate lesions, hyperemia was induced successively by the ICB method (48 g in the left coronary artery, 36 g in the right coronary artery), and the IVC method (140 g/min per kilogram) via the femoral vein. After completion of the IVC method, an IC microcatheter (Progreat Microcatheter System, Terumo, Japan) was advanced, and the tip of the microcatheter was positioned at the coronary ostium. During measurement of the FFR, ICC of adenosine via the microcatheter was performed with different infusion rates (60, 120, 180, 240, 300, and 360 g/min). Results: During the ICC method, the proximal coronary pressure showed no significant change among baselines and during the infusion of adenosine. The FFR measured by the IVC method was lower than that of the ICB method (0.766 0.098 vs 0.788 0.080, respectively; p 0.001). Chest pain or atrioventricular block occurred in 5 patients during the IVC method. The FFR induced by the ICC method using 180, 240, 300, and 360 g/min were significantly lower than by the IVC method (0.742 0.105, vs 0.766 0.098, p 0.001; 0.738 0.104, p 0.001; 0.732 0.1105, p 0.001; 0.729 0.109, p 0.001; respectively) without adverse complications and keeping steady-state hyperemia during ICC of adenosine. Times to inducing optimal hyperemia (90% of maximal hyperemia) by the ICC method was more rapid than that by the IVC method using 120, 180, 240, 300, 360 g/min (24 11 seconds vs 68 37 seconds, p 0.001; 19 7 seconds, p