Efficacy and Safety of High-Dose Intracoronary Adenosine Injection in Fractional Flow Reserve Assessment.

IF 1.8 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Acta Cardiologica Sinica Pub Date : 2022-09-01 DOI:10.6515/ACS.202209_38(5).20220309A

Chien-Boon Jong, Min-Tsun Liao, Tsui-Shan Lu, Shih-Wei Meng, Chun-Kai Chen, Ya-Chin Tsai, Jui-Cheng Kuo, Chih-Cheng Wu

{"title":"Efficacy and Safety of High-Dose Intracoronary Adenosine Injection in Fractional Flow Reserve Assessment.","authors":"Chien-Boon Jong, Min-Tsun Liao, Tsui-Shan Lu, Shih-Wei Meng, Chun-Kai Chen, Ya-Chin Tsai, Jui-Cheng Kuo, Chih-Cheng Wu","doi":"10.6515/ACS.202209_38(5).20220309A","DOIUrl":null,"url":null,"abstract":"Background: The recommended dosage of intracoronary adenosine in fractional flow reserve (FFR) assessment is controversial. High-dose adenosine may overcome the biological variability of adenosine response in hyperemia.Objectives: We aimed to test the efficacy and safety of a high-dose escalation protocol at our institute.Methods: Using the adenosine dose escalation protocol, the percentages of FFR ≤ 0.75 and 0.80 after high-dose escalation were compared with those at conventional doses. The chi-squared test was used to evaluate the accuracy of FFR values with the tested doses by comparing them with the results of a non-invasive pretest.Results: A total of 87 patients (130 vessels) were included, and protocol adherence was 93.1%. High-dose intracoronary adenosine was injected in 78.5% of the vessels. The dose escalation strategy was well-tolerated without serious complications. The positive rate increased significantly after conducting the protocol compared to that with a conventional dose (28.2% vs. 23.6% with an FFR threshold of 0.75, and 48.7% vs. 42.5% with a threshold of 0.80, both p < 0.05). In the validation cohort, only FFR ≤ 0.75 was associated with the binary result of the non-invasive pretest (p < 0.01 vs. p = 0.37). The high-dose adenosine escalation strategy did not increase the accuracy of FFR (77.8% vs. 75.6% in conventional dose and high-dose adenosine, respectively).Conclusions: The use of a high-dose escalation strategy increased the positive rate in FFR assessments.","PeriodicalId":6957,"journal":{"name":"Acta Cardiologica Sinica","volume":"38 5","pages":"553-563"},"PeriodicalIF":1.8000,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9479048/pdf/acs-38-553.pdf","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Acta Cardiologica Sinica","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.6515/ACS.202209_38(5).20220309A","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

Abstract

Background: The recommended dosage of intracoronary adenosine in fractional flow reserve (FFR) assessment is controversial. High-dose adenosine may overcome the biological variability of adenosine response in hyperemia.

Objectives: We aimed to test the efficacy and safety of a high-dose escalation protocol at our institute.

Methods: Using the adenosine dose escalation protocol, the percentages of FFR ≤ 0.75 and 0.80 after high-dose escalation were compared with those at conventional doses. The chi-squared test was used to evaluate the accuracy of FFR values with the tested doses by comparing them with the results of a non-invasive pretest.

Results: A total of 87 patients (130 vessels) were included, and protocol adherence was 93.1%. High-dose intracoronary adenosine was injected in 78.5% of the vessels. The dose escalation strategy was well-tolerated without serious complications. The positive rate increased significantly after conducting the protocol compared to that with a conventional dose (28.2% vs. 23.6% with an FFR threshold of 0.75, and 48.7% vs. 42.5% with a threshold of 0.80, both p < 0.05). In the validation cohort, only FFR ≤ 0.75 was associated with the binary result of the non-invasive pretest (p < 0.01 vs. p = 0.37). The high-dose adenosine escalation strategy did not increase the accuracy of FFR (77.8% vs. 75.6% in conventional dose and high-dose adenosine, respectively).

Conclusions: The use of a high-dose escalation strategy increased the positive rate in FFR assessments.

查看原文本刊更多论文

大剂量冠状动脉内腺苷注射在分数血流储备评估中的有效性和安全性

背景：冠状动脉内腺苷在分数血流储备（FFR）评估中的推荐剂量存在争议。大剂量腺苷可克服高血流状态下腺苷反应的生物变异性：我们的目的是在本研究所测试高剂量升级方案的有效性和安全性：方法：采用腺苷剂量递增方案，将高剂量递增后FFR≤0.75和0.80的百分比与常规剂量进行比较。通过与无创预检结果进行比较，采用卡方检验来评估测试剂量下 FFR 值的准确性：结果：共纳入87名患者（130条血管），方案依从性为93.1%。78.5%的血管注射了高剂量冠脉内腺苷。剂量升级策略的耐受性良好，未出现严重并发症。与常规剂量相比，采用该方案后阳性率明显增加（FFR阈值为0.75时为28.2%对23.6%，阈值为0.80时为48.7%对42.5%，P均<0.05）。在验证队列中，只有 FFR ≤ 0.75 与无创预检的二元结果相关（p < 0.01 vs. p = 0.37）。大剂量腺苷升级策略并未提高FFR的准确率（常规剂量和大剂量腺苷的准确率分别为77.8%和75.6%）：结论：使用大剂量腺苷升级策略提高了FFR评估的阳性率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Acta Cardiologica Sinica 医学-心血管系统

CiteScore

2.90

自引率

15.80%

发文量

144

审稿时长

>12 weeks

期刊介绍： Acta Cardiologica Sinica welcomes all the papers in the fields related to cardiovascular medicine including basic research, vascular biology, clinical pharmacology, clinical trial, critical care medicine, coronary artery disease, interventional cardiology, arrythmia and electrophysiology, atherosclerosis, hypertension, cardiomyopathy and heart failure, valvular and structure cardiac disease, pediatric cardiology, cardiovascular surgery, and so on. We received papers from more than 20 countries and areas of the world. Currently, 40% of the papers were submitted to Acta Cardiologica Sinica from Taiwan, 20% from China, and 20% from the other countries and areas in the world. The acceptance rate for publication was around 50% in general.