Intracoronary Adenosine: Dose-Response Relationship With Hyperemia.

Details

Serval ID
serval:BIB_FC7B6C0F0990
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Intracoronary Adenosine: Dose-Response Relationship With Hyperemia.
Journal
Jacc. Cardiovascular Interventions
Author(s)
Adjedj J., Toth G.G., Johnson N.P., Pellicano M., Ferrara A., Floré V., Di Gioia G., Barbato E., Muller O., De Bruyne B.
ISSN
1876-7605 (Electronic)
ISSN-L
1936-8798
Publication state
Published
Issued date
2015
Peer-reviewed
Oui
Volume
8
Number
11
Pages
1422-1430
Language
english
Abstract
OBJECTIVES: The present study sought to establish the dosage of intracoronary (IC) adenosine associated with minimal side effects and above which no further increase in flow can be expected.
BACKGROUND: Despite the widespread adoption of IC adenosine in clinical practice, no wide-ranging, dose-response study has been conducted. A recurring debate still exists regarding its optimal dose.
METHODS: In 30 patients, Doppler-derived flow velocity measurements were obtained in 10 right coronary arteries (RCAs) and 20 left coronary arteries (LCAs) free of stenoses >20% in diameter. Flow velocity was measured at baseline and after 8 ml bolus administrations of arterial blood, saline, contrast medium, and 9 escalating doses of adenosine (4 to 500 μg). The hyperemic value was expressed in percent of the maximum flow velocity reached in a given artery (Q/Qmax, %).
RESULTS: Q/Qmax did not increase significantly beyond dosages of 60 μg for the RCA and 160 μg for LCA. Heart rate did not change, whereas mean arterial blood pressure decreased by a maximum of 7% (p < 0.05) after bolus injections of IC adenosine. The incidence of transient A-V blocks was 40% after injection of 100 μg in the RCA and was 15% after injection of 200 μg in the LCA. The duration of the plateau reached 12 ± 13 s after injection of 100 μg in the RCA and 21 ± 6 s after the injection of 200 μg in the LCA. A progressive prolongation of the time needed to return to baseline was observed. Hyperemic response after injection of 8 ml of contrast medium reached 65 ± 36% of that achieved after injection of 200 μg of adenosine.
CONCLUSIONS: This wide-ranging, dose-response study indicates that an IC adenosine bolus injection of 100 μg in the RCA and 200 μg in the LCA induces maximum hyperemia while being associated with minimal side effects.
Keywords
Adenosine/administration & dosage, Adenosine/adverse effects, Aged, Blood Flow Velocity, Contrast Media/administration & dosage, Coronary Artery Disease/diagnosis, Coronary Artery Disease/physiopathology, Coronary Circulation/drug effects, Coronary Vessels/drug effects, Coronary Vessels/physiopathology, Dose-Response Relationship, Drug, Echocardiography, Doppler, Female, Humans, Hyperemia/physiopathology, Male, Middle Aged, Predictive Value of Tests, Regional Blood Flow, Time Factors, Vasodilation/drug effects, Vasodilator Agents/administration & dosage, Vasodilator Agents/adverse effects
Pubmed
Create date
20/07/2016 17:46
Last modification date
20/08/2019 17:27
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