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Intracoronary bolus of 100 mc of sodium nitroprusside (IC–NTP) achieves the same amount of coronary hyperemia and is better tolerated than intravenous infusion of adenosine (IVA) for fractional flow reserve (FFR) studies. However; it usually causes significant short–lasting decrease in systemic arterial blood pressure. This study compared FFR response and systemic effects of two doses of IC–NTP: 50 and 100 mcg.
FFR, arterial blood pressure (BP) and heart rate (HR) were measured after sequential intracoronary boluses of 50 and 100 mcg of NTP (injected over <3 seconds and spaced 60 seconds apart) followed by IVA (140 mcg/kg/min for 120 seconds). Conventional FFR wires (Prime Wire, Volcano) and guiding catheters were used.
27 lesions were assessed in 14 patients (mean age 61.7±4.7 years). Mean FFR values after 50 mcg IC–NTP, 100 mcg IC–NTP and IVA were not statistically different (0.795±0.102; 0.798±0.100; 0.802±0.0100; F=0.590, P=0.897). Correlation of FFR values obtained after 50 and 100 mcg of IC–NTP was excellent (r=.987, p<0.001). IC–NTP at a dose of 50 mcg decreased systolic and mean arterial pressures only by 3% and 1 %; respectively. Diastolic blood pressure was not affected. Hemodynamic effects were not statistically significant. IC–NTP at a dose of 100 mcg significantly decreased systolic blood pressure by 13%, t=3.32, p=0.02. Mean blood pressure decreased by 5% (t=1.6, p=0.06). Diastolic blood pressure was not affected. After both doses of IC–NTP, HR increased by about 6% which was not statistically significant. No patient noted any unpleasant side effects after any dose of IC–NTP.
Intracoronary bolus of 50 mcg IC–NTP results in similar coronary hyperemia and FFR values as 100 mcg. This lower dose of IC–NTP exerts less systemic hemodynamic effects and probably should be preferred especially when evaluating patients who have low systemic blood pressure.
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.–10:30 a.m.
Session Title: Physiological Assessment
Abstract Category: 47. TCT@ACC–i2: Coronary Intervention, Devices
Presentation Number: 2107–230
- 2013 American College of Cardiology Foundation