Author + information
- Sayan Sen,
- Sukhjinder Nijjer,
- Ricardo Petraco,
- Rodney Foale,
- Iqbal Malik,
- Ghada Mikail,
- Alun Hughes,
- Javier Escaned,
- Darrel Francis,
- Jamil Mayet and
- Justin Davies
Adenosine is known to have a variable effect between patients and the optimal dose of adenosine for the induction of hyperaemia is debated. This leads to uncertainty regarding accurate lesion assessment during adenosine based physiologic guided revascularisation. In this study we use wave–intensity analysis to determine if there is a period in the cardiac cycle when the effect of adenosine is more consistent. If such a period can be identified easily its use will lead to less uncertainty by permitting a consistent effect of adenosine during stenosis assessment.
In 51 vessels intra–coronary pressure and flow velocity was measured distal to the stenosis at rest and during adenosine mediated hyperaemia. Intra–coronary resistance and variance of resistance reduction (compared to resistance during the resting complete cardiac cycle) was calculated during the wave–free period and over the complete cardiac cycle during hyperaemia. An F–test was used to compare variances.
Microvascular resistance during the hyperaemic diastolic wave–free period was significantly lower than hyperaemic complete cycle resistance (median hyperaemic wave–free microvascular resistance reduction 75.6% (63.3–87.9%) vs median complete cycle microvascular resistance reduction 53.9% (24.9–82.9%), p<0.001). Furthermore the reduction in microvascular resistance was significantly more consistent than that achieved during the complete cardiac cycle (inter–quartile range wave–free period microvascular resistance reduction 12.3% vs complete cycle 29%, F–test, p<0.001).
Adenosine administration during the diastolic wave–free period consistently provides greater hyperaemia and less variability between patients than that achieved when the entire cardiac cycle is used; suggesting the wave–free period as a more reliable window than the complete cardiac cycle for the adenosine mediated assessment of coronary stenoses.
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.–10:30 a.m.
Session Title: Physiological Assessment
Abstract Category: 38. TCT@ACC–i2: Intravascular Imaging and Physiology
Presentation Number: 2107–231
- 2013 American College of Cardiology Foundation