Author + information
- Received February 12, 2015
- Revision received March 30, 2015
- Accepted April 9, 2015
- Published online September 1, 2015.
- Julien Adjedj, MD∗,
- Gabor G. Toth, MD∗,
- Nils P. Johnson, MD†,
- Mariano Pellicano, MD∗,
- Angela Ferrara, MD∗,
- Vincent Floré, MD, PhD∗,
- Giuseppe Di Gioia, MD∗,
- Emanuele Barbato, MD, PhD∗,
- Olivier Muller, MD, PhD‡ and
- Bernard De Bruyne, MD, PhD∗∗ ()
- ∗Cardiovascular Centre Aalst, OLV Clinic Aalst, Aalst, Belgium
- †Weatherhead PET Center for Preventing and Reversing Atherosclerosis, Division of Cardiology, Department of Medicine, University of Texas Medical School and Memorial Hermann Hospital, Houston, Texas
- ‡Department of Cardiology, Hopital Cantonal Universitaire Vaudois, Lausanne, Switzerland
- ↵∗Reprint requests and correspondence:
Dr. Bernard De Bruyne, Cardiovascular Centre Aalst, OLV-Clinic, Moorselbaan, 164, B-9300 Aalst, Belgium.
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.
- coronary flow measurements
- Doppler-derived flow velocity
- dose-response curve
- fractional flow reserve
- intracoronary adenosine
Dr. Adjedj was supported by a grant from the Fédération Francaise de Cardiologie. Dr. Johnson has received significant research support (to institution) from St. Jude Medical and Volcano Corporation. Dr. De Bruyne has received consultancy fees (to institution) from St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Adjedj and Toth contributed equally to this work.
- Received February 12, 2015.
- Revision received March 30, 2015.
- Accepted April 9, 2015.
- American College of Cardiology Foundation