Efficacy of combined administration of intracoronary papaverine plus intravenous adenosine 5′-triphosphate in assessment of fractional flow reserve

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• 作者：Takeshi Nishi ; MD ; ^{takeshi24@hotmail.co.jp" class="auth_mail" title="E-mail the corresponding author} ; Hideki Kitahara ; MD ; Yo Iwata ; MD ; Yoshihide Fujimoto ; MD ; Takashi Nakayama ; MD ; Masayuki Takahara ; MD ; Kazumasa Sugimoto ; MD ; Yoshio Kobayashi ; MD ; FJCC
• 关键词：Fractional flow reserve ; Hyperemia ; Papaverine
• 刊名：Journal of Cardiology
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：68
• 期：6
• 页码：512-516
• 全文大小：370 K

文摘

Inducing maximal coronary hyperemia is important to measure fractional flow reserve (FFR) accurately. Intravenous adenosine and adenosine 5′-triphosphate (ATP) have been used to achieve maximal hyperemia. However, they may not induce maximal hyperemia in all patients. The present study evaluated the combined effect of intracoronary papaverine and intravenous ATP on FFR measurements.

Methods

FFR measurements with administration of intracoronary papaverine (12 mg in the left coronary artery and 8 mg in the right coronary artery), intravenous ATP (140 μg/kg/min), and combined administration of intracoronary papaverine and intravenous ATP were performed in 51 patients with 57 intermediate lesions.

Results

The mean FFR after intravenous ATP was higher compared to intracoronary papaverine and intravenous ATP plus intracoronary papaverine (0.76 ± 0.13 vs. 0.75 ± 0.13 vs. 0.75 ± 0.13, p = 0.01). FFR-positive lesions (FFR ≤0.80) were observed more frequently with intravenous ATP plus intracoronary papaverine compared to intravenous ATP (64.9% vs. 47.4%, p = 0.02). Of 32 and 25 FFR-negative lesions with intravenous ATP and intracoronary papaverine, 11 (34%) and 7 (28%) had positive FFR after administration of intravenous ATP plus intracoronary papaverine. No ventricular tachycardia or ventricular fibrillation was observed after administration of intracoronary papaverine.

Conclusions

Maximal hyperemia may not be induced with intravenous ATP in all lesions. When sufficient hyperemia is doubtful during intravenous infusion of ATP, additional intracoronary administration of papaverine may be a possible option.