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Updated: Jan 19, 2026
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
[Adenosine for pulmonary vasodilator testing in children with idiopathic pulmonary arterial hypertension]
Li-jun Fu1, Ai-qing Zhou, Ying Guo
1Department of Cardiology, Shanghai Children's Medical Center, Medical College of Shanghai Jiao Tong University, Shanghai 200127, China.
Insights
Adenosine effectively assesses pulmonary vasodilator reserve in pediatric idiopathic pulmonary arterial hypertension (IPAH). This safe and rapid method helps manage children with IPAH.
Area of Science:
- Pediatric Cardiology
- Pulmonary Hypertension Research
- Hemodynamic Assessment
Context:
- Idiopathic pulmonary arterial hypertension (IPAH) requires careful management, with pulmonary vascular reactivity assessment being crucial.
- Pediatric patients with IPAH, particularly those in WHO functional classes II to III, need specific diagnostic approaches.
- Understanding vasodilator response is key to treatment strategies in pediatric IPAH.
Purpose:
- To investigate the indications and methodology for pulmonary vasodilator testing in children diagnosed with IPAH.
- To evaluate the effectiveness and safety of adenosine infusion for assessing pulmonary vascular reactivity in pediatric IPAH patients.
- To determine the response criteria and potential adverse effects of adenosine testing in this population.
Summary:
- A cohort of 15 pediatric patients with IPAH underwent right heart catheterization with adenosine infusion for vasodilator testing.
- Adenosine was administered incrementally, with responders defined by a significant drop in mean pulmonary artery pressure (mPAP).
- Three patients responded to adenosine, while twelve did not; adverse effects were transient and mild.
Impact:
- Adenosine serves as a safe and effective agent for the rapid assessment of vasodilator reserve in pediatric IPAH.
- The findings support the use of adenosine testing in the clinical management of children with idiopathic pulmonary arterial hypertension.
- This study contributes to optimizing diagnostic protocols for pediatric pulmonary vascular diseases.
Objective:
The assessment of pulmonary vascular reactivity plays an important role in the management of idiopathic pulmonary arterial hypertension (IPAH). The aim of this study was to explore the indications and methodology of pulmonary vasodilator testing in children with IPAH.
Methods:
From October 2009 to June 2011, a cohort of pediatric patients with IPAH in WHO functional classes II to III were enrolled in the study. Right heart catheterization was performed in all patients. After baseline hemodynamics were obtained, adenosine infusions were started at a dose of 50 µg/(kg·min), increased by 25 µg/(kg·min) at 2 min intervals to a maximum of 250 µg/(kg·min) or until a positive acute response.
Results:
A total of 15 patients with IPAH were enrolled in the study. The mean age of the patients was 6.3 yrs. Mean pulmonary artery pressure (mPAP) was (67.1 ± 15.9) mm Hg. Pulmonary capillary wedge pressure (PCWP) was (9.7 ± 2.9) mm Hg. Pulmonary vascular resistance index (PVRI) was (17.9 ± 7.5) Wood U·m(2). Three patients were responders, defined as a fall in mPAP of at least 10 mm Hg to a pressure level of 40 mm Hg or lower. Twelve patients were nonresponders according to the same criteria. Five out of the 15 patients experienced adverse effects, including chest discomfort (n = 1), systemic hypotension (n = 3) and bradycardia (n = 1). All side effects abated within 30-60 s of the discontinuation of the adenosine infusion.
Conclusion:
Adenosine is an effective vasodilator in children with IPAH and can be used for safe and rapid assessment of vasodilator reserve in these patients.
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