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Published on: February 3, 2021
Comparing invasive hemodynamic responses in adenosine hyperemia versus physical exercise stress in chronic coronary
Christopher M Cook1, James P Howard2, Yousif Ahmad2
1Imperial College London, London, UK; Essex Cardiothoracic Centre, Basildon, UK.
Insights
Intravenous adenosine hyperemia and physical exercise yield distinct hemodynamic responses in patients with coronary artery disease. These differences impact systemic, coronary, and microcirculatory measures, influencing diagnostic interpretations.
Area of Science:
- Cardiovascular Physiology
- Interventional Cardiology
- Diagnostic Imaging
Background:
- Adenosine hyperemia is crucial for assessing obstructive coronary artery disease in chronic coronary syndrome (CCS).
- Understanding hemodynamic differences between pharmacological and physiological stress is vital for accurate patient assessment.
Purpose of the Study:
- To compare systemic, coronary, and microcirculatory hemodynamic responses during intravenous (IV) adenosine hyperemia versus physical exercise stress.
- To evaluate the impact of different hyperemia methods on pressure-flow dynamics in CCS patients with coronary stenosis.
Main Methods:
- Twenty-three CCS patients with single-vessel coronary stenosis underwent invasive hemodynamic monitoring during cardiac catheterization.
- Continuous trans-stenotic coronary pressure-flow measurements were recorded during both IV adenosine infusion and supine physical exercise.
- Systemic, coronary, and microcirculatory hemodynamic parameters were compared between the two stress modalities.
Main Results:
- Intravenous adenosine hyperemia resulted in significantly lower mean aortic pressure, distal coronary pressure, and rate-pressure product compared to exercise stress.
- Microvascular resistance was lower during adenosine hyperemia, while coronary flow velocity was higher.
- Temporal hemodynamic changes differed significantly between adenosine and exercise, indicating distinct physiological responses.
Conclusions:
- Invasive hemodynamic responses during IV adenosine hyperemia and physical exercise stress differ significantly in patients with CCS and coronary stenosis.
- These discrepancies extend across systemic, coronary, and microcirculatory compartments, highlighting the importance of considering the stress modality used in hemodynamic assessments.
Objectives:
Adenosine hyperemia is an integral component of the physiological assessment of obstructive coronary artery disease in patients with chronic coronary syndrome (CCS). The aim of this study was to compare systemic, coronary and microcirculatory hemodynamics between intravenous (IV) adenosine hyperemia versus physical exercise stress in patients with CCS and coronary stenosis.
Methods:
Twenty-three patients (mean age, 60.6 ± 8.1 years) with CCS and single-vessel coronary stenosis underwent cardiac catheterization. Continuous trans-stenotic coronary pressure-flow measurements were performed during: i) IV adenosine hyperemia, and ii) physical exercise using a catheter-table-mounted supine ergometer. Systemic, coronary and microcirculatory hemodynamic responses were compared between IV adenosine and exercise stimuli.
Results:
Mean stenosis diameter was 74.6% ± 10.4. Median (interquartile range) FFR was 0.54 (0.44-0.72). At adenosine hyperemia versus exercise stress, mean aortic pressure (Pa, 91 ± 16 mmHg vs 99 ± 15 mmHg, p < 0.0001), distal coronary pressure (Pd, 58 ± 21 mmHg vs 69 ± 24 mmHg, p < 0.0001), trans-stenotic pressure ratio (Pd/Pa, 0.63 ± 0.18 vs 0.69 ± 0.19, p < 0.0001), microvascular resistance (MR, 2.9 ± 2.2 mmHg.cm-1.sec-1 vs 4.2 ± 1.7 mmHg.cm-1.sec-1, p = 0.001), heart rate (HR, 80 ± 15 bpm vs 85 ± 21 bpm, p = 0.02) and rate-pressure product (RPP, 7522 ± 2335 vs 9077 ± 3200, p = 0.0001) were all lower. Conversely, coronary flow velocity (APV, 23.7 ± 9.5 cm/s vs 18.5 ± 6.8 cm/s, p = 0.02) was higher. Additionally, temporal changes in Pa, Pd, Pd/Pa, MR, HR, RPP and APV during IV adenosine hyperemia versus exercise were all significantly different (p < 0.05 for all).
Conclusions:
In patients with CCS and coronary stenosis, invasive hemodynamic responses differed markedly between IV adenosine hyperemia versus physical exercise stress. These differences were observed across systemic, coronary and microcirculatory hemodynamics.
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