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Feasibility and Improved Diagnostic Yield of Intracoronary Adenosine to Assess Microvascular Dysfunction With Bolus
Hernan Mejia-Renteria1, Asad Shabbir1, Ivan J Nuñez-Gil1
1Cardiology Department, Hospital Clínico San Carlos, IDISSC Universidad Complutense de Madrid Spain.
Insights
High-dose intracoronary adenosine (HDIC) provides superior coronary microcirculatory assessment compared to intravenous adenosine. HDIC offers enhanced hyperemia, shorter procedure times, and better patient tolerance for myocardial ischemia diagnosis.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Diagnostic Imaging
Background:
- Established methods for coronary microcirculatory assessment include bolus thermodilution and intravenous adenosine.
- Current adoption is limited by procedural time and patient discomfort associated with intravenous adenosine.
- Investigating intracoronary versus intravenous adenosine is crucial for optimizing diagnostic procedures.
Purpose of the Study:
- To compare intracoronary and intravenous adenosine for coronary microcirculatory assessment using bolus thermodilution.
- To evaluate differences in microcirculatory indices, procedural time, and patient side effects.
- To determine the optimal adenosine administration route for patients with myocardial ischemia and nonobstructive coronary arteries.
Main Methods:
- Prospective, observational study involving 102 patients with suspected myocardial ischemia and nonobstructive coronary arteries.
- Measurements included mean transit time, coronary flow reserve, and index of microcirculatory resistance.
- Comparison of low-dose intracoronary adenosine, high-dose intracoronary adenosine (HDIC), and intravenous adenosine administration.
Main Results:
- HDIC induced greater hyperemia and a shorter hyperemic mean transit time compared to low-dose intracoronary and intravenous adenosine (P<0.0001).
- Coronary flow reserve was higher and index of microcirculatory resistance was lower with HDIC (P<0.05).
- Intracoronary adenosine resulted in shorter procedure times (P<0.0001) and was better tolerated, with less chest pain (P<0.01).
Conclusions:
- High-dose intracoronary adenosine enhances hyperemia induction for coronary microcirculatory assessment in relevant patient populations.
- Intracoronary adenosine administration is associated with reduced procedural times compared to intravenous administration.
- Intracoronary adenosine offers improved patient tolerability, making it a preferred method for microcirculatory assessment.
Background:
Bolus thermodilution and intravenous adenosine are established methods for coronary microcirculatory assessment. Yet, its adoption remains low, partly due to procedural time and patient discomfort associated with intravenous adenosine. We investigated differences between intracoronary and intravenous adenosine using bolus thermodilution in terms of microcirculatory indices, procedural time, and side effects associated with adenosine in patients with myocardial ischemia and nonobstructive coronary arteries.
Methods And Results:
In this prospective, observational study, 102 patients with suspected myocardial ischemia and nonobstructive coronary arteries underwent measurements of mean transit time, coronary flow reserve, index of microcirculatory resistance, procedure time and patient tolerability with low-dose intracoronary adenosine, high-dose intracoronary adenosine (HDIC), and intravenous adenosine. HDIC induced greater hyperemia compared with low-dose intracoronary IC adenosine and intravenous adenosine with a shorter hyperemic mean transit time, P<0.0001. Coronary flow reserve was higher and index of microcirculatory resistance lowest with HDIC, compared with low-dose intracoronary IC adenosine and intravenous adenosine, P<0.05. Low coronary flow reserve was downgraded from 21% with intravenous adenosine to 10% with HDIC adenosine (P=0.031); high index of microcirculatory resistance was downgraded from 23% with intravenous adenosine to 14% with HDIC (P=0.098). Intracoronary adenosine was associated with lower procedural times (P<0.0001). More patients experienced chest pain with intravenous adenosine (P<0.01) and the chest pain intensity was higher compared with intracoronary adenosine (P<0.0001).
Conclusions:
In patients with suspected myocardial ischemia and nonobstructive coronary arteries undergoing coronary microcirculatory assessment with bolus thermodilution, the use of HDIC compared with intravenous adenosine was associated with enhanced induction of hyperemia. The use of intracoronary adenosine allowed for a shorter procedure time and was better tolerated.
Registration+:
URL: clinicaltrials.gov; Unique Identifier: NCT04827498.
