Back to Search
Start Over
Effect of Phentolamine on the Hyperemic Response to Adenosine in Patients With Microvascular Disease
- Source :
- American Journal of Cardiology, 96(12), 1627-1630. Elsevier
- Publication Year :
- 2005
- Publisher :
- Elsevier, 2005.
-
Abstract
- For accurate measurement of the fractional flow reserve (FFR) of the myocardium, the presence of maximum hyperemia is of paramount importance. It has been suggested that the hyperemic effect of the conventionally used hyperemic stimulus, adenosine, could be submaximal in patients who have microvascular dysfunction and that adding α-blocking agents could augment the hyperemic response in these patients. We studied the effect of the nonselective α-blocking agent phentolamine, which was administered in addition to adenosine after achieving hyperemia, in patients who had microvascular disease and those who did not. Thirty patients who were referred for percutaneous coronary intervention were selected. Of these 30 patients, 15 had strong indications for microvascular disease and 15 did not. FFR was measured using intracoronary adenosine, intravenous adenosine, and intracoronary papaverine before and after intracoronary administration of the nonselective α blocker phentolamine. In patients who did not have microvascular disease, no differences in hyperemic response to adenosine were noted, whether or not α blockade was given before adenosine administration; FFR levels before and after phentolamine were 0.76 and 0.75, respectively, using intracoronary adenosine (p = 0.10) and 0.75 and 0.74, respectively, using intravenous adenosine (p = 0.20). In contrast, in patients who had microvascular disease, some increase in hyperemic response was observed after administration of phentolamine; FFR levels decreased from 0.74 to 0.70 using intracoronary adenosine (p = 0.003) and from 0.75 to 0.72 using intravenous adenosine (p = 0.04). Although statistically significant, the observed further decrease in microvascular resistance after addition of phentolamine was small and did not affect clinical decision making in any patient. In conclusion, when measuring FFR, routinely adding an α-blocking agent to adenosine does not affect clinical decision making. © 2005 Elsevier Inc. All rights reserved.
- Subjects :
- Male
Coronary Stenosi
medicine.medical_treatment
Vasodilator Agents
phentolamine, adult
Fractional flow reserve
Injections, Intravenou
Coronary Angiography
Severity of Illness Index
coronary artery blood flow
Papaverine
comparative study
Coronary Vessel
statistical significance
clinical article
transluminal coronary angioplasty, Adenosine
adult
drug effect
article
Middle Aged
Coronary Vessels
microvascular ischemia
Vasodilation
female
priority journal
Injections, Intra-Arterial
adenosine
papaverine
phentolamine
controlled study
diagnostic accuracy
functional assessment
human
hyperemia
male
medical decision making
patient selection
transluminal coronary angioplasty
Adenosine
Adrenergic alpha-Antagonists
Blood Flow Velocity
Coronary Stenosis
Female
Follow-Up Studies
Humans
Hyperemia
Injections
Intra-Arterial
Intravenous
Microcirculation
Phentolamine
Reproducibility of Results
Anesthesia
Injections, Intravenous
Circulatory system
Cardiology
Cardiology and Cardiovascular Medicine
medicine.drug
medicine.medical_specialty
Reproducibility of Result
Follow-Up Studie
Internal medicine
medicine
Adrenergic alpha-Antagonist
business.industry
Vascular disease
Percutaneous coronary intervention
medicine.disease
business
Subjects
Details
- Language :
- English
- ISSN :
- 00029149
- Volume :
- 96
- Issue :
- 12
- Database :
- OpenAIRE
- Journal :
- American Journal of Cardiology
- Accession number :
- edsair.doi.dedup.....719f0e1a1f310251258109acb4724ff9