020 Comparison of fractional flow reserve measurements obtained using central vs distal peripheral intravenous adenosine infusion to induce hyperaemia

Abstract

Introduction Measurement of fractional flow reserve (FFR) permits physiological evaluation of coronary lesions. Maximal hyperaemia is required and adenosine is most often used for this. The gold standard method is continuous adenosine infusion via a large central (usually femoral) vein. Use of radial access for coronary angiography is now used in over 50% of cases performed in the UK. Hence it is desirable to have an alternative route for adenosine delivery. Peripheral venous access is frequently obtained in the hand, since veins are often most readily accessible here. However concerns exist as to whether delivery from this site would achieve adequate vasodilatation. Our aim was to address this question. Methods Ethical approval and informed consent was obtained. Subjects were selected from patients attending for coronary angiography who were deemed to need a pressure wire to assess an intermediate coronary stenosis. Subjects received intravenous adenosine infusion sequentially by two routes: first, via a 20G hand cannula, and then, after a washout period, via a 6F femoral venous sheath. Adenosine was administered at 140 μg/kg/min for each site. Data interpretation was performed in a blinded manner. Baseline values of FFR were recorded, as was the minimal FFR achieved with adenosine infusion, from each infusion site. Time to peak hyperaemia was also recorded separately for each infusion site. Results 37 coronary artery lesions were evaluated in 23 patients. For the overall group, FFR using hand vein adenosine infusion was 0. 86±0.09; FFR using femoral vein adenosine infusion was 0.85±0.09. Individual paired comparisons of FFR readings using the different routes of adenosine administration are shown in Abstract 020 figures 1 and 2 below. Abstract 020 figure 1 shows FFR using hand vein for adenosine vs FFR using femoral (groin) vein for adenosine-paired data are shown as (x, y) points. The line of unity is shown for a theoretical perfect agreement between the measures. Abstract 020 figure 2 shows a Bland Altman plot of FFR derived from hand vs groin adenosine infusions. Conclusion The use of hand vein adenosine infusion produced very similar values of minimum FFR to those using femoral vein adenosine. These data have important practical implications for patients undergoing transradial procedures who require FFR assessment.