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Continuous intracoronary versus standard intravenous infusion of adenosine for fractional flow reserve assessment: the HYPEREMIC trial.

连续冠状动脉内与标准静脉输注腺苷用于血流储备分数评估: 充血试验。

  • 影响因子:2.41
  • DOI:10.4244/EIJ-D-18-01067
  • 作者列表:"Elghamaz A","Myat A","de Belder A","Collison D","Cocks K","Stone GW","Oldroyd K
  • 发表时间:2020-09-18
Abstract

AIMS:The aim of this study was to evaluate the accuracy of a continuous intracoronary (IC) adenosine infusion, administered through the novel HYPEREM™IC over-the-wire microcatheter, to measure fractional flow reserve (FFR). METHODS AND RESULTS:The HYPEREMIC trial was a randomised, non-inferiority, crossover study in which patients with intermediate coronary lesions were enrolled for sequential pressure wire studies. FFR was measured using intravenous (IV) (140-180 mcg/kg/min) versus continuous non-weight-adjusted IC (360 mcg/min) adenosine. Patients were randomised and blinded to the order in which they received the adenosine, separated by a washout period. The primary endpoint was the mean hyperaemic FFR. Forty-one patients were enrolled at three UK sites between June and November 2016. The mean (standard deviation) FFR was 0.82 (±0.09) after IC versus 0.84 (±0.09) after IV adenosine. The difference of -0.02 (95% confidence interval [CI]: -0.03 to -0.01) confirmed the non-inferiority (margin <0.05) of IC to IV adenosine. Intracoronary adenosine was associated with a shorter mean time to maximal hyperaemia (difference -44 [95% CI: -59 to -29] seconds; p<0.0001). Chest discomfort was reported in 32/41 (78.0%) patients during IV adenosine versus 12/41 (29.3%) patients during IC adenosine. CONCLUSIONS:Continuous IC adenosine was a reliable, faster and better tolerated method of achieving maximal hyperaemia compared to IV adenosine.

摘要

目的: 本研究的目的是评估连续冠状动脉内 (IC) 腺苷输注的准确性,通过新的HYPEREM给药™IC过线微导管,测量血流储备分数 (FFR)。 方法和结果: 充血试验是一项随机、非劣效性、交叉研究,其中有中等冠状动脉病变的患者被纳入连续压力导丝研究。使用静脉内 (IV) (140-180 mcg/kg/min) 对比连续非重量调整的IC (360 mcg/min) 腺苷测量FFR。患者被随机分组,并根据他们接受腺苷的顺序进行盲法,通过清除期分开。主要终点是平均高血FFR。2016年6月至11月,在3个英国研究中心招募了41例患者。IC后平均 (标准偏差) FFR为0.82 (± 0.09),IV腺苷后为0.84 (± 0.09)。-0.02 (95% 置信区间 [CI]: -0.03至-0.01) 的差异证实了IC与IV腺苷的非劣效性 (界值 <0.05)。冠状动脉内腺苷与达到最大充血的平均时间较短相关 (差异-44 [95% CI: -59至-29] 秒; p<0.0001)。在IV腺苷期间,32/41 (78.0%) 患者报告了胸部不适,而在IC腺苷期间,12/41 (29.3%) 患者报告了胸部不适。 结论: 与IV腺苷相比,连续IC腺苷是实现最大充血的可靠、快速和更好的耐受性方法。

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影响因子:2.41
发表时间:2020-06-12
DOI:10.4244/EIJ-D-18-01138
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METHODS:AIMS:Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS:Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS:In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.

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影响因子:1.67
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DOI:10.2174/1573403X15666190513105231
作者列表:["Dev M","Sharma M","Rana N"]

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心脏影像技术方向

心脏结构和心脏血流的可视化,用于诊断评估或通过内窥镜、放射性核素成像等技术来指导心脏手术。

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