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(Circulation. 2004;109:1236-1243.)
© 2004 American Heart Association, Inc.

Clinical Investigation and Reports

Coronary Hyperemic Dose Responses of Intracoronary Sodium Nitroprusside

Walter A. Parham, MD; Andre Bouhasin, MD; Jeffrey P. Ciaramita, MD; Souheil Khoukaz, MD; Steven C. Herrmann, MD; Morton J. Kern, MD

From the J. Gerard Mudd Cardiac Catheterization Laboratory, St Louis University Health Sciences Center, St Louis, Mo.

Correspondence to Morton J. Kern, MD, J. Gerard Mudd Cardiac, Catheterization Laboratory, St Louis University Health Sciences Center, 3635 Vista Ave at Grand Blvd, PO Box 15250, St Louis, MO. E-mail kernm{at}slu.edu

Received August 28, 2003; revision received December 10, 2003; accepted December 11, 2003.

Background— Sodium nitroprusside is one of several agents considered effective for treating the no-reflow phenomenon during acute coronary interventions. However, the coronary hyperemic dose responses and systemic hemodynamic effects of intracoronary nitroprusside have yet to be determined in humans. The purpose of this study was to compare the hyperemic and hemodynamic responses of intracoronary nitroprusside to intracoronary adenosine in patients during cardiac catheterization with angiographically normal anterior descending arteries.

Methods and Results— In 21 patients, coronary blood flow velocity (0.014-inch Doppler flow wire), heart rate, and blood pressure were measured in unobstructed left anterior descending coronary arteries at rest, after intracoronary adenosine (30- to 50-µg boluses), and after 3 serial doses (0.3-, 0.6-, and 0.9-µg/kg boluses) of intracoronary nitroprusside. Coronary reserve was calculated as hyperemia/basal coronary flow velocity. In an additional 9 patients with intermediate stenoses (53±7%), 14 fractional flow reserve (FFR) measurements (using 0.014-inch pressure wire) were performed with both intracoronary adenosine and nitroprusside (0.6 µg/kg). Intracoronary nitroprusside produced equivalent coronary hyperemia with a longer duration (25%) compared with intracoronary adenosine. Intracoronary nitroprusside (0.9 µg/kg) decreased systolic blood pressure by <20%, with minimal change in heart rate, whereas intracoronary adenosine had no effect on these parameters. FFR measurements with intracoronary nitroprusside were identical to those obtained with intracoronary adenosine (r=0.97).

Conclusions— Compared with adenosine, intracoronary nitroprusside produces an equivalent but more prolonged coronary hyperemic response in normal coronary arteries. Intracoronary nitroprusside, in doses commonly used for the treatment of the no-reflow phenomenon, can produce sustained coronary hyperemia without detrimental systemic hemodynamics. On the basis of FFR measurements compared with adenosine, sodium nitroprusside also appears to be a suitable hyperemic stimulus for coronary physiological measurements.

Key Words: blood flow • hemodynamics • circulation

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