Circulation, Vol 82, 1595-1606, Copyright © 1990 by American Heart Association
RF Wilson, K Wyche, BV Christensen, S Zimmer and DD Laxson
Adenosine is a potent vasodilator used extensively to study the coronary
circulation of animals. Its use in humans, however, has been hampered by
lack of knowledge about its effects on the human coronary circulation and
by concern about its safety. We investigated in humans the effects of
adenosine, administered by intracoronary bolus (2-16 micrograms),
intracoronary infusion (10-240 micrograms/min), or intravenous infusion
(35-140 micrograms/kg/min) on coronary and systemic hemodynamics and the
electrocardiogram. Coronary blood flow velocity (CBFV) was measured with a
3F coronary Doppler catheter. The maximal CBFV was determined with
intracoronary papaverine (4.5 +/- 0.2.resting CBFV). In normal left
coronary arteries (n = 20), 16- micrograms boluses of adenosine caused
coronary hyperemia similar to that caused by papaverine (4.6 +/-
0.7.resting CBFV). In the right coronary artery (n = 5), 12-micrograms
boluses caused maximal hyperemia (4.4 +/- 1.0.resting CBFV). Intracoronary
boluses caused a small, brief decrease in arterial pressure (similar to
that caused by papaverine) and no changes in heart rate or in the
electrocardiogram. The duration of hyperemia was much shorter after
adenosine than after papaverine administration. Intracoronary infusions of
80 micrograms/min or more into the left coronary artery (n = 6) also caused
maximal hyperemia (4.4 +/- 0.1.resting CBFV), and doses up to 240
micrograms/min caused a minimal decrease in arterial pressure (-6 +/- 2 mm
Hg) and no significant change in heart rate or in electrocardiographic
variables. Intravenous infusions in normal patients (n = 25) at 140
micrograms/kg/min caused coronary vasodilation similar to that caused by
papaverine in 84% of patients (4.4 +/- 0.9.resting CBFV). At submaximal
infusion rates, however, CBFV often fluctuated widely. During the
140-micrograms/kg/min infusion, arterial pressure decreased 6 +/- 7 mm Hg,
and heart rate increased 24 +/- 14 beats/min. One patient developed 1 cycle
of 2:1 atrioventricular block, but otherwise, the electrocardiogram did not
change. In eight patients with microvascular vasodilator dysfunction (delta
CBFV, less than 3.5 peak/resting velocity after a maximally vasodilating
dose of intracoronary papaverine), the dose-response characteristics to
intracoronary boluses and intravenous infusions of adenosine were similar
to those found in normal patients.(ABSTRACT TRUNCATED AT 400 WORDS)
ARTICLES
Effects of adenosine on human coronary arterial circulation
Department of Medicine, University of Minnesota, Minneapolis.
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G. Stankovic, A. Manginas, V. Voudris, G. Pavlides, G. Athanassopoulos, M. Ostojic, and D. V. Cokkinos Prediction of Restenosis After Coronary Angioplasty by Use of a New Index : TIMI Frame Count/Minimal Luminal Diameter Ratio Circulation, March 7, 2000; 101(9): 962 - 968. [Abstract] [Full Text] [PDF]
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A. Jeremias, S. D. Filardo, R. J. Whitbourn, R. S. Kernoff, A. C. Yeung, P. J. Fitzgerald, and P. G. Yock Effects of Intravenous and Intracoronary Adenosine 5'-Triphosphate as Compared With Adenosine on Coronary Flow and Pressure Dynamics Circulation, January 25, 2000; 101(3): 318 - 323. [Abstract] [Full Text] [PDF]
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C. Seiler, M. Fleisch, M. Billinger, and B. Meier Simultaneous intracoronary velocity- and pressure-derived assessment of adenosine-induced collateral hemodynamics in patients with one- to two-vessel coronary artery disease J. Am. Coll. Cardiol., December 1, 1999; 34(7): 1985 - 1994. [Abstract] [Full Text] [PDF]
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S. J. Duffy, S. F. Castle, R. W. Harper, and I. T. Meredith Contribution of Vasodilator Prostanoids and Nitric Oxide to Resting Flow, Metabolic Vasodilation, and Flow-Mediated Dilation in Human Coronary Circulation Circulation, November 9, 1999; 100(19): 1951 - 1957. [Abstract] [Full Text] [PDF]
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C. Caiati, C. Montaldo, N. Zedda, R. Montisci, M. Ruscazio, G. Lai, M. Cadeddu, L. Meloni, and S. Iliceto Validation of a new noninvasive method (contrast-enhanced transthoracic second harmonic echo Doppler) for the evaluation of coronary flow reserve: Comparison with intracoronary Doppler flow wire J. Am. Coll. Cardiol., October 1, 1999; 34(4): 1193 - 1200. [Abstract] [Full Text] [PDF]
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A. L'Abbate, G. Sambuceti, S. Haunso, and J. Schneider-Eicke Methods for evaluating coronary microvasculature in humans Eur. Heart J., September 2, 1999; 20(18): 1300 - 1313. [PDF]
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J. Bartunek, W. Wijns, G. R. Heyndrickx, and B. de Bruyne Effects of Dobutamine on Coronary Stenosis Physiology and Morphology : Comparison With Intracoronary Adenosine Circulation, July 20, 1999; 100(3): 243 - 249. [Abstract] [Full Text] [PDF]
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J. H. S. Cullen, M. A. Horsfield, C. R. Reek, G. R. Cherryman, D. B. Barnett, and N. J. Samani A myocardial perfusion reserve index in humans using first-pass contrast-enhanced magnetic resonance imaging J. Am. Coll. Cardiol., April 1, 1999; 33(5): 1386 - 1394. [Abstract] [Full Text] [PDF]
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C. E. E. Hanekamp, J. J. Koolen, N. H. J. Pijls, H. R. Michels, and H. J. R. M. Bonnier Comparison of Quantitative Coronary Angiography, Intravascular Ultrasound, and Coronary Pressure Measurement to Assess Optimum Stent Deployment Circulation, March 2, 1999; 99(8): 1015 - 1021. [Abstract] [Full Text] [PDF]
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C. S. Duvernoy, C. Meyer, V. Seifert-Klauss, F. Dayanikli, I. Matsunari, J. Rattenhuber, C. Hoss, H. Graeff, and M. Schwaiger Gender differences in myocardial blood flow dynamics: Lipid profile and hemodynamic effects J. Am. Coll. Cardiol., February 1, 1999; 33(2): 463 - 470. [Abstract] [Full Text] [PDF]
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T. Hozumi, K. Yoshida, T. Akasaka, Y. Asami, Y. Ogata, T. Takagi, S. Kaji, T. Kawamoto, Y. Ueda, and S. Morioka Noninvasive assessment of coronary flow velocity and coronary flow velocity reserve in the left anterior descending coronary artery by Doppler echocardiography: Comparison with invasive technique J. Am. Coll. Cardiol., November 1, 1998; 32(5): 1251 - 1259. [Abstract] [Full Text] [PDF]
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C. Seiler, M. Fleisch, A. Garachemani, and B. Meier Coronary collateral quantitation in patients with coronary artery disease using intravascular flow velocity or pressure measurements J. Am. Coll. Cardiol., November 1, 1998; 32(5): 1272 - 1279. [Abstract] [Full Text] [PDF]
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C. Seiler, M. Billinger, R. Bolli, M. M. Leesar, M. M. Ahmed, M. M. Stoddard, and M. J. Broadbent Adenosine-Induced Preconditioning of Human Myocardium? • Response Circulation, August 25, 1998; 98(8): 824 - 825. [Full Text]
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H. Laine, O. T. Raitakari, H. Niinikoski, O.-P. Pitkanen, H. Iida, J. Viikari, P. Nuutila, and J. Knuuti Early impairment of coronary flow reserve in young men with borderline hypertension J. Am. Coll. Cardiol., July 1, 1998; 32(1): 147 - 153. [Abstract] [Full Text] [PDF]
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T. Hozumi, K. Yoshida, Y. Ogata, T. Akasaka, Y. Asami, T. Takagi, and S. Morioka Noninvasive Assessment of Significant Left Anterior Descending Coronary Artery Stenosis by Coronary Flow Velocity Reserve With Transthoracic Color Doppler Echocardiography Circulation, April 28, 1998; 97(16): 1557 - 1562. [Abstract] [Full Text] [PDF]
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C. Seiler, M. Fleisch, and B. Meier Direct Intracoronary Evidence of Collateral Steal in Humans Circulation, December 16, 1997; 96(12): 4261 - 4267. [Abstract] [Full Text]
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M. Yesil, S. Bayata, N. Postacl, and C. Aydin Acute Electrophysiological Effects of Dipyridamole on Sinus Node Function in Patients with Sick Sinus Syndrome Angiology, December 1, 1997; 48(12): 1051 - 1054. [Abstract] [PDF]
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P. W. Serruys, C. di Mario, J. Piek, E. Schroeder, C. Vrints, P. Probst, B. de Bruyne, C. Hanet, E. Fleck, M. Haude, et al. Prognostic Value of Intracoronary Flow Velocity and Diameter Stenosis in Assessing the Short- and Long-term Outcomes of Coronary Balloon Angioplasty : The DEBATE Study (Doppler Endpoints Balloon Angioplasty Trial Europe) Circulation, November 18, 1997; 96(10): 3369 - 3377. [Abstract] [Full Text]
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G. Sambuceti, M. Marzilli, P. Marraccini, J. Schneider-Eicke, E. Gliozheni, O. Parodi, and A. L'Abbate Coronary Vasoconstriction During Myocardial Ischemia Induced by Rises in Metabolic Demand in Patients With Coronary Artery Disease Circulation, June 17, 1997; 95(12): 2652 - 2659. [Abstract] [Full Text]
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R. Luise, G. Teodori, G. Di Giammarco, E. D'Annunzio, L. Paloscia, A. Barsotti, S. Gallina, M. Contini, G. Vitolla, and A. M. Calafiore Persistence of Mammary Artery Branches and Blood Supply to the Left Anterior Descending Artery Ann. Thorac. Surg., June 1, 1997; 63(6): 1759 - 1764. [Abstract] [Full Text]
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T. R. Bowers, R. E. Stewart, W. W. O'Neill, V. M. Reddy, and R. D. Safian Effect of Rotablator Atherectomy and Adjunctive Balloon Angioplasty on Coronary Blood Flow Circulation, March 4, 1997; 95(5): 1157 - 1164. [Abstract] [Full Text]
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 J. L. Houghton, V. E. Smith, D. S. Strogatz, N. L. Henches, W. M. Breisblatt, and A. A. Carr Effect of African-American Race and Hypertensive Left Ventricular Hypertrophy on Coronary Vascular Reactivity and Endothelial Function Hypertension, March 1, 1997; 29(3): 706 - 714. [Abstract] [Full Text]
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B. de Bruyne, J. Bartunek, S. U. Sys, N. H.J. Pijls, G. R. Heyndrickx, and W. Wijns Simultaneous Coronary Pressure and Flow Velocity Measurements in Humans: Feasibility, Reproducibility, and Hemodynamic Dependence of Coronary Flow Velocity Reserve, Hyperemic Flow Versus Pressure Slope Index, and Fractional Flow Reserve Circulation, October 15, 1996; 94(8): 1842 - 1849. [Abstract] [Full Text]
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M. J. Kern, J. A. Moore, F. V. Aguirre, R. G. Bach, E. A. Caracciolo, T. Wolford, A. F. Khoury, C. Mechem, and T. J. Donohue Determination of Angiographic (TIMI Grade) Blood Flow by Intracoronary Doppler Flow Velocity During Acute Myocardial Infarction Circulation, October 1, 1996; 94(7): 1545 - 1552. [Abstract] [Full Text]
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M. Haude, G. Caspari, D. Baumgart, R. Brennecke, J. Meyer, and R. Erbel Comparison of Myocardial Perfusion Reserve Before and After Coronary Balloon Predilatation and After Stent Implantation in Patients With Postangioplasty Restenosis Circulation, August 1, 1996; 94(3): 286 - 297. [Abstract] [Full Text]
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N. H.J. Pijls, B. de Bruyne, K. Peels, P. H. van der Voort, H. J.R.M. Bonnier, J. Bartunek, and J. J. Koolen Measurement of Fractional Flow Reserve to Assess the Functional Severity of Coronary-Artery Stenoses N. Engl. J. Med., June 27, 1996; 334(26): 1703 - 1708. [Abstract] [Full Text] [PDF]
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W. G. Hundley, R. A. Lange, G. D. Clarke, B. M. Meshack, J. Payne, C. Landau, R. McColl, D. E. Sayad, D. L. Willett, J. E. Willard, et al. Assessment of Coronary Arterial Flow and Flow Reserve in Humans With Magnetic Resonance Imaging Circulation, April 15, 1996; 93(8): 1502 - 1508. [Abstract] [Full Text]
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A. P. Rocchini, R. F. Wilson, P. Marker, and T. Cervenka Metabolic and Hemodynamic Effects of a Graded Intracoronary Insulin Infusion in Normal and Fat Anesthetized Dogs : A Preliminary Study Hypertension, March 1, 1996; 27(3): 354 - 359. [Abstract] [Full Text]
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N. H.J. Pijls, B. Van Gelder, P. Van der Voort, K. Peels, F. A.L.E. Bracke, H. J.R.M. Bonnier, and M. I.H. El Gamal Fractional Flow Reserve : A Useful Index to Evaluate the Influence of an Epicardial Coronary Stenosis on Myocardial Blood Flow Circulation, December 1, 1995; 92(11): 3183 - 3193. [Abstract] [Full Text]
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