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Age and Vasodilator Response to Different Hyperemic Agents: Adenosine versus Contrast Medium.
Galante, Domenico; Migliaro, Stefano; Di Giusto, Federico; Anastasia, Gianluca; Petrolati, Edoardo; Vicerè, Andrea; Zimbardo, Giuseppe; Cialdella, Pio; Romagnoli, Enrico; Aurigemma, Cristina; Burzotta, Francesco; Trani, Carlo; Martin-Reyes, Roberto; Baptista, Sergio Bravo; Faria, Daniel; Amabile, Nicolas; Raposo, Luis; Crea, Filippo; Leone, Antonio Maria.
Afiliação
  • Galante D; Diagnostic, Interventional and Acute Cardiac Care Unit, Ospedale Isola Tiberina - Gemelli Isola, 00186 Rome, Italy.
  • Migliaro S; Clinical, Interventional and Hemodynamic Cardiology Unit, Aurelia Hospital, 00165 Rome, Italy.
  • Di Giusto F; Cardiology Unit, C. and G. Mazzoni Hospital, 63100 AST Ascoli Piceno, Italy.
  • Anastasia G; Department of Internal Medicine, University of Genoa, 16132 Genova, Italy.
  • Petrolati E; Department of Cardiovascular and Pneumological Sciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
  • Vicerè A; Department of Cardiovascular and Pneumological Sciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
  • Zimbardo G; Cardiologia e Unità terapia intensiva, Policlinico Casilino, 00169 Rome, Italy.
  • Cialdella P; Cardiologia e Unità terapia intensiva, Policlinico Casilino, 00169 Rome, Italy.
  • Romagnoli E; Department of Cardiovascular and Pneumological Sciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
  • Aurigemma C; Department of Cardiovascular Sciences Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy.
  • Burzotta F; Department of Cardiovascular and Pneumological Sciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
  • Trani C; Department of Cardiovascular Sciences Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy.
  • Martin-Reyes R; Department of Cardiovascular and Pneumological Sciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
  • Baptista SB; Department of Cardiovascular Sciences Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy.
  • Faria D; Department of Cardiovascular and Pneumological Sciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
  • Amabile N; Department of Cardiovascular Sciences Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy.
  • Raposo L; Unidad Integral de Cardiologia (UICAR). Hospital Universitario La Luz Quironsalud and Hospital Universitario Fundacion Jimenez Díaz Quironsalud, 28003 Madrid, Spain.
  • Crea F; Cardiology Department, Hospital Prof. Doutor Fernando Fonseca, 2720-276 Amadora, Portugal.
  • Leone AM; Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisboa, Portugal.
Rev Cardiovasc Med ; 25(7): 239, 2024 Jul.
Article em En | MEDLINE | ID: mdl-39139436
ABSTRACT

Background:

Age-related remodelling has the potential to affect the microvascular response to hyperemic stimuli. However, its precise effects on the vasodilatory response to adenosine and contrast medium, as well as its influence on fractional flow reserve (FFR) and contrast fractional flow reserve (cFFR), have not been previously investigated. We investigate the impact of age on these indices.

Methods:

We extrapolated data from the post-revascularization optimization and physiological evaluation of intermediate lesions using fractional flow reserve (PROPHET-FFR) and The Multi-center Evaluation of the Accuracy of the Contrast MEdium INduced Pd/Pa RaTiO in Predicting (MEMENTO) studies. Only lesions with a relevant vasodilatory response to adenosine and contrast medium were considered of interest. A total of 2080 patients, accounting for 2294 pressure recordings were available for analysis. The cohort was stratified into three age terciles. Age-dependent correlations with FFR, cFFR, distal pressure/aortic pressure (Pd/Pa) and instantaneous wave-free ratio (iFR) were calculated. The vasodilatory response was calculated in 1619 lesions (with both FFR and cFFR) as the difference between resting and hyperaemic pressure ratios and correlated with aging. The prevalence of FFR-cFFR discordance was assessed.

Results:

Age correlated positively to FFR (r = 0.062, p = 0.006), but not with cFFR (r = 0.024, p = 0.298), Pd/Pa (r = -0.015, p = 0.481) and iFR (r = -0.026, p = 0.648). The hyperemic response to adenosine (r = -0.102, p ≤ 0.0001) and to contrast medium (r = -0.076, p = 0.0023) showed a negative correlation with age. When adjusted for potential confounders, adenosine induced hyperaemia was negatively associated with age (p = 0.04 vs p = 0.08 for cFFR). Discordance decreased across age terciles (14.64% vs 12.72% vs 10.12%, p = 0.032).

Conclusions:

As compared to adenosine, contrast induced hyperaemia appeared to be less affected by age. cFFR may be considered a more stable and reproducible tool to assess epicardial stenosis in elderly patients. Clinical Trial Registration PROPHET-FFR STUDY, Clinicaltrials.gov (NCT05056662).
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Ano de publicação: 2024 Tipo de documento: Article