Kodeboina, Monika (2022) Assessment of Coronary Circulation using Bolus and Continuous Thermodilution. [Tesi di dottorato]

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Abstract

Background The IMR method is based on the mean transit time calculated from bolus thermodilution during pharmacologically induced hyperemia. An abnormal IMR of >25 units is a diagnostic criterion for microvascular angina. Intravenous (IV) adenosine has long been the preferred hyperemic drug in the catheterization lab. However, in order to achieve a consistent and sustained adenosine hyperemic response, this necessitates longer infusions, which frequently cause patient discomfort. Papaverine is an alternative to adenosine and it produces stable hyperemic platue required to measure IMR. Using intracoronary papaverine and IV adenosine as the reference standard, we aimed to evaluate the feasibility, accuracy, and reproducibility of IMR measurement. Methods 29 patients were included in the study. The 3 measurements of IMR and CRF are performed using ic papaverine and hyperemic agent and the next 3 measurements are performed using intravenous adenosin. The ratio between the distal coronary pressure and aortic pressure (Pd/Pa) was recorded. Fractional flow reserve and Pd/Pa values from the first measurements of both IC papaverine and IV adenosine are presented for the current analysis. Results IMR measurements using IC papaverine showed excellent reproducibility (mean difference −0.34, limits of agreement −5.93 to 5.26, and ICC of 0.93 (95% CI 0.87 to 0.96) compared to adenosine. Pa was reduced by both papaverine and adenosine. When IC papaverine was used instead of IV adenosine, the time needed to perform CFR/IMR measurements was significantly shortened (3.23 (2.84, 3.78) mins vs. 5.48 (4.94, 7.09) mins; p 0.0001). Neither papaverine nor adenosine administration resulted in any complications. None of the individuals displayed any symptoms when papaverine was being administered. 31% of patients reported experiencing shortness of breath during the IV adenosine administration, while 82% reported chest pain. Conclusion It was feasible to evaluate IMR using intracoronary papaverine, and the results were comparable to those obtained using intravenous adenosine. Papaverine was used as a hyperemic drug, which shortened procedure times, increased IMR reproducibility, and improved patient comfort. The invasive evaluation of the coronary microcirculation in the catheterization laboratory is made simpler by using intracoronary papaverine for the measurement of IMR, which could result in an increase in the use of invasive microcirculation resistance measurements.

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