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허혈성 심질환에 있어서 아데노신 급속 정맥투여후 관동맥압의 변화에 관한 연구
봉종대,오종용,배성한,신원용,김철현,이광희,최태명,현민수,김성구,권영주 순천향의학연구소 1998 Journal of Soonchunhyang Medical Science Vol.4 No.2
Background: Adenosine interacts with A1 receptors present on the extracellular surface of cardiac cells, activating K+channels in a fashion. It produces coronary vasodilatation and AV nodal block. The half-time is one to six second and has ultra-short action. In ischemic heart disease, fractional flow reserve(FFR) can be achieved safely with intravenous adenosine infusions at a rate of 150㎍/kg/min which cause maximal coronary hyperemia. Purpose: We investigated the patients who have had ischemic heart disease(n=8). After adenosine intravenous administration(150㎍/kg/min), the effect cause maximal hyperemia of coronary artery. During peak maximal hyperemia, we reported clinical findings, coronary hemodynamics and electrocardiogram findings. Methods: After diagnostic coronary angiography and left ventriculography, catheter was advanced into the ostium of coronary artery. We investigated coronary hemodynamics such as systolic coronary artery pressure, diastolic coronary artery pressure, mean coronary artery pressure and heart rate. To assess the use of adenosine for determination of fractional flow reserve, hemodynamics and electrocardiogram were measured at basal state and during peak maximal hyperemia. Results: Symptoms developed 1.5-2 minute after adenosine intravenous administration and each symptom disappeared 2-2.5 minute after adenosine administration. Two patients represented asymptomatic appearance and six patients complained of flushing, chest pain, palpitation and headache. In eight patients with ischemic heart disease, 1.5 minute after venous administration of 150㎍/kg/min of adenosine, coronary artery pressure decreased and heart rate increased significantly. Conduction abnormalities after administration of 150㎍/kg/min of adenosine were transient 2nd degree AV block 2 cases(25%). Conclusions: Adenosine is a potent ultra short-acting vasodilator. Although coronary artery pressure decreased and heart rate increased and mild cardiovascular symptoms occurred after continuous infusion of 150㎍/kg/min of adenosine, it is useful as an agent for determination of fractional flow reserve.