2013, Number 3
<< Back Next >>
Rev Mex Cardiol 2013; 24 (3)
Intracoronary administration of levosimendan in the coronary fractional flow reserve test
García-Alcántara J, González-Coronado V, Vela-Huerta A
Language: Spanish
References: 34
Page: 130-137
PDF size: 555.79 Kb.
ABSTRACT
Aims: The hemodynamic study of a coronary stenosis of intermediate severity, by testing fraction flow reserve (FFR) is essential in terms of major cardiovascular events in the short and long term. Currently not published in this context the intracoronary application of levosimendan.
Objectives: To determine the hemodynamic effects of intracoronary administration of levosimendan, a vasodilator in the FFR test, compared with intracoronary adenosine.
Material and methods: Were evaluated by FFR, 48 intermediate lesions in major epicardial coronary arteries.
Results: Of the 48 lesions with FFR assessed, the application of adenosine versus intracoronary levosimendan, the percentage of coronary stenosis was 55.83 (± 11.64), intracoronary adenosine FFR 0.8633 (± 0.1130) and 0.8652 FFR intracoronary levosimendan (± 0.1090) correlation coefficient of 0.9859 and 0.9720 quadratic correlation. Demonstrating that induction of vasodilatation is similar, including revascularization positive cases compared FFR ‹ 0.80.
Conclusions: Intracoronary levosimendan in the FFR test showed similarity in the assessment of intermediate coronary stenosis compared with intracoronary adenosine. Levosimendan is an excellent alternative in the induction of coronary hyperemia decisions to regulate physiological revascularization with assistance.
REFERENCES
Crossman DC. The pathophysiology of myocardial ischemia. Heart. 2004; 90: 576-580.
Kassiotis C, Rajabi M et al. Metabolic reserve of the heart: the forgotten link between contraction and coronary flow. Progress Cardiov Dis. 2008; 51: 74-88.
Staley WC, Recchia FA, Lopaschuk GD. Myocardial substrate metabolism in the normal and failing heart. Physiol Rev. 2005; 85: 1093-1129.
Lim MJ, Kern M. Coronary pathophysiology in the cardiac catheterization laboratory. Curr Probl Cardiol. 2006; 31: 493-550.
Barrera C, Escaned J. Fisiología coronaria y utilidad para el cardiólogo intervencionista: medición invasiva de la presión y flujo coronarios. Arch Cardiol Mex. 2005; 75: 335-349.
Epstein FH, Ross R. Atherosclerosis an inflammatory disease. N Engl J Med. 1999; 340: 115-126.
Glass CK, Witztum JL. Atherosclerosis: the road ahead. Cell. 2001; 104: 503-516.
Libby P, Ridker PM et al. Inflammation in atherosclerosis: from pathophysiology to practice. J Am Coll Cardiol. 2009; 54: 2129-2138.
King JY, Ferrara R et al. Pathway analysis of coronary atherosclerosis. Physiol genomics. 2005; 23: 103-118.
Hau WK. Routine pressure-derived fractional flow reserve guidance: from diagnostic to everyday practice. J Invasive Cardiol. 2006; 18 (5): 240-245.
Jiménez-Navarro MF, Alonso JB et al. Usefulness of fractional flow reserve in multivessel coronary artery disease with intermediate lesions. J Interven Cardiol. 2006; 19: 148-152.
Tobis J, Azarbal B et al. Assessment of intermediate severity coronary lesions in the catheterization laboratory. J Am Coll Cardiol. 2007; 49: 839-848.
López R, Pinar E et al. Utility of the fractional flow reserve in the evaluation of angiographically moderate in-stent restenosis. European Heart Journal. 2004; 25: 2040-2047.
Kern M, De Bruyne B et al. Physiological assessment of coronary artery disease in the cardiac catheterization laboratory. Circulation. 2006; 114: 1321-1341.
Kern MJ, Samady H. Current concepts of integrated coronary physiology in the catheterization laboratory. J Am Coll Cardiol. 2010; 55: 173-185.
Abe M, Tomiyama H, Yoshida H et al. Diastolic fractional flow reserve to assess the functional severity of moderate coronary artery stenoses: comparison with fractional flow reserve and coronary flow velocity reserve. Circulation. 2000; 102: 2365-2370.
Pijls NHJ, De Bruyne B et al. Measurement of fractional flow reserve to assess the functional severity of coronary-artery stenoses. N Engl J Med. 1996; 334: 1703-1708.
Pijls NHJ, De Bruyne B et al. Coronary pressure measurement and fractional flow reserve. Heart. 1998; 80: 539-542.
Bishop AH, Samady H et al. Fractional flow reserve: critical review of an important physiologic adjunct to angiography. Am Heart J. 2004; 147: 792-802.
Melikian N, Del Furia F et al. Physiologic lesion assessment during percutaneous coronary intervention. Cardiol Clin. 2010; 28: 31-54.
De Bruyne B, Sarma J. Fractional flow reserve: a review. Heart. 2008; 94: 949-959.
Lederman SJ, Menegus MA, Greenberg MA. Fractional flow reserve brief review. Acc Curr J Review. 1997; 34-35.
Blows LJ, Redwood SR. The pressure wire in practice. Heart. 2007; 93: 419-422.
Lilleberg J, Nieminen MS, Akkila JL et al. Effects of a new calcium sensitizer, levosimendan, on hemodynamics, coronary blood flow and myocardial substrate utilization early after coronary artery bypass grafting. Eur Heart J. 1998; 19: 660-668.
Pollesello P, Papp Z. The cardioprotective effects of levosimendan: preclinical and clinical evidence. J Cardiovasc Pharmacol. 2007; 50: 257-263.
Nieminen MS, Pollesello P et al. Effects of levosimendan on the energy balance: preclinical and clinical evidence. J Cardiovasc Pharmacol. 2009; 53: 302-310.
Grossini E, Caimmi PP et al. Hemodynamic effect of intracoronary administration of levosimendan in the anesthetized pig. J Cardiovasc Pharmacol. 2005; 46: 333-342.
Jamali IN, Kersten JR et al. Intracoronary levosimendan enhances contractile function of stunned myocardium. Anesth Analg. 1997; 85: 23-29.
Givertz MM, Andreou C et al. Direct myocardial effects of levosimendan in humans with left ventricular dysfunction alteration of force-frequency and relaxation-frequency relationships. Circulation. 2007; 115: 1218-1224.
Antila S, Sundberg S et al. Clinical pharmacology of levosimendan. Clin Pharmacokinet. 2007; 46 (7): 535-552.
De Luca L, Proietti P et al. Levosimendan improves hemodynamics and coronary flow reserve after percutaneous coronary intervention in patients with acute myocardial infarction and left ventricular dysfunction. Am Heart J. 2005; 150: 563-568.
Montes FR, Echeverri D et al. The vasodilatory effects of levosimendan on the human internal mammary artery. Anesth Analg. 2006; 103: 1094-1098.
De Luca L, Colucci WS et al. Evidence-based use of levosimendan in different clinical settings. Eur Heart J. 2006; 27: 1908-1920.
MacCarthy P, Berger A et al. Pressure-derived measurement of coronary flow reserve. J Am Coll Cardiol. 2005; 45: 216-220.