Effect of Caffeine on Myocardial Perfusion Imaging Using Single Photon Emission Computed Tomography During Adenosine Pharmacologic Stress

Abstract

Approximately 6 million cardiac stress tests are performed annually in the United States, of which 2.4 million are pharmacologic stress tests using agents such as adenosine. Adenosine induces differential coronary hyperemia in normal coronary arteries versus coronary arteries with atherosclerosis, allowing single photon emission computed tomography (SPECT) imaging to identify reduced coronary flow in segments subtended by diseased coronary arteries. The potential attenuation of pharmacologic effects of adenosine in the presence of caffeine is why patients are routinely instructed to abstain from caffeine for 12 to 24 hours prior to administration of an adenosine stress test. Failure to abstain from caffeine results in cancellation or delaying of cardiac stress testing, resulting in procedural delays and its impact on patient throughput. Recent studies have evaluated such interaction and suggested a lack of clinically significant effect of caffeine on adenosine-induced hyperemia during myocardial SPECT imaging. This article reviews the clinical pharmacology of caffeine, adenosine, and dipyridamole and effect of caffeine on myocardial stress testing using adenosine and dipyridamole in clinical cardiovascular medicine. The limited published data are conflicting, but some recent publications suggest that myocardial perfusion SPECT imaging using adenosine may not be clinically significantly altered by routine consumption of caffeine, such as a cup of coffee. Although prospective randomized studies would be required to obtain a definitive answer to this question, it appears on the basis of some of the studies reviewed in this article that caffeine consumption prior to myocardial perfusion imaging may not necessitate cancellation or rescheduling of adenosine stress testing.

ASNC imaging guidelines for SPECT nuclear cardiology procedures: Stress, protocols, and tracers

“…The halflife of caffeine varies widely among individuals based on factors such as age, liver function, medication, smoking use, and pregnancy, and is approximately 5 hours in a healthy adult. 52 Caffeine is most commonly found in coffee, tea, soda, energy drinks, and chocolate (Appendix 1). While the caffeine content depends on the particular product and method of preparation, the caffeine contents of some common products are shown in the table in Appendix 1.…”

Southern Hospitality: How We Changed the NPO Practice in the Emergency Department

“…2 Patients preparing for cardiac testing should not ingest caffeine from 12 to 24 hours prior to their procedure. 6 The recommendations suggest a history, examination, and interview that should include pertinent assessment of gastroesophageal reflux disease, dysphagia symptoms, or other gastrointestinal motility disorders, along with the potential for difficult airway management and metabolic disorders (eg, diabetes mellitus) that may increase the risk of regurgitation and pulmonary aspiration. 1,2 A carbohydrate-rich beverage given before anesthesia and surgery alters the metabolism from the overnight fasted state to the fed state, thus reducing the catabolic response (insulin resistance) after surgery, which may have implications for postoperative recovery.…”

Effect of caffeine on SPECT myocardial perfusion imaging during regadenoson pharmacologic stress: Rationale and design of a prospective, randomized, multicenter study

“…[40][41][42] Therefore, oral caffeine capsules were used in this study to standardize the doses among centers, and because some individuals may not tolerate multiple cups of coffee on an empty stomach. The effects of two doses of caffeine were evaluated, 200 and 400 mg, to assess whether there is a dose-response effect of caffeine on the number of reversible defects detected using pharmacologic stress with regadenoson.…”