Effect of maintenance oral theophylline on dipyridamole-thallium-201 myocardial imaging using SPECT and dipyridamole-induced hemodynamic changes

Daley, Patrick; Mahn, Thomas H; Zielonka, Jason S.; Krubsack, Arnold J.; Akhtar, Rashi; Bamrah, Virinderjit S.

doi:10.1016/0002-8703(88)90006-3

Cited by 26 publications

(6 citation statements)

References 15 publications

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“…Bottcher et al [14] and Kubo et al [13] both used dynamic positron emission tomography while Smits et al [18] used thallium myocardial perfusion imaging to show that caffeine blunted the expected dipyridamole‐induced increase in myocardial blood flow in healthy patients and caused false negative dipyridamole‐stress tests in patients with known coronary artery disease. Granato et al [15], using a dog model to measure direct coronary dynamic effects, and Daley et al [19], using thallium SPECT showed that theophylline prevented dipyridamole‐induced hyperemia and lowered the diagnostic accuracy for the thallium SPECT stress tests, respectively. The stark differences between the adenosine and dipyridamole studies likely results from the differences of their physiologic interactions.…”

Section: Discussionmentioning

confidence: 99%

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Effects of caffeine and theophylline on coronary hyperemia induced by adenosine or dipyridamole

Salcedo

Kern

2009

Cathet Cardio Intervent

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For dipyridamole-stress myocardial perfusion studies, caffeine products and theophylline medications should be discontinued for 24 hr. For adenosine-stress myocardial perfusion studies, theophylline medications should be discontinued for 12 hr; however, one cup of coffee may be taken up to 1 hr before the test without necessitating a delay or cancellation of the study. These same considerations hold true for patients undergoing cardiac catheterization and intravenous adenosine-induced hyperemia.

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Section: Discussionmentioning

confidence: 99%

“…Daley et al [19] focused on the effects of theophylline on dipyridamole‐induced hyperemia using TI‐SPECT imaging. Their subjects consisted of eight patients who had unequivocal reversible perfusion defects on their first dipyridamole‐TI SPECT imaging test while not receiving any methylxanthine therapy.…”

Section: Methods For Data Reviewmentioning

confidence: 99%

Effects of caffeine and theophylline on coronary hyperemia induced by adenosine or dipyridamole

Salcedo

Kern

2009

Cathet Cardio Intervent

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“…Adverse effects associated with dipyridamole are usually less severe but more often require reversal with IV aminophylline. 9,19 Both adenosine and dipyridamole may produce bronchospasm in patients with asthma and are contraindicated in such patients.…”

Section: Discussionmentioning

confidence: 99%

Randomized, Controlled Dose-Ranging Study of the Selective Adenosine A _2A Receptor Agonist Binodenoson for Pharmacological Stress as an Adjunct to Myocardial Perfusion Imaging

et al. 2004

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and adenosine cause frequent side effects as a result of nonspecific adenosine receptor stimulation. Selective agonism of the adenosine A 2A receptor should result in a similar degree of coronary vasodilation (and thus similar perfusion images) with fewer side effects. Methods and Results-In a multicenter, randomized, single-blind, 2-arm crossover trial, 240 patients underwent 2 single photon emission computed tomographic (SPECT) imaging studies in random order, first after pharmacological stress with adenosine and a second study with the selective adenosine A 2A receptor agonist binodenoson, using 1 of 4 dosing regimens. Safety, tolerability, and SPECT image concordance between the 2 agents were examined. Exact categorical agreement in the extent and severity of reversible perfusion defects ranged from 79% to 87%, with kappa values from 0.69 to 0.85, indicating very good to excellent agreement between binodenoson and adenosine. The risk of any safety event/side effect was significantly lower with any dose of binodenoson than with adenosine (PՅ0.01) because of a dose-related reduction in subjective side effects, as objective events were infrequent. There was a reduction in the severity of chest pain, dyspnea, and flushing in all binodenoson doses compared with adenosine (PϽ0.01), and the magnitude of severity reduction was dose-related. Conclusions-The

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“…Both dipyridamole [1,2] and adenosine [3,4] are used to produce coronary vasodilatation to enhance detection of areas of myocardium with decreased blood flow. However, as the effect of these pharmacologic agents is inhibited by methylxanthine compounds such as theophylline [5][6][7] and caffeine [7][8][9][10][11], it is common practice to discontinue theophylline-containing medications at least 48 h and to request caffeine abstinence for 6-24 h prior to the performance of dipyridamole or adenosine myocardial perfusion scinfigraphy. Although typical plasma caffeine levels following ingestion of two cups of coffee (4-5 mg/1) [8] are sufficient to attenuate adenosine-induced vasodilatation [7] and caffeine clearance can be significantly prolonged in some patients, such as those with liver disease [12,13], no systematic examination of caffeine levels in a clinical population of patients undergoing myocardial perfusion scintigraphy has been reported.…”

Section: Introductionmentioning

confidence: 99%

Serum caffeine levels after 24 hours of caffeine abstention: observations on clinical patients undergoing myocardial perfusion imaging with dipyridamole or adenosine

Jacobson¹,

Cerqueira

Raisys

et al. 1994

Eur J Nucl Med

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Although caffeine attenuates the vasodilatation produced by dipyridamole and adenosine, and is therefore contraindicated when these agents are used for myocardial perfusion scintigraphy, caffeine levels in clinical patients undergoing standard imaging protocols have not been studied. Eight-six patients undergoing clinically indicated intravenous dipyridamole (n = 75) or adenosine (n = 11) thallium-201 myocardial perfusion scintigraphy, all of whom reported abstention from products containing caffeine for 24 h, were studied prospectively. Blood samples were drawn prior to initiation of the pharmacologic infusion, and serum caffeine levels were determined using an enzyme immunoassay technique. Results of these determinations were correlated with maximum pulse and blood pressure changes measured during and immediately after the stressor infusion, and thallium imaging findings. Detectable caffeine levels were found in 34 patients (40%), ranging from 0.1 to 5.0 mg/l. There was no significant difference in mean systolic blood pressure decrease or mean pulse increase between patients with caffeine levels > 1.0 mg/l (20.4 +/- 18.2 mmHg, 11.0 +/- 8.9 BPM; n = 5) and those with lower (0.1 to 0.9 mg/l) (15.4 +/- 9.5 mmHg, 14.4 +/- 8.2 BPM; n = 29) or no detectable caffeine levels (18.0 +/- 11.5 mmHg, 16.6 +/- 10.1 BPM; n = 52). Redistribution on thallium imaging was also identified with a similar frequency in these three groups (2/5, 40%; 8/29, 28%; 22/52, 42% respectively).

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Effect of maintenance oral theophylline on dipyridamole-thallium-201 myocardial imaging using SPECT and dipyridamole-induced hemodynamic changes

Cited by 26 publications

References 15 publications

Effects of caffeine and theophylline on coronary hyperemia induced by adenosine or dipyridamole

Effects of caffeine and theophylline on coronary hyperemia induced by adenosine or dipyridamole

Randomized, Controlled Dose-Ranging Study of the Selective Adenosine A _2A Receptor Agonist Binodenoson for Pharmacological Stress as an Adjunct to Myocardial Perfusion Imaging

Serum caffeine levels after 24 hours of caffeine abstention: observations on clinical patients undergoing myocardial perfusion imaging with dipyridamole or adenosine

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Effect of maintenance oral theophylline on dipyridamole-thallium-201 myocardial imaging using SPECT and dipyridamole-induced hemodynamic changes

Cited by 26 publications

References 15 publications

Effects of caffeine and theophylline on coronary hyperemia induced by adenosine or dipyridamole

Effects of caffeine and theophylline on coronary hyperemia induced by adenosine or dipyridamole

Randomized, Controlled Dose-Ranging Study of the Selective Adenosine A 2A Receptor Agonist Binodenoson for Pharmacological Stress as an Adjunct to Myocardial Perfusion Imaging

Serum caffeine levels after 24 hours of caffeine abstention: observations on clinical patients undergoing myocardial perfusion imaging with dipyridamole or adenosine

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Randomized, Controlled Dose-Ranging Study of the Selective Adenosine A _2A Receptor Agonist Binodenoson for Pharmacological Stress as an Adjunct to Myocardial Perfusion Imaging