Effects of caffeine intake prior to stress cardiac magnetic resonance perfusion imaging on regadenoson- versus adenosine-induced hyperemia as measured by T1 mapping

Abstract

The antagonistic effects of caffeine on adenosine receptors are a possible cause of false-negative stress perfusion imaging. The purpose of this study was to determine the effects of coffee intake <4 h prior to stress perfusion cardiac magnetic resonance imaging (CMR) in regadenoson- versus adenosine-induced hyperemia as measured with T1-mapping. 98 consecutive patients with suspected coronary artery disease referred for either adenosine or regadenoson perfusion CMR were included in this analysis. Twenty-four patients reported coffee consumption <4 h before CMR (15 patients with adenosine, and 9 patients with regadenoson); 74 patients reported no coffee intake (50 patients with adenosine, and 24 patients with regadenoson). T1 mapping was performed using a modified look-locker inversion recovery sequence. T1 reactivity was determined by subtracting T1rest from T1stress. T1rest, T1stress, and T1 reactivity in patients referred for regadenoson perfusion CMR were not significantly different when comparing patients with <4 h coffee intake and patients who reported no coffee intake (976 ± 4 ms, 1019 ± 48 ms, and 4.4 ± 3.2% vs 971 ± 33 ms, 1023 ± 43 ms, and 5.4 ± 2.4%) (p = 0.70, 0.79, and 0.40), and similar to values in patients without coffee intake undergoing adenosine CMR. In patients with <4 h coffee intake, T1stress, and T1 reactivity were significantly lower for adenosine (898 ± 51 ms, and −7.8 ± 5.0%) compared to regadenoson perfusion CMR (p < 0.001). Coffee intake <4 h prior to regadenoson perfusion CMR has no effect on stress-induced hyperemia as measured with T1 mapping.

Impact of caffeine on myocardial perfusion reserve assessed by semiquantitative adenosine stress perfusion cardiovascular magnetic resonance

“…To our knowledge, no previous study has been published using semiquantitative analysis of adenosine stress perfusion CMR to assess the impact of caffeine on myocardial perfusion reserve in patients with substantial myocardial ischemia under caffeinenaïve conditions. In two recently published CMR studies applying native T1 mapping at stress and rest, myocardial blood volume under adenosine was decreased in subjects with self-reported consumption of 1-2 cups of coffee < 4 h prior to the exam compared to caffeine-naïve patients [5,22]. In remote segments, RU after caffeine intake was enhanced in rest perfusion but decreased under adenosine compared to the corresponding caffeinenaïve CMR, Fig.…”

“…Patients demonstrated a preserved LV ejection fraction of 64 ± 6%, and a normal LV end-diastolic volume index, Table 1. The median time period between the initial (caffeine-naïve) and the repeat (after defined caffeine intake) adenosine stress CMR was 12 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14) days. Hemodynamics (blood pressure, heart rate) during stress perfusion and rest perfusion were similar at both CMR exams, Table 3.…”

“…Previous studies have investigated the impact of caffeine on adenosine stress perfusion imaging using single photon emission computed tomography (SPECT), CMR or PET [6][7][8][9][10]. Despite overall inconsistent results about the impact of caffeine on adenosine stress exams, most groups found a reduced ischemic myocardial burden in some degree, if stress perfusion imaging was performed after caffeine consumption using the standard dose of adenosine (140 μg/kg/min) [4][5][6][7]10]. However, in the majority of studies, ischemic burden was defined rather by the size of perfusion defects and number of ischemic segments than by (semi-)quantitative assessment of myocardial perfusion.…”

“…Caffeine is a nonselective competitive inhibitor of adenosine2A-receptors, which might attenuate the vasodilator effect of adenosine, and increases sympathetic activity yielding to capillary de-recruitment, leading to decreased myocardial perfusion reserve [2,3]. However, studies investigating the effect of caffeine on adenosine-induced hyperemia reported inconsistent results: We and others have previously reported that caffeine consumption prior to adenosine stress perfusion CMR led to a reduction of ischemic burden on qualitative assessment [4][5][6][7]. Other groups, however, did not observe significant impact of caffeine on stress perfusion defect size [8,9].…”

Cardiovascular imaging 2017 in the International Journal of Cardiovascular Imaging

“…The effects of caffeine intake prior to cardiac magnetic resonance perfusion imaging were compared using regadenoson verses adenosine induced hyperemia measured by T1 mapping by van Dijk et al [57]. These workers found T1 reactivity was significantly reduced following coffee intake with adenosine induced hyperemia compared with regadenoson.…”