CLINICAL RESEARCH: CARDIAC IMAGING
Effect of Caffeine on Ischemia Detection by Adenosine Single-Photon Emission Computed Tomography Perfusion Imaging
Gilbert J. Zoghbi, MD, FACC*, ,*,
Thien Htay, MD ,
Raed Aqel, MD, FACC*,,
Linda Blackmon, RN*,
Jaekyeong Heo, MD, FACC* and
Ami E. Iskandrian, MD, FACC, FAHA*
* Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
Birmingham Veterans Affairs Medical Center, Birmingham, Alabama
University of Southern California, Los Angeles, California
Manuscript received August 14, 2005;
revised manuscript received November 2, 2005,
accepted November 8, 2005.
* Reprint requests and correspondence: Dr. Gilbert J. Zoghbi, University of Alabama at Birmingham, LHRB 306, 1530 Third Avenue South, Birmingham, Alabama 35294 (Email: gzoghbi{at}uab.edu).
OBJECTIVES: The purpose of this research was to study the effect of one cup of coffee taken 1 h before adenosine stress on the results of myocardial perfusion imaging.
BACKGROUND: Caffeine is believed to attenuate the coronary hyperemic response to adenosine by competitive blockade of the A2a receptor. Caffeine is commonly withheld before adenosine single-photon emission computed tomography (SPECT) perfusion imaging so as not to mask ischemia detection.
METHODS: We studied the effect of one 8-oz cup of coffee taken 1 h before adenosine stress in patients who had demonstrable reversible defects on adenosine SPECT perfusion imaging performed while off caffeine.
RESULTS: There were 22 men and 8 women, age 64 ± 9 years. The blood level of caffeine 1 h after intake was 3.1 ± 1.6 mg/l. There were two patients with ST-segment depression before and one after caffeine intake (p = NS). The summed stress score (SSS) based on 17 segments (scale of 0 to 3, 3 being normal) was 44 ± 5 before and 45 ± 5 after caffeine (p = NS). The summed difference score was 3.8 ± 1.9 before and. 3.9 ± 2.3 after caffeine (p = NS), reflecting that around 50% of the perfusion abnormality was reversible before and after caffeine. Using polar maps, the perfusion abnormality was 12 ± 10% at baseline and 12 ± 10% after caffeine (p = NS) in agreement with SSS. The left ventricular ejection fraction by gated SPECT was 50 ± 13% at baseline and 51 ± 13 % after caffeine (p = NS).
CONCLUSIONS: A cup of coffee does not mask the presence or severity of reversible defects induced by adenosine SPECT imaging.
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Abbreviations and Acronyms
| | ATP = adenosine triphosphate | | CFR = coronary flow velocity ratio | | MBF = myocardial blood flow | | SDS = summed difference score | | SPECT = single-photon emission computed tomography | | SRS = summed rest score | | SSS = summed stress score |
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