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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

View larger version (11K): [in a new window]   Figure 1 Distribution of caffeine levels among 29 patients.

View larger version (13K): [in a new window]   Figure 2 Scatter plot of the summed difference score (SDS) before and after caffeine.

View larger version (13K): [in a new window]   Figure 3 (A) Scatter plot of percent total defect size with (Caffeine +) and without (Caffeine –) caffeine. (B) Bland-Altman plot of the difference of the percent total defect sizes between the study with caffeine (Caffeine +) and the study without caffeine (Caffeine –) versus average percent total defect size. The data are compatible with the hypothesis that the mean Caffeine (+) and Caffeine (–) percent defect size difference is 0 (t test p value = 0.61). For percent defect size, the empirical variance of within-patient differences is 2.46%, which for n = 30 yields a 95% confidence interval for the mean difference with half-width <1% (0.92%).

View larger version (24K): [in a new window]   Figure 4 Perfusion defect size before (top panel) and after (bottom panel) caffeine stratified by caffeine levels.

View larger version (51K): [in a new window]   Figure 5 Polar map showing a perfusion defect before (Caffeine –) and after caffeine (Caffeine +). A 53-year-old white woman with diabetes mellitus, hypertension, dyslipidemia, and a history of moderate coronary artery disease underwent adenosine single-photon emission computed tomography for evaluation of chest pain. The baseline and caffeine study showed two-vessel ischemia with no significant difference in extent and severity of the defect between the two studies (caffeine blood level 2 mg/l). LAD = left anterior descending coronary artery; LCX = left circumflex coronary artery; RCA = right coronary artery; TOT = total.