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Lee C, Dennett AM, Pinson JA, Lewis AK. Caffeine consumed prior to cardiac stress testing may affect diagnostic accuracy of nuclear medicine myocardial imaging of myocardial ischemia: A systematic review and meta-analysis. J Med Imaging Radiat Sci 2024; 55:134-145. [PMID: 38233285 DOI: 10.1016/j.jmir.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/15/2023] [Accepted: 12/21/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND Myocardial perfusion imaging (MPI) is a well-established, non-invasive imaging procedure for the diagnosis and evaluation of patients with known or suspected coronary artery disease. With the increasing use of pharmacologic stress agents in myocardial perfusion imaging, strict preparation, including caffeine abstinence, is required. The aim of this review was to determine the effect of caffeine consumed prior to nuclear cardiac stress testing on the diagnostic accuracy. METHODS Medline, Embase and CINAHL were searched from the earliest available time until August 2022. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies version 2. Data pertaining to diagnostic accuracy were analysed using meta-analysis where appropriate and overall certainty of evidence evaluated using the Grades of Research, Assessment, Development and Evaluation approach. RESULTS Six studies (307 participants) from a yield of 735 articles were identified. Meta-analysis of two studies found no difference in the left ventricular ejection fraction of patients pre and post caffeine consumption (MD -0.31 %, 95% CI -4.32% to 3.7%). Meta-analysis of three studies found there was uncertainty as to whether caffeine consumption affected reversibility (MD -2.16 segments 95% CI -4.61 to 0.28) and descriptive summary of three studies found mixed results for size of stress defects. CONCLUSION The low quality evidence synthesized in this systematic review suggests caffeine may affect the diagnostic accuracy in myocardial perfusion imaging for ischemia detection in patients with chest pain and intermediate-to-high risk of coronary artery disease.
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Affiliation(s)
- Christine Lee
- Department of Nuclear Medicine, Eastern Health, Box Hill Hospital, Box Hill, Melbourne, Australia.
| | - Amy M Dennett
- Eastern Health, Allied Health Clinical Research Office, Box Hill, Australia; School of Allied Health Human Services and Sport, La Trobe University, Bundoora Australia
| | - Jo-Anne Pinson
- Sir Peter MacCallum Department of Oncology, The Radiopharmaceutical Research Laboratory, The Peter MacCallum Cancer Centre, The University of Melbourne, Melbourne, Australia; Medicinal Chemistry, Faculty of Pharmacy and Pharmaceutical Sciences, Monash Institute of Pharmaceutical Sciences, Monash University (Parkville Campus), Parkville, Australia
| | - Annie K Lewis
- Eastern Health, Allied Health Clinical Research Office, Box Hill, Australia; School of Allied Health Human Services and Sport, La Trobe University, Bundoora Australia
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Tanaka H, Matsumoto H, Takahashi H, Hosonuma M, Sato S, Ogura K, Oishi Y, Masaki R, Sakai K, Sekimoto T, Kondo S, Tsujita H, Tsukamoto S, Sumida A, Okada N, Inoue K, Shinke T. Linear concentration-response relationship of serum caffeine with adenosine-induced fractional flow reserve overestimation: a comparison with papaverine. EUROINTERVENTION 2021; 17:e925-e931. [PMID: 34647891 PMCID: PMC9725067 DOI: 10.4244/eij-d-21-00453] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Caffeine intake from one cup of coffee one hour before adenosine stress tests, corresponding to serum caffeine levels of 3-4 mg/L, is thought to be acceptable for non-invasive imaging. AIMS We aimed to elucidate whether serum caffeine is independently associated with adenosine-induced fractional flow reserve (FFR) overestimation and their concentration-response relationship. METHODS FFR was measured using adenosine (FFRADN) and papaverine (FFRPAP) in 209 patients. FFRADN overestimation was defined as FFRADN - FFRPAP. The locally weighted scatterplot smoothing (LOWESS) approach was applied to evaluate the relationship between serum caffeine level and FFRADN overestimation. Multiple regression analysis was used to determine independent factors associated with FFRADN overestimation. RESULTS Caffeine was ingested at <12 hours in 85 patients, at 12-24 hours in 35 patients, and at >24 hours in 89 patients. Multiple regression analysis identified serum caffeine level as the strongest factor associated with FFRADN overestimation (p<0.001). The LOWESS curve demonstrated that FFRADN overestimation started from just above the lower detection limit of serum caffeine and increased approximately 0.01 FFR unit per 1 mg/L increase in serum caffeine level with a linear relationship. The 90th percentile of serum caffeine levels for the ≤12-hour, the 12-24-hour, and the >24-hour groups corresponded to FFRADN overestimations by 0.06, 0.03, and 0.02, respectively. CONCLUSIONS Serum caffeine overestimates FFRADN values in a linear concentration-response manner. FFRADN overestimation occurs at much lower serum caffeine levels than those that were previously believed. Our results highlight that standardised caffeine control is required for reliable adenosine-induced FFR measurements.
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Affiliation(s)
- Hideaki Tanaka
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Hidenari Matsumoto
- Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan
| | - Haruya Takahashi
- Division of Food Science and Biotechnology, Graduate School of Agriculture, Kyoto University, Uji, Kyoto, Japan
| | - Masahiro Hosonuma
- Department of Clinical Immuno Oncology, Clinical Research Institute for Clinical Pharmacology and Therapeutics, Showa University, Tokyo, Japan
| | - Shunya Sato
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Kunihiro Ogura
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Yosuke Oishi
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Ryota Masaki
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Koshiro Sakai
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Teruo Sekimoto
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Seita Kondo
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Hiroaki Tsujita
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Shigeto Tsukamoto
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Arihiro Sumida
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Natsumi Okada
- Department of Clinical Immuno Oncology, Clinical Research Institute for Clinical Pharmacology and Therapeutics, Showa University, Tokyo, Japan
| | - Kazuo Inoue
- Department of Hospital Pharmaceutics, Showa University School of Pharmacy, Tokyo, Japan
| | - Toshiro Shinke
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
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Ishibuchi K, Fujii K. Author's reply. J Cardiol 2020; 77:207. [PMID: 33082058 DOI: 10.1016/j.jjcc.2020.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 08/31/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Kasumi Ishibuchi
- Department of Cardiology, Higashi Takarazuka Satoh Hospital, Takarazuka, Japan
| | - Kenichi Fujii
- Department of Cardiology, Higashi Takarazuka Satoh Hospital, Takarazuka, Japan; Department of Medicine II, Kansai Medical University, Hirakata, Japan.
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Xu J, Fan W, Budoff MJ, Heckbert SR, Amsterdam EA, Alonso A, Wong ND. Intermittent Nonhabitual Coffee Consumption and Risk of Atrial Fibrillation: The Multi-Ethnic Study of Atherosclerosis. J Atr Fibrillation 2019; 12:2205. [PMID: 31687073 DOI: 10.4022/jafib.2205] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 12/14/2018] [Accepted: 02/26/2019] [Indexed: 11/10/2022]
Abstract
Background Though it is a widely held belief that caffeinated beverages predispose individuals to arrhythmias, it is not clear whether regular coffee consumption is associated with development of atrial fibrillation (AF). Objective We examined the association between long-term coffee consumption and development of AF in both habitual (≥0.5 cups of daily coffee) and nonhabitual (<0.5 cups/day) drinkers. Methods A total of 5,972 men and women, aged 45-84 years and without a history of cardiovascular disease at baseline in the Multi-Ethnic Study of Atherosclerosis (MESA) were followed from 2000 to 2014 for incident AF with baseline coffee consumption assessed in 2000-2002 via a Food Frequency Questionnaire and divided into quartiles of 0 cups/day, >0 to <0.5 cups/day, ≥0.5 to 1.5 cups/day, and ≥1.5 cups/day. Results Out of the 828 incident cases of AF, intermittent coffee consumption (>0 to 0.5 cups of daily coffee) was associated with a greater risk of incident AF (HR 1.22, 95% CI 1.01-1.48) relative to 0 cups/day in multivariable Cox proportional hazards models after adjustment for numerous AF risk factors. This relation was particularly pronounced in men (adjusted HR=1.36, 95% CI 1.04-1.77). Higher coffee consumption was not associated with AF risk (HR 1.03, 95%CI 0.93-1.14 for ≥0.5 to 1.5 cups/day and 1.05, 95%CI 0.97-1.13 for ≥1.5 cups/day). Conclusions While there appears to be no dose-response association between habitual coffee intake and AF risk, we found evidence that intermittent, but not habitual, coffee consumption is associated with a modestly increased risk of incident AF that deserves further study.
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Affiliation(s)
- Jennifer Xu
- University of California, Irvine Division of Cardiology, C240 Medical Sciences Irvine, CA 92629
| | - Wenjun Fan
- University of California, Irvine Division of Cardiology, C240 Medical Sciences Irvine, CA 92629
| | - Matthew J Budoff
- Los Angeles Biomedical Research Institute, 1124 West Carson Street, Torrance, CA 90502
| | - Susan R Heckbert
- University of Washington Department of Epidemiology, Box 358085, 1730 Minor Avenue, Suite 1360, Seattle WA 98101
| | - Ezra A Amsterdam
- University of California Davis Medical Center Division of Cardiovascular Medicine, 4860 Y Street #2820, Sacramento, CA 95817
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322
| | - Nathan D Wong
- University of California, Irvine Division of Cardiology, C240 Medical Sciences Irvine, CA 92629
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5
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Seitz A, Kaesemann P, Chatzitofi M, Löbig S, Tauscher G, Bekeredjian R, Sechtem U, Mahrholdt H, Greulich S. Impact of caffeine on myocardial perfusion reserve assessed by semiquantitative adenosine stress perfusion cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2019; 21:33. [PMID: 31230593 PMCID: PMC6589875 DOI: 10.1186/s12968-019-0542-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 05/20/2019] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Adenosine is used in stress perfusion cardiac imaging to reveal myocardial ischemia by its vasodilator effects. Caffeine is a competitive antagonist of adenosine. However, previous studies reported inconsistent results about the influence of caffeine on adenosine's vasodilator effect. This study assessed the impact of caffeine on the myocardial perfusion reserve index (MPRI) using adenosine stress cardiovascular magnetic resonance imaging (CMR). Moreover, we sought to evaluate if the splenic switch-off sign might be indicative of prior caffeine consumption. METHODS Semiquantitative perfusion analysis was performed in 25 patients who underwent: 1) caffeine-naïve adenosine stress CMR demonstrating myocardial ischemia and, 2) repeat adenosine stress CMR after intake of caffeine. MPRI (global; remote and ischemic segments), and splenic perfusion ratio (SPR) were assessed and compared between both exams. RESULTS Global MPRI after caffeine was lower vs. caffeine-naïve conditions (1.09 ± 0.19 vs. 1.24 ± 0.19; p < 0.01). MPRI in remote myocardium decreased by caffeine (1.24 ± 0.19 vs. 1.49 ± 0.19; p < 0.001) whereas MPRI in ischemic segments (0.89 ± 0.18 vs. 0.95 ± 0.23; p = 0.23) was similar, resulting in a lower MPRI ratio (=remote/ischemic segments) after caffeine consumption vs. caffeine-naïve conditions (1.41 ± 0.19 vs. 1.64 ± 0.35, p = 0.01). The SPR was unaffected by caffeine (SPR 0.38 ± 0.19 vs. 0.38 ± 0.18; p = 0.92). CONCLUSION Caffeine consumption prior to adenosine stress CMR results in a lower global MPRI, which is driven by the decreased MPRI in remote myocardium and underlines the need of abstinence from caffeine. The splenic switch-off sign is not affected by prior caffeine intake.
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Affiliation(s)
- Andreas Seitz
- Department of Cardiology, Robert Bosch Medical Center, Auerbachstraße 110, 70376 Stuttgart, Germany
| | - Philipp Kaesemann
- Department of Cardiology, Robert Bosch Medical Center, Auerbachstraße 110, 70376 Stuttgart, Germany
| | - Maria Chatzitofi
- Department of Cardiology, Robert Bosch Medical Center, Auerbachstraße 110, 70376 Stuttgart, Germany
| | - Stephanie Löbig
- Department of Cardiology, Robert Bosch Medical Center, Auerbachstraße 110, 70376 Stuttgart, Germany
| | - Gloria Tauscher
- Department of Cardiology, Robert Bosch Medical Center, Auerbachstraße 110, 70376 Stuttgart, Germany
| | - Raffi Bekeredjian
- Department of Cardiology, Robert Bosch Medical Center, Auerbachstraße 110, 70376 Stuttgart, Germany
| | - Udo Sechtem
- Department of Cardiology, Robert Bosch Medical Center, Auerbachstraße 110, 70376 Stuttgart, Germany
| | - Heiko Mahrholdt
- Department of Cardiology, Robert Bosch Medical Center, Auerbachstraße 110, 70376 Stuttgart, Germany
| | - Simon Greulich
- Department of Cardiology and Angiology, University Hospital Tübingen, Tübingen, Germany
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Byrne C, Kjaer A, Hasbak P. The Authors’ Reply:. JACC Cardiovasc Imaging 2019; 12:946-947. [DOI: 10.1016/j.jcmg.2019.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 03/07/2019] [Accepted: 03/08/2019] [Indexed: 12/01/2022]
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Abstract
Background: Calculation of fractional flow reserve (FFR) using computed tomography (CT)-based 3D anatomical models and computational fluid dynamics (CFD) has become a common method to non-invasively assess the functional severity of atherosclerotic narrowing in coronary arteries. We examined the impact of various inflow boundary conditions on computation of FFR to shed light on the requirements for inflow boundary conditions to ensure model representation. Methods: Three-dimensional anatomical models of coronary arteries for four patients with mild to severe stenosis were reconstructed from CT images. FFR and its commonly-used alternatives were derived using the models and CFD. A combination of four types of inflow boundary conditions (BC) was employed: pulsatile, steady, patient-specific and population average. Results: The maximum difference of FFR between pulsatile and steady inflow conditions was 0.02 (2.4%), approximately at a level similar to a reported uncertainty level of clinical FFR measurement (3–4%). The flow with steady BC appeared to represent well the diastolic phase of pulsatile flow, where FFR is measured. Though the difference between patient-specific and population average BCs affected the flow more, the maximum discrepancy of FFR was 0.07 (8.3%), despite the patient-specific inflow of one patient being nearly twice as the population average. Conclusions: In the patients investigated, the type of inflow boundary condition, especially flow pulsatility, does not have a significant impact on computed FFRs in narrowed coronary arteries.
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van Dijk R, Ties D, Kuijpers D, van der Harst P, Oudkerk M. Effects of Caffeine on Myocardial Blood Flow: A Systematic Review. Nutrients 2018; 10:nu10081083. [PMID: 30104545 PMCID: PMC6115837 DOI: 10.3390/nu10081083] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/09/2018] [Accepted: 08/10/2018] [Indexed: 01/31/2023] Open
Abstract
Background. Caffeine is one of the most widely consumed stimulants worldwide. It is a well-recognized antagonist of adenosine and a potential cause of false-negative functional measurements during vasodilator myocardial perfusion. The aim of this systematic review is to summarize the evidence regarding the effects of caffeine intake on functional measurements of myocardial perfusion in patients with suspected coronary artery disease. Pubmed, Web of Science, and Embase were searched using a predefined electronic search strategy. Participants—healthy subjects or patients with known or suspected CAD. Comparisons—recent caffeine intake versus no caffeine intake. Outcomes—measurements of functional myocardial perfusion. Study design—observational. Fourteen studies were deemed eligible for this systematic review. There was a wide range of variability in study design with varying imaging modalities, vasodilator agents, serum concentrations of caffeine, and primary outcome measurements. The available data indicate a significant influence of recent caffeine intake on cardiac perfusion measurements during adenosine and dipyridamole induced hyperemia. These effects have the potential to affect the clinical decision making by re-classification to different risk-categories.
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Affiliation(s)
- Randy van Dijk
- Center for Medical Imaging, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands.
- Department of Cardiology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands.
| | - Daan Ties
- Center for Medical Imaging, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands.
- Department of Cardiology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands.
| | - Dirkjan Kuijpers
- Center for Medical Imaging, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands.
- HMC-Bronovo, Haaglanden Medisch Centrum, Department of Radiology, Haaglanden Medisch Centrum-Bronovo, 2597 AX The Hague, The Netherlands.
| | - Pim van der Harst
- Center for Medical Imaging, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands.
- Department of Cardiology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands.
| | - Matthijs Oudkerk
- Center for Medical Imaging, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands.
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Greulich S, Kaesemann P, Seitz A, Birkmeier S, Abu-Zaid E, Vecchio F, Sechtem U, Mahrholdt H. Effects of caffeine on the detection of ischemia in patients undergoing adenosine stress cardiovascular magnetic resonance imaging. J Cardiovasc Magn Reson 2017; 19:103. [PMID: 29254482 PMCID: PMC5735931 DOI: 10.1186/s12968-017-0412-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 11/20/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adenosine stress cardiovascular magnetic resonance (CMR) can detect significant coronary artery stenoses with high diagnostic accuracy. Caffeine is a nonselective competitive inhibitor of adenosine2A-receptors, which might hamper the vasodilator effect of adenosine stress, potentially yielding false-negative results. Much controversy exists about the influence of caffeine on adenosine myocardial perfusion imaging. Our study sought to investigate the effects of caffeine on ischemia detection in patients with suspected or known coronary artery disease (CAD) undergoing adenosine stress CMR. METHODS Thirty patients with evidence of myocardial ischemia on caffeine-naïve adenosine stress CMR were prospectively enrolled and underwent repeat adenosine stress CMR after intake of 200 mg caffeine. Both CMR exams were then compared for evaluation of ischemic burden. RESULTS Despite intake of caffeine, no conversion of a positive to a negative stress study occurred on a per patient basis. Although we found significant lower ischemic burden in CMR exams with caffeine compared to caffeine-naïve CMR exams, absolute differences varied only slightly (1 segment based on a 16-segment model, 3 segments on a 60-segment model, and 1 ml in total ischemic myocardial volume, p < 0.001 each). Moreover, no relevant ischemia (≥2 segments in a 16-segment model) was missed by prior ingestion of caffeine. CONCLUSIONS Although differences were small and no relevant myocardial ischemia had been missed, prior consumption of caffeine led to significant reduction of ischemic burden, and might lower the high diagnostic and prognostic value of adenosine stress CMR. Therefore, we suggest that patients should still refrain from caffeine prior adenosine stress CMR tests.
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Affiliation(s)
- Simon Greulich
- Division of Cardiology, Robert-Bosch-Medical Center Stuttgart, Auerbachstrasse 110, 70376 Stuttgart, Germany
- Department of Cardiology and Cardiovascular Diseases, University Hospital Tübingen, Tübingen, Germany
| | - Philipp Kaesemann
- Division of Cardiology, Robert-Bosch-Medical Center Stuttgart, Auerbachstrasse 110, 70376 Stuttgart, Germany
| | - Andreas Seitz
- Division of Cardiology, Robert-Bosch-Medical Center Stuttgart, Auerbachstrasse 110, 70376 Stuttgart, Germany
| | | | - Eed Abu-Zaid
- Division of Cardiology, Robert-Bosch-Medical Center Stuttgart, Auerbachstrasse 110, 70376 Stuttgart, Germany
| | - Francesco Vecchio
- Division of Cardiology, Robert-Bosch-Medical Center Stuttgart, Auerbachstrasse 110, 70376 Stuttgart, Germany
| | - Udo Sechtem
- Division of Cardiology, Robert-Bosch-Medical Center Stuttgart, Auerbachstrasse 110, 70376 Stuttgart, Germany
| | - Heiko Mahrholdt
- Division of Cardiology, Robert-Bosch-Medical Center Stuttgart, Auerbachstrasse 110, 70376 Stuttgart, Germany
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Additive value of nicorandil on ATP for further inducing hyperemia in patients with an intermediate coronary artery stenosis. Coron Artery Dis 2017; 28:104-109. [PMID: 27611876 DOI: 10.1097/mca.0000000000000433] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The induction of hyperemia is of importance to precisely assess the functional significance of coronary artery lesions with fractional flow reserve (FFR). Adenosine or ATP alone is used widely in this setting; however, little is known about the additive value of nicorandil, which acts as a nitrate and a K-ATP channel opener, to induce further hyperemia. PATIENTS AND METHODS A total of 183 intermediate native coronary artery lesions from 112 patients were prospectively enrolled into this study. FFR was measured using a coronary pressure wire during an intravenous ATP infusion alone (150 mcg/kg/min) (FFRATP) and repeated after an adjunctive intracoronary nicorandil injection (2.0 mg) (FFRATP+Nico). RESULTS Physiologic measurements were completed without any severe adverse effects from ATP and nicorandil in all patients. FFRATP and FFRATP+Nico had a strong linear correlation (R=0.79, P<0.001). The FFR value became significantly lower with an adjunctive intracoronary nicorandil injection compared with ATP alone [FFRATP vs. FFRATP+Nico, 0.87 (interquartile range: 0.81-0.92) vs. 0.85 (0.79-0.90), P<0.001]. A total of 18 lesions out of 183 (9.8%) were reclassified after a nicorandil injection (12 from FFR>0.80 to ≤0.80 vs. six from FFR≤0.80 to >0.80, P=0.26). The adjunctive effect of nicorandil was accentuated with each increment of FFRATP strata (per 0.05 increase, P for trend<0.001), but with minimal effect around the borderline FFR zone. CONCLUSION An adjunctive intracoronary nicorandil injection is safe, but appears to have little effect in inducing further hyperemia. Therefore, its effect on the clinical scenario is limited.
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11
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Nakayama M, Chikamori T, Uchiyama T, Kimura Y, Hijikata N, Ito R, Yuhara M, Sato H, Kobori Y, Yamashina A. Effects of caffeine on fractional flow reserve values measured using intravenous adenosine triphosphate. Cardiovasc Interv Ther 2017; 33:116-124. [PMID: 28110424 DOI: 10.1007/s12928-017-0456-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 01/04/2017] [Indexed: 01/09/2023]
Abstract
We investigated the effects of caffeine intake on fractional flow reserve (FFR) values measured using intravenous adenosine triphosphate (ATP) before cardiac catheterization. Caffeine is a competitive antagonist for adenosine receptors; however, it is unclear whether this antagonism affects FFR values. Patients were evenly randomized into 2 groups preceding the FFR study. In the caffeine group (n = 15), participants were given coffee containing 222 mg of caffeine 2 h before the catheterization. In the non-caffeine group (n = 15), participants were instructed not to take any caffeine-containing drinks or foods for at least 12 h before the catheterization. FFR was performed in patients with more than intermediate coronary stenosis using the intravenous infusion of ATP at 140 μg/kg/min (normal dose) and 170 μg/kg/min (high dose), and the intracoronary infusion of papaverine. FFR was followed for 30 s after maximal hyperemia. In the non-caffeine group, the FFR values measured with ATP infusion were not significantly different from those measured with papaverine infusion. However, in the caffeine group, the FFR values were significantly higher after ATP infusion than after papaverine infusion (P = 0.002 and P = 0.007, at normal and high dose ATP vs. papaverine, respectively). FFR values with ATP infusion were significantly increased 30 s after maximal hyperemia (P = 0.001 and P < 0.001 for normal and high dose ATP, respectively). The stability of the FFR values using papaverine showed no significant difference between the 2 groups. Caffeine intake before the FFR study affected FFR values and their stability. These effects could not be reversed by an increased ATP dose.
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Affiliation(s)
- Masafumi Nakayama
- Cardiovascular Center, Toda Central General Hospital, 1-19-3 Hon-cho, Toda, Saitama, 335-0023, Japan.
| | | | - Takashi Uchiyama
- Cardiovascular Center, Toda Central General Hospital, 1-19-3 Hon-cho, Toda, Saitama, 335-0023, Japan
| | - Yo Kimura
- Cardiovascular Center, Toda Central General Hospital, 1-19-3 Hon-cho, Toda, Saitama, 335-0023, Japan
| | - Nobuhiro Hijikata
- Cardiovascular Center, Toda Central General Hospital, 1-19-3 Hon-cho, Toda, Saitama, 335-0023, Japan
| | - Ryosuke Ito
- Cardiovascular Center, Toda Central General Hospital, 1-19-3 Hon-cho, Toda, Saitama, 335-0023, Japan
| | - Mikio Yuhara
- Cardiovascular Center, Toda Central General Hospital, 1-19-3 Hon-cho, Toda, Saitama, 335-0023, Japan
| | - Hideaki Sato
- Cardiovascular Center, Toda Central General Hospital, 1-19-3 Hon-cho, Toda, Saitama, 335-0023, Japan
| | - Yuichi Kobori
- Cardiovascular Center, Toda Central General Hospital, 1-19-3 Hon-cho, Toda, Saitama, 335-0023, Japan
| | - Akira Yamashina
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan
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12
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Reyes E. Caffeine does not significantly reduce the sensitivity of vasodilator stress MPI: Rebuttal. J Nucl Cardiol 2016; 23:604. [PMID: 26864091 DOI: 10.1007/s12350-016-0421-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 01/19/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Eliana Reyes
- Nuclear Medicine Department, Royal Brompton and Harefield Hospitals, Sydney Street, London, SW3 6NP, United Kingdom.
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Henzlova MJ, Duvall WL, Einstein AJ, Travin MI, Verberne HJ. ASNC imaging guidelines for SPECT nuclear cardiology procedures: Stress, protocols, and tracers. J Nucl Cardiol 2016; 23:606-39. [PMID: 26914678 DOI: 10.1007/s12350-015-0387-x] [Citation(s) in RCA: 364] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
| | | | - Andrew J Einstein
- New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Mark I Travin
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Saab R, Bajaj NS, Hage FG. Caffeine does not significantly reduce the sensitivity of vasodilator stress myocardial perfusion imaging. J Nucl Cardiol 2016; 23:442-6. [PMID: 26667815 DOI: 10.1007/s12350-015-0364-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 11/18/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Rayan Saab
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Lyons Harrison Research Building 306, 1720 2nd AVE S, Birmingham, AL, 35294-0007, USA
| | - Navkaranbir S Bajaj
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Lyons Harrison Research Building 306, 1720 2nd AVE S, Birmingham, AL, 35294-0007, USA
| | - Fadi G Hage
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Lyons Harrison Research Building 306, 1720 2nd AVE S, Birmingham, AL, 35294-0007, USA.
- Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA.
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Reyes E. Caffeine reduces the sensitivity of vasodilator MPI for the detection of myocardial ischaemia: Pro. J Nucl Cardiol 2016; 23:447-53. [PMID: 26883776 DOI: 10.1007/s12350-015-0371-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 12/01/2015] [Indexed: 10/22/2022]
Abstract
Caffeine is a non-selective antagonist at the adenosine receptors, which is expected to reverse both the intended (coronary vasodilation) and unintended (hypotension, flushing) effects of exogenously administered adenosine and adenosine-related compounds. In the past, several studies were conducted to characterize the effect of caffeine on vasodilator myocardial perfusion imaging (MPI) with conflicting results. However, new evidence supports earlier observations and shows that recent caffeine intake attenuates vasodilator-induced myocardial hyperaemia and may therefore reduce the sensitivity of radionuclide MPI for the detection of inducible perfusion abnormality in patients with coronary artery disease. Although the magnitude of this effect and hence its clinical significance are dose dependent, the acute response to equivalent doses of caffeine varies largely among individuals, and this might be explained by differences in caffeine exposure and genetically determined variations in caffeine metabolism. Abstinence from caffeinated foods and beverages for a minimum of 12 hours before vasodilator stress is therefore recommended although longer abstention might be required in order to prevent the potentially blocking effect of residual caffeine on vasodilator-mediated actions.
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Affiliation(s)
- Eliana Reyes
- Nuclear Medicine Department, Royal Brompton and Harefield Hospitals, Sydney Street, London, SW3 6NP, United Kingdom.
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Teixeira T, Nadeshalingam G, Fischer K, Marcotte F, Friedrich MG. Breathing maneuvers as a coronary vasodilator for myocardial perfusion imaging. J Magn Reson Imaging 2016; 44:947-55. [DOI: 10.1002/jmri.25224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 02/22/2016] [Indexed: 11/10/2022] Open
Affiliation(s)
- Tiago Teixeira
- Montreal Heart Institute; Departments of Cardiology and Radiology; Université de Montréal; Montréal Canada
- Lenitudes Medical Center and Research; Sta Maria da Feira Portugal
| | - Gobinath Nadeshalingam
- Montreal Heart Institute; Departments of Cardiology and Radiology; Université de Montréal; Montréal Canada
| | - Kady Fischer
- Montreal Heart Institute; Departments of Cardiology and Radiology; Université de Montréal; Montréal Canada
| | - François Marcotte
- Montreal Heart Institute; Departments of Cardiology and Radiology; Université de Montréal; Montréal Canada
| | - Matthias G. Friedrich
- Montreal Heart Institute; Departments of Cardiology and Radiology; Université de Montréal; Montréal Canada
- McGill University Health Centre; Departments of Cardiology and Diagnostic Radiology; McGill University; Montreal Canada
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Manisty C, Ripley DP, Herrey AS, Captur G, Wong TC, Petersen SE, Plein S, Peebles C, Schelbert EB, Greenwood JP, Moon JC. Splenic Switch-off: A Tool to Assess Stress Adequacy in Adenosine Perfusion Cardiac MR Imaging. Radiology 2015; 276:732-40. [PMID: 25923223 DOI: 10.1148/radiol.2015142059] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE To investigate the pharmacology and potential clinical utility of splenic switch-off to identify understress in adenosine perfusion cardiac magnetic resonance (MR) imaging. MATERIALS AND METHODS Splenic switch-off was assessed in perfusion cardiac MR examinations from 100 patients (mean age, 62 years [age range, 18-87 years]) by using three stress agents (adenosine, dobutamine, and regadenoson) in three different institutions, with appropriate ethical permissions. In addition, 100 negative adenosine images from the Clinical Evaluation of MR Imaging in Coronary Heart Disease (CE-MARC) trial (35 false and 65 true negative; mean age, 59 years [age range, 40-73 years]) were assessed to ascertain the clinical utility of the sign to detect likely pharmacologic understress. Differences in splenic perfusion were compared by using Wilcoxon signed rank or Wilcoxon rank sum tests, and true-negative and false-negative findings in CE-MARC groups were compared by using the Fisher exact test. RESULTS The spleen was visible in 99% (198 of 200) of examinations and interobserver agreement in the visual grading of splenic switch-off was excellent (κ = 0.92). Visually, splenic switch-off occurred in 90% of adenosine studies, but never in dobutamine or regadenoson studies. Semiquantitative assessments supported these observations: peak signal intensity was 78% less with adenosine than at rest (P < .001), but unchanged with regadenoson (4% reduction; P = .08). Calculated peak splenic divided by myocardial signal intensity (peak splenic/myocardial signal intensity) differed between stress agents (adenosine median, 0.34; dobutamine median, 1.34; regadenoson median, 1.13; P < .001). Failed splenic switch-off was significantly more common in CE-MARC patients with false-negative findings than with true-negative findings (34% vs 9%, P < .005). CONCLUSION Failed splenic switch-off with adenosine is a new, simple observation that identifies understressed patients who are at risk for false-negative findings on perfusion MR images. These data suggest that almost 10% of all patients may be understressed, and that repeat examination of individuals with failed splenic switch-off may significantly improve test sensitivity.
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Affiliation(s)
- Charlotte Manisty
- From the Heart Hospital Imaging Centre, University College London, 16-18 Westmoreland St, London W1G 8PH, England (C.M., A.S.H., G.C., J.C.M.); Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, England (D.P.R., S.P., J.P.G.); Department of Medicine (T.C.W., E.B.S.) and UPMC Cardiovascular Magnetic Resonance Center (E.B.S.), University of Pittsburgh School of Medicine, Pittsburgh, Pa; NIHR Cardiovascular Biomedical Research Unit, Barts Health NHS Trust and Queen Mary University of London, London, England (S.E.P.); and Wessex Cardiothoracic Unit, Southampton University Hospitals NHS Trust, Southampton, England (C.P.)
| | - David P Ripley
- From the Heart Hospital Imaging Centre, University College London, 16-18 Westmoreland St, London W1G 8PH, England (C.M., A.S.H., G.C., J.C.M.); Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, England (D.P.R., S.P., J.P.G.); Department of Medicine (T.C.W., E.B.S.) and UPMC Cardiovascular Magnetic Resonance Center (E.B.S.), University of Pittsburgh School of Medicine, Pittsburgh, Pa; NIHR Cardiovascular Biomedical Research Unit, Barts Health NHS Trust and Queen Mary University of London, London, England (S.E.P.); and Wessex Cardiothoracic Unit, Southampton University Hospitals NHS Trust, Southampton, England (C.P.)
| | - Anna S Herrey
- From the Heart Hospital Imaging Centre, University College London, 16-18 Westmoreland St, London W1G 8PH, England (C.M., A.S.H., G.C., J.C.M.); Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, England (D.P.R., S.P., J.P.G.); Department of Medicine (T.C.W., E.B.S.) and UPMC Cardiovascular Magnetic Resonance Center (E.B.S.), University of Pittsburgh School of Medicine, Pittsburgh, Pa; NIHR Cardiovascular Biomedical Research Unit, Barts Health NHS Trust and Queen Mary University of London, London, England (S.E.P.); and Wessex Cardiothoracic Unit, Southampton University Hospitals NHS Trust, Southampton, England (C.P.)
| | - Gabriella Captur
- From the Heart Hospital Imaging Centre, University College London, 16-18 Westmoreland St, London W1G 8PH, England (C.M., A.S.H., G.C., J.C.M.); Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, England (D.P.R., S.P., J.P.G.); Department of Medicine (T.C.W., E.B.S.) and UPMC Cardiovascular Magnetic Resonance Center (E.B.S.), University of Pittsburgh School of Medicine, Pittsburgh, Pa; NIHR Cardiovascular Biomedical Research Unit, Barts Health NHS Trust and Queen Mary University of London, London, England (S.E.P.); and Wessex Cardiothoracic Unit, Southampton University Hospitals NHS Trust, Southampton, England (C.P.)
| | - Timothy C Wong
- From the Heart Hospital Imaging Centre, University College London, 16-18 Westmoreland St, London W1G 8PH, England (C.M., A.S.H., G.C., J.C.M.); Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, England (D.P.R., S.P., J.P.G.); Department of Medicine (T.C.W., E.B.S.) and UPMC Cardiovascular Magnetic Resonance Center (E.B.S.), University of Pittsburgh School of Medicine, Pittsburgh, Pa; NIHR Cardiovascular Biomedical Research Unit, Barts Health NHS Trust and Queen Mary University of London, London, England (S.E.P.); and Wessex Cardiothoracic Unit, Southampton University Hospitals NHS Trust, Southampton, England (C.P.)
| | - Steffen E Petersen
- From the Heart Hospital Imaging Centre, University College London, 16-18 Westmoreland St, London W1G 8PH, England (C.M., A.S.H., G.C., J.C.M.); Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, England (D.P.R., S.P., J.P.G.); Department of Medicine (T.C.W., E.B.S.) and UPMC Cardiovascular Magnetic Resonance Center (E.B.S.), University of Pittsburgh School of Medicine, Pittsburgh, Pa; NIHR Cardiovascular Biomedical Research Unit, Barts Health NHS Trust and Queen Mary University of London, London, England (S.E.P.); and Wessex Cardiothoracic Unit, Southampton University Hospitals NHS Trust, Southampton, England (C.P.)
| | - Sven Plein
- From the Heart Hospital Imaging Centre, University College London, 16-18 Westmoreland St, London W1G 8PH, England (C.M., A.S.H., G.C., J.C.M.); Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, England (D.P.R., S.P., J.P.G.); Department of Medicine (T.C.W., E.B.S.) and UPMC Cardiovascular Magnetic Resonance Center (E.B.S.), University of Pittsburgh School of Medicine, Pittsburgh, Pa; NIHR Cardiovascular Biomedical Research Unit, Barts Health NHS Trust and Queen Mary University of London, London, England (S.E.P.); and Wessex Cardiothoracic Unit, Southampton University Hospitals NHS Trust, Southampton, England (C.P.)
| | - Charles Peebles
- From the Heart Hospital Imaging Centre, University College London, 16-18 Westmoreland St, London W1G 8PH, England (C.M., A.S.H., G.C., J.C.M.); Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, England (D.P.R., S.P., J.P.G.); Department of Medicine (T.C.W., E.B.S.) and UPMC Cardiovascular Magnetic Resonance Center (E.B.S.), University of Pittsburgh School of Medicine, Pittsburgh, Pa; NIHR Cardiovascular Biomedical Research Unit, Barts Health NHS Trust and Queen Mary University of London, London, England (S.E.P.); and Wessex Cardiothoracic Unit, Southampton University Hospitals NHS Trust, Southampton, England (C.P.)
| | - Erik B Schelbert
- From the Heart Hospital Imaging Centre, University College London, 16-18 Westmoreland St, London W1G 8PH, England (C.M., A.S.H., G.C., J.C.M.); Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, England (D.P.R., S.P., J.P.G.); Department of Medicine (T.C.W., E.B.S.) and UPMC Cardiovascular Magnetic Resonance Center (E.B.S.), University of Pittsburgh School of Medicine, Pittsburgh, Pa; NIHR Cardiovascular Biomedical Research Unit, Barts Health NHS Trust and Queen Mary University of London, London, England (S.E.P.); and Wessex Cardiothoracic Unit, Southampton University Hospitals NHS Trust, Southampton, England (C.P.)
| | - John P Greenwood
- From the Heart Hospital Imaging Centre, University College London, 16-18 Westmoreland St, London W1G 8PH, England (C.M., A.S.H., G.C., J.C.M.); Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, England (D.P.R., S.P., J.P.G.); Department of Medicine (T.C.W., E.B.S.) and UPMC Cardiovascular Magnetic Resonance Center (E.B.S.), University of Pittsburgh School of Medicine, Pittsburgh, Pa; NIHR Cardiovascular Biomedical Research Unit, Barts Health NHS Trust and Queen Mary University of London, London, England (S.E.P.); and Wessex Cardiothoracic Unit, Southampton University Hospitals NHS Trust, Southampton, England (C.P.)
| | - James C Moon
- From the Heart Hospital Imaging Centre, University College London, 16-18 Westmoreland St, London W1G 8PH, England (C.M., A.S.H., G.C., J.C.M.); Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, England (D.P.R., S.P., J.P.G.); Department of Medicine (T.C.W., E.B.S.) and UPMC Cardiovascular Magnetic Resonance Center (E.B.S.), University of Pittsburgh School of Medicine, Pittsburgh, Pa; NIHR Cardiovascular Biomedical Research Unit, Barts Health NHS Trust and Queen Mary University of London, London, England (S.E.P.); and Wessex Cardiothoracic Unit, Southampton University Hospitals NHS Trust, Southampton, England (C.P.)
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Mutha V, Asrar Ul Haq M, Van Gaal WJ. Effects of intravenous caffeine on fractional flow reserve measurements in coronary artery disease. Open Heart 2014; 1:e000060. [PMID: 25332801 PMCID: PMC4189297 DOI: 10.1136/openhrt-2014-000060] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 06/17/2014] [Accepted: 07/15/2014] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Intravenous adenosine is used to minimise the coronary micro-resistance to achieve maximal hyperaemia along with nitrates for optimal fractional flow reserve (FFR) measurements. We hypothesise that caffeine, being a competitive inhibitor of adenosine, would influence adenosine-mediated FFR readings. METHODS Consecutive patients undergoing angiogram and FFR measurements were enrolled after abstaining from caffeine for 24 h. Patients with any contraindications to intravenous adenosine or caffeine were excluded. FFR measurements were taken using nitrates and adenosine pre and post 4 mg/kg intravenous caffeine administration and results were compared. RESULTS 10 patients were analysed (80% men, age 59.9±9.4, weight 87.5±15.6). Baseline caffeine levels were undetectable in all patients and increased significantly postintravenous caffeine administration (16.4±5.5 μg/mL). Baseline preadenosine FFR values were similar before and after caffeine administration (0.91±0.06 vs 0.91±0.07; p=0.41). Postadenosine FFR readings were 0.79±0.07, which increased non-significantly to 0.82±0.11 postcaffeine (p=0.15). Two significant FFR readings (≤0.8) changed to non-significant after caffeine administration (0.77-0.93 and 0.8-0.91). CONCLUSIONS Caffeine may affect FFR results in some patients. Larger studies are warranted to clarify the extent and magnitude of caffeine/adenosine interaction particularly due to ubiquitous nature of caffeine and increasing importance of FFR in clinical practice.
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Affiliation(s)
- Vivek Mutha
- Department of Cardiology , The Northern Hospital , Melbourne, Victoria , Australia
| | - Muhammad Asrar Ul Haq
- Department of Cardiology , The Northern Hospital , Melbourne, Victoria , Australia ; Department of Medicine , University of Melbourne , Melbourne, Victoria , Australia
| | - William J Van Gaal
- Department of Cardiology , The Northern Hospital , Melbourne, Victoria , Australia
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Layland J, Carrick D, Lee M, Oldroyd K, Berry C. Adenosine. JACC Cardiovasc Interv 2014; 7:581-91. [DOI: 10.1016/j.jcin.2014.02.009] [Citation(s) in RCA: 172] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 02/10/2014] [Accepted: 02/13/2014] [Indexed: 01/05/2023]
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Novel insights into the pathophysiology of different forms of stress testing. Clin Biochem 2014; 47:338-43. [DOI: 10.1016/j.clinbiochem.2014.02.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 02/11/2014] [Accepted: 02/16/2014] [Indexed: 11/19/2022]
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Carlsson M, Jögi J, Markenroth Bloch K, Hedén B, Ekelund U, Ståhlberg F, Arheden H. Submaximal adenosine‐induced coronary hyperaemia with 12 h caffeine abstinence: implications for clinical adenosine perfusion imaging tests. Clin Physiol Funct Imaging 2014; 35:49-56. [DOI: 10.1111/cpf.12125] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 12/11/2013] [Indexed: 12/01/2022]
Affiliation(s)
- Marcus Carlsson
- Department of Clinical Physiology and Nuclear Medicine Lund University Hospital Lund University Lund Sweden
| | - Jonas Jögi
- Department of Clinical Physiology and Nuclear Medicine Lund University Hospital Lund University Lund Sweden
| | - Karin Markenroth Bloch
- Philips Healthcare Lund Sweden
- Department of Medical Radiation Physics Lund University Lund Sweden
| | - Bo Hedén
- Department of Clinical Physiology and Nuclear Medicine Lund University Hospital Lund University Lund Sweden
| | - Ulf Ekelund
- Department of Emergency Medicine Lund University Hospital Lund University Lund Sweden
| | - Freddy Ståhlberg
- Department of Medical Radiation Physics Lund University Lund Sweden
- Department of Diagnostic Radiology Lund University Hospital Lund University Lund Sweden
| | - Håkan Arheden
- Department of Clinical Physiology and Nuclear Medicine Lund University Hospital Lund University Lund Sweden
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Regadenoson in Europe: first-year experience of regadenoson stress combined with submaximal exercise in patients undergoing myocardial perfusion scintigraphy. Eur J Nucl Med Mol Imaging 2013; 41:511-21. [PMID: 24265072 PMCID: PMC3913852 DOI: 10.1007/s00259-013-2619-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 10/14/2013] [Indexed: 11/19/2022]
Abstract
Purpose Regadenoson was approved for clinical use in Europe in 2011. Since then, it has become the default form of stress at our institution. We have assessed the side-effect profile and tolerability of regadenoson in patients undergoing clinically indicated myocardial perfusion scintigraphy between July 2011 and July 2012. Methods Clinical, stress and imaging data were recorded prospectively. Symptoms during stress were recorded and defined as mild, moderate or severe. An adverse event was defined as any symptom that persisted for more than 30 min or that required investigation or treatment. Results Of 1,764 consecutive patients, 1,581 (90 %) received regadenoson combined with submaximal exercise unless contraindicated. Symptoms were common (63 %) but transient and well-tolerated. The severity of symptoms was recorded in most patients as mild (84 %). Dyspnoea (36 %) and chest discomfort (12 %) were the commonest side effects. Adverse events were reported in eight patients (0.5 %), thought to be vasovagal in seven of these. All patients recovered fully without sequelae. There were no deaths, myocardial infarction or hospital admissions. Regadenoson stress was performed in 206 patients (12 %) with asthma or chronic obstructive pulmonary disease (COPD) without bronchospasm or any other major side effect. Conclusion We studied the symptom profile of regadenoson in the largest European cohort to date. Regadenoson combined with submaximal exercise was well tolerated, notably also in patients with asthma or COPD. The majority of regadenoson-related adverse events were vasovagal episodes without sequelae.
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Pharmacologic manipulation of coronary vascular physiology for the evaluation of coronary artery disease. Pharmacol Ther 2013; 140:121-32. [DOI: 10.1016/j.pharmthera.2013.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 05/23/2013] [Indexed: 11/24/2022]
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Berry C, Layland J, Sood A, Curzen NP, Balachandran KP, Das R, Junejo S, Henderson RA, Briggs AH, Ford I, Oldroyd KG. Fractional flow reserve versus angiography in guiding management to optimize outcomes in non-ST-elevation myocardial infarction (FAMOUS-NSTEMI): rationale and design of a randomized controlled clinical trial. Am Heart J 2013; 166:662-668.e3. [PMID: 24093845 PMCID: PMC3807653 DOI: 10.1016/j.ahj.2013.07.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 07/01/2013] [Indexed: 01/21/2023]
Abstract
BACKGROUND In patients with acute non-ST-elevation myocardial infarction (NSTEMI), coronary arteriography is usually recommended; but visual interpretation of the angiogram is subjective. We hypothesized that functional assessment of coronary stenosis severity with a pressure-sensitive guide wire (fractional flow reserve [FFR]) would have additive diagnostic, clinical, and health economic utility as compared with angiography-guided standard care. METHODS AND DESIGN A prospective multicenter parallel-group 1:1 randomized controlled superiority trial in 350 NSTEMI patients with ≥1 coronary stenosis ≥30% severity (threshold for FFR measurement) will be conducted. Patients will be randomized immediately after coronary angiography to the FFR-guided group or angiography-guided group. All patients will then undergo FFR measurement in all vessels with a coronary stenosis ≥30% severity including culprit and nonculprit lesions. Fractional flow reserve will be disclosed to guide treatment in the FFR-guided group but not disclosed in the "angiography-guided" group. In the FFR-guided group, an FFR ≤0.80 will be an indication for revascularization by percutaneous coronary intervention or coronary artery bypass surgery, as appropriate. The primary outcome is the between-group difference in the proportion of patients allocated to medical management only compared with revascularization. Secondary outcomes include the occurrence of cardiac death or hospitalization for myocardial infarction or heart failure, quality of life, and health care costs. The minimum and average follow-up periods for the primary analysis are 6 and 18 months, respectively. CONCLUSIONS Our developmental clinical trial will address the feasibility of FFR measurement in NSTEMI and the influence of FFR disclosure on treatment decisions and health and economic outcomes.
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Affiliation(s)
- Colin Berry
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom; BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom.
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Procedure guidelines for radionuclide myocardial perfusion imaging with single-photon emission computed tomography. Nucl Med Commun 2013; 34:813-26. [PMID: 23719150 DOI: 10.1097/mnm.0b013e32836171eb] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hage FG, Iskandrian AE. The effect of caffeine on adenosine myocardial perfusion imaging: time to reassess? J Nucl Cardiol 2012; 19:415-9. [PMID: 22297853 DOI: 10.1007/s12350-012-9519-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Lee JC, Fraser JF, Barnett AG, Johnson LP, Wilson MG, McHenry CM, Walters DL, Warnholtz CR, Khafagi FA. Effect of caffeine on adenosine-induced reversible perfusion defects assessed by automated analysis. J Nucl Cardiol 2012; 19:474-81. [PMID: 22302182 DOI: 10.1007/s12350-012-9517-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2011] [Accepted: 01/07/2012] [Indexed: 10/14/2022]
Abstract
OBJECTIVES This prospective study investigated the effects of caffeine ingestion on the extent of adenosine-induced perfusion abnormalities during myocardial perfusion imaging (MPI). METHODS Thirty patients with inducible perfusion abnormalities on standard (caffeineabstinent) adenosine MPI underwent repeat testing with supplementary coffee intake. Baseline and test MPIs were assessed for stress percent defect, rest percent defect, and percent defect reversibility. Plasma levels of caffeine and metabolites were assessed on both occasions and correlated with MPI findings. RESULTS Despite significant increases in caffeine [mean difference 3,106 μg/L (95% CI 2,460 to 3,752 μg/L; P < .001)] and metabolite concentrations over a wide range, there was no statistically significant change in stress percent defect and percent defect reversibility between the baseline and test scans. The increase in caffeine concentration between the baseline and the test phases did not affect percent defect reversibility (average change -0.003 for every 100 μg/L increase; 95% CI -0.17 to 0.16; P = .97). CONCLUSION There was no significant relationship between the extent of adenosine-induced coronary flow heterogeneity and the serum concentration of caffeine or its principal metabolites. Hence, the stringent requirements for prolonged abstinence from caffeine before adenosine MPI - based on limited studies - appear ill-founded.
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Affiliation(s)
- Joseph C Lee
- Department of Nuclear Medicine, The Prince Charles Hospital, Chermside, QLD 4032, Australia.
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Morton G, Jogiya R, Plein S, Schuster A, Chiribiri A, Nagel E. Quantitative cardiovascular magnetic resonance perfusion imaging: inter-study reproducibility. Eur Heart J Cardiovasc Imaging 2012; 13:954-60. [PMID: 22634739 DOI: 10.1093/ehjci/jes103] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS To evaluate the inter-study reproducibility of quantitative cardiovascular magnetic resonance (CMR) myocardial perfusion imaging and the influence of diurnal variation on perfusion. Data on these are limited, despite being crucially important for performing serial examinations both in clinical practice and in trials. METHODS AND RESULTS Sixteen healthy volunteers underwent high-resolution 3 T perfusion imaging three times during a single day to evaluate inter-study reproducibility and the effects of diurnal variation. Absolute perfusion was determined in each coronary artery territory and globally by Fermi constrained deconvolution of myocardial signal intensity curves. Left ventricular (LV) volumes and function were also calculated. Eleven full data sets were suitable for quantitative perfusion analysis. Global rest and stress perfusion and myocardial perfusion reserve (MPR) were 0.6 ± 0.1 and 2.5 ± 0.5 mL/min/g and 4.3 ± 0.9, respectively, for the first scan and were 0.5 ± 0.2 and 2.1 ± 0.5 mL/min/g and 4.2 ± 1.2 for the second (P= 0.1, 0.19, and 0.37, respectively). Inter-study reproducibility was moderate. The coefficient of variation (CV) was 16.0, 26.8, and 23.9% for global rest and stress perfusion and MPR, respectively. The corresponding territorial CVs were 27.5, 35.2, and 33.5%. The reproducibility of LV volumes and function was excellent (CV 4, 7.7, and 4.6% for end-diastolic volume, end-systolic volume, and ejection fraction, respectively). There were no significant detectable diurnal variations in perfusion or LV volumes and function (P≥ 0.05 for all). CONCLUSION The inter-study reproducibility of quantitative myocardial perfusion is reasonable and best for global rest perfusion. No significant diurnal variation in perfusion was observed.
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Affiliation(s)
- Geraint Morton
- Division of Imaging Sciences, The Rayne Institute, King’s College London, 4th Floor Lambeth Wing, St Thomas’ Hospital, London SE1 7EH, UK.
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Depuey EG, Mahmarian JJ, Miller TD, Einstein AJ, Hansen CL, Holly TA, Miller EJ, Polk DM, Samuel Wann L. Patient-centered imaging. J Nucl Cardiol 2012; 19:185-215. [PMID: 22328324 DOI: 10.1007/s12350-012-9523-z] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Stress perfusion imaging using cardiovascular magnetic resonance: a review. Heart Lung Circ 2011; 19:697-705. [PMID: 20869310 DOI: 10.1016/j.hlc.2010.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Revised: 08/09/2010] [Accepted: 08/11/2010] [Indexed: 01/25/2023]
Abstract
Stress perfusion CMR can provide both excellent diagnostic and important prognostic information in the context of a comprehensive assessment of cardiac anatomy and function. This coupled with the high spatial resolution, and the lack of both attenuation artefacts and ionising radiation, make CMR stress perfusion imaging a highly attractive stress imaging modality. It is now in routine use in many centres, and shows promise in evaluating patients with clinical problems beyond those of epicardial coronary disease.
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Tejani FH, Thompson RC, Iskandrian AE, McNutt BE, Franks B. Effect of caffeine on SPECT myocardial perfusion imaging during regadenoson pharmacologic stress: rationale and design of a prospective, randomized, multicenter study. J Nucl Cardiol 2011; 18:73-81. [PMID: 21082298 DOI: 10.1007/s12350-010-9311-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Accepted: 10/17/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Caffeine attenuates the coronary hyperemic response to adenosine by competitive A₂(A) receptor blockade. This study aims to determine whether oral caffeine administration compromises diagnostic accuracy in patients undergoing vasodilator stress myocardial perfusion imaging (MPI) with regadenoson, a selective adenosine A(2A) agonist. METHODS This multicenter, randomized, double-blind, placebo-controlled, parallel-group study includes patients with suspected coronary artery disease who regularly consume caffeine. Each participant undergoes three SPECT MPI studies: a rest study on day 1 (MPI-1); a regadenoson stress study on day 3 (MPI-2), and a regadenoson stress study on day 5 with double-blind administration of oral caffeine 200 or 400 mg or placebo capsules (MPI-3; n = 90 per arm). Only participants with ≥ 1 reversible defect on the second MPI study undergo the subsequent stress MPI test. The primary endpoint is the difference in the number of reversible defects on the two stress tests using a 17-segment model. Pharmacokinetic/pharmacodynamic analyses will evaluate the effect of caffeine on the regadenoson exposure-response relationship. Safety will also be assessed. CONCLUSION The results of this study will show whether the consumption of caffeine equivalent to 2-4 cups of coffee prior to an MPI study with regadenoson affects the diagnostic validity of stress testing (ClinicalTrials.gov number, NCT00826280).
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Karamitsos TD, Ntusi NAB, Francis JM, Holloway CJ, Myerson SG, Neubauer S. Feasibility and safety of high-dose adenosine perfusion cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2010; 12:66. [PMID: 21080924 PMCID: PMC2996376 DOI: 10.1186/1532-429x-12-66] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Accepted: 11/16/2010] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Adenosine is the most widely used vasodilator stress agent for cardiovascular magnetic resonance (CMR) perfusion studies. With the standard dose of 140 mcg/kg/min some patients fail to demonstrate characteristic haemodynamic changes: a significant increase in heart rate (HR) and mild decrease in systolic blood pressure (SBP). Whether an increase in the rate of adenosine infusion would improve peripheral and, likely, coronary vasodilatation in those patients is unknown. The aim of the present study was to assess the tolerance and safety of a high-dose adenosine protocol in patients with inadequate haemodynamic response to the standard adenosine protocol when undergoing CMR perfusion imaging. METHODS 98 consecutive patients with known or suspected coronary artery disease (CAD) underwent CMR perfusion imaging at 1.5 Tesla. Subjects were screened for contraindications to adenosine, and an electrocardiogram was performed prior to the scan. All patients initially received the standard adenosine protocol (140 mcg/kg/min for at least 3 minutes). If the haemodynamic response was inadequate (HR increase < 10 bpm or SBP decrease < 10 mmHg) then the infusion rate was increased up to a maximum of 210 mcg/kg/min (maximal infusion duration 7 minutes). RESULTS All patients successfully completed the CMR scan. Of a total of 98 patients, 18 (18%) did not demonstrate evidence of a significant increase in HR or decrease in SBP under the standard adenosine infusion rate. Following the increase in the rate of infusion, 16 out of those 18 patients showed an adequate haemodynamic response. One patient of the standard infusion group and two patients of the high-dose group developed transient advanced AV block. Significantly more patients complained of chest pain in the high-dose group (61% vs. 29%, p = 0.009). On multivariate analysis, age > 65 years and ejection fraction < 57% were the only independent predictors of blunted haemodynamic responsiveness to adenosine. CONCLUSIONS A substantial number of patients do not show adequate peripheral haemodynamic response to standard-dose adenosine stress during perfusion CMR imaging. Age and reduced ejection fraction are predictors of inadequate response to standard dose adenosine. A high-dose adenosine protocol (up to 210 mcg/kg/min) is well tolerated and results in adequate haemodynamic response in nearly all patients.
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Affiliation(s)
- Theodoros D Karamitsos
- Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, UK
| | - Ntobeko AB Ntusi
- Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, UK
| | - Jane M Francis
- Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, UK
| | - Cameron J Holloway
- Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, UK
| | - Saul G Myerson
- Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, UK
| | - Stefan Neubauer
- Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, UK
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Reyes E, Pennell DJ. Regadenoson for myocardial perfusion scintigraphy. EXPERT OPINION ON MEDICAL DIAGNOSTICS 2010; 4:447-54. [PMID: 23496201 DOI: 10.1517/17530059.2010.506909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
IMPORTANCE OF THE FIELD Stress myocardial perfusion scintigraphy (MPS) plays a major role in the detection of obstructive coronary artery disease and provides valuable diagnostic and prognostic information to guide clinical decision-making with regard to medical therapy and coronary revascularisation. Current stress techniques for MPS are effective but their use may be limited by reduced tolerability, contraindications and untoward side effects. The recently developed selective adenosine A2A receptor agonists have the potential for improving stress tolerability, hence expanding the indications for functional imaging in the assessment of coronary artery disease. AREAS COVERED IN THIS REVIEW This article reviews the basic principles underlying activation of coronary arteriolar adenosine A2A receptors. It describes the benefits and limitations of current vasodilator stress agents and highlights the effectiveness, side effect profile and tolerability of regadenoson, the only selective adenosine A2A receptor agonist available at present for clinical use. WHAT THE READER WILL GAIN The reader will gain an understanding of the pharmacokinetics and mechanism of action of regadenoson for the assessment of coronary artery disease when combined with myocardial perfusion imaging. The reader will also become aware of the available evidence on the clinical usefulness of regadenoson MPS and its future applications. TAKE HOME MESSAGE Selective activation of coronary arteriolar adenosine A2A receptors by regadenoson provides an effective modality of stress for the detection of inducible perfusion abnormality in patients with known or suspected coronary disease. The effectiveness of regadenoson is similar to that of adenosine, but test tolerability is improved with regadenoson. The use of this agent simplifies stress testing and has the potential for expanding the applications of functional imaging to patient populations unsuitable for conventional vasodilator stress with adenosine or dipyridamole.
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Affiliation(s)
- Eliana Reyes
- National Heart and Lung Institute, Imperial College, London SW7 2AZ, UK
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McParland P, Nicol ED, Harden SP. Cardiac drugs used in cross-sectional cardiac imaging: what the radiologist needs to know. Clin Radiol 2010; 65:677-84. [PMID: 20696294 DOI: 10.1016/j.crad.2010.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Revised: 03/28/2010] [Accepted: 04/06/2010] [Indexed: 11/27/2022]
Abstract
The demand for cross-sectional imaging of the heart is increasing dramatically and in many centres these imaging techniques are being performed by radiologists. Although radiologists are familiar with the computed tomography (CT) and magnetic resonance imaging (MRI) techniques to generate high-quality images and with using contrast agents, many are less familiar with administering the drugs necessary to perform CT coronary angiography and cardiac MR reliably. The aim of this article is to give an overview of the indications for and the contraindications to administering cardiac drugs in cross-sectional imaging departments. We also outline the complications that may be encountered and provide advice on how to treat these complications when they occur.
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Affiliation(s)
- P McParland
- Department of Cardiothoracic Radiology, Southampton University Hospitals NHS Trust, Southampton, UK
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Gibbons RJ, Araoz PA, Williamson EE. The year in cardiac imaging. J Am Coll Cardiol 2010; 55:483-95. [PMID: 20117464 DOI: 10.1016/j.jacc.2009.09.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2009] [Revised: 09/25/2009] [Accepted: 09/28/2009] [Indexed: 01/09/2023]
Affiliation(s)
- Raymond J Gibbons
- Department of Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA.
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Al Jaroudi W, Iskandrian AE. Regadenoson: a new myocardial stress agent. J Am Coll Cardiol 2009; 54:1123-30. [PMID: 19761931 DOI: 10.1016/j.jacc.2009.04.089] [Citation(s) in RCA: 165] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Revised: 03/10/2009] [Accepted: 04/26/2009] [Indexed: 12/21/2022]
Abstract
Vasodilator stress myocardial perfusion imaging (MPI) accounts for up to 50% of all stress MPI studies performed in the U.S. In 2008, the Food and Drug Administration approved regadenoson for stress testing in conjunction with MPI. Regadenoson, unlike adenosine, is a selective A(2A) agonist that is given as an intravenous bolus at a fixed dose, with less undesirable side effects including atrioventricular block and bronchospasm. Unlike adenosine, regadenoson could be used in patients with mild-to-moderate reactive airway disease. This review will summarize the pre-clinical and clinical data on regadenoson, as they specifically relate to its use as a vasodilator stress agent, currently the only approved selective A(2A) agonist.
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Affiliation(s)
- Wael Al Jaroudi
- Department of Medicine, The University of Alabama at Birmingham, USA.
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