Caffeine intake inverts the effect of adenosine on myocardial perfusion during stress as measured by T1 mapping

Abstract

Caffeine intake before adenosine stress myocardial perfusion imaging may cause false negative findings. We hypothesized that the antagonistic effect of caffeine can be measured by T1 relaxation times in rest and adenosine stress cardiac magnetic resonance imaging (CMR), as T1 mapping techniques are sensitive to changes in myocardial blood volume. We prospectively analyzed 105 consecutive patients with adenosine stress perfusion CMR on a 1.5-T MRI system. Rest and stress T1 mapping was performed using Modified Look-Locker Inversion recovery. T1 reactivity was defined as difference in T1rest and T1stress (∆T1). Fifteen patients drank coffee within 4 h of CMR (<4H caffeine group), and 10 patients had coffee the day before (>8H caffeine group). Comparison was made to patients without self-reported coffee intake: 50 with normal CMR (control group), 18 with myocardial ischemia, and 12 with myocardial infarction. The national review board approved the study; all patients gave written informed consent. The <4H caffeine group showed inverted ∆T1 of −7.8 % (T1rest 975 ± 42 ms, T1stress 898 ± 51 ms, p < 0.0005). The >8H caffeine group showed reduced T1 reactivity (1.8 %; T1rest 979 ms, T1stress 997 ms) compared to the controls (4.3 %; T1rest 977 ± 40 ms, T1stress 1018 ± 40 ms), p < 0.0005. Ischemic and infarcted myocardium showed minimal T1 reactivity (0.2 and 0.3 %, respectively). Caffeine intake inverts the adenosine effect during stress perfusion CMR as measured by T1 mapping. T1 reactivity can assess the adequacy of adenosine-induced stress in perfusion CMR.

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

“…1 . Results on rest-stress T1-mapping of the study population undergoing adenosine perfusion CMR was previously reported [ 13 ].…”

“…Recently, we showed that T1 mapping can also identify patients who are stressed inadequately during adenosine perfusion CMR. Coffee intake less than 4 h prior to the examination caused an inversion of T1 reactivity during adenosine perfusion CMR [ 13 ]. So far no studies analyzed the effect of caffeine intake on regadenoson perfusion CMR.…”

Cardiac T1 mapping: Techniques and applications

“…More recent stress T 1 studies have distinguished microvascular dysfunction and epicardial obstructive CAD in native coronary arteries and identified reduced T 1 stress reactivity in patients with well‐controlled type 2 diabetes mellitus without obstructive CAD, suggestive of early microvascular changes . Other groups have also employed the technique in small samples but the ability to reliably distinguish between normal, ischemic, and infarcted myocardium remains to be definitively proven …”

State-of-the-art review: stress T1 mapping—technical considerations, pitfalls and emerging clinical applications

“…Stress T1 mapping has obvious potential applications in patients with CAD and ischemic heart disease [ 28 , 47 ]. Liu et al [ 28 ] demonstrated that, in normal myocardium, the resting T1 is normal, with a 6% rise during vasodilatory stress.…”

“…The impact of this issue is particularly apparent for stress T1 applications, as illustrated by two recent studies that used different MOLLI techniques to perform adenosine stress T1 mapping: Liu et al [ 28 ] performed stress T1 mapping using ShMOLLI to study normal volunteers compared to patients with CAD, while Kuijpers et al used MOLLI 5(3)3 stress T1 mapping to study patients who had normal findings on conventional CMR (served as controls) compared to CAD patients. Liu et al observed a normal stress T1 response of 6.2 ± 0.5% at 1.5 T and 6.3 ± 1.1% at 3 T [ 28 ], while Kuijpers et al obtained a lower stress T1 response and larger standard deviations of 4.3 ± 2.8% in controls at 1.5 T [ 47 ]. In CAD patients with remote myocardium, Liu et al noted a blunted T1 response of 3.9 ± 0.6%, while Kuijpers et al reported lower averages of 2.6 ± 3.4%.…”