Effect of caffeine on SPECT myocardial perfusion imaging during regadenoson pharmacologic stress: a prospective, randomized, multicenter study

Abstract

A multicenter, double-blind, randomized study was conducted to assess the effect of caffeine on regadenoson stress myocardial perfusion imaging (MPI). Subjects with a high likelihood of coronary artery disease underwent a rest single-photon emission computed tomography MPI on day 1 (MPI-1) and a stress MPI with regadenoson on day 3 (MPI-2). Individuals with ≥1 segment with a reversible defect received double-blind caffeine tablets (200 or 400 mg) or placebo 90 min before a repeat regadenoson stress MPI (MPI-3) on day 5. Overall, 207 subjects completed the study (caffeine 200 mg, n = 70; caffeine 400 mg, n = 71; placebo, n = 66). The mean number of segments with reversible defects decreased from MPI-2 to MPI-3 in the caffeine 200 and 400 mg groups versus no significant change in the placebo group [mean ± standard deviation: −0.61 ± 1.097, −0.62 ± 1.367, and 0.12 ± 0.981, respectively (overall treatment effect, P < 0.001)]. The majority of subjects who received caffeine shifted to a lower ischemia size category from MPI-2 to MPI-3, with no clear pattern observed in subjects who received placebo. For caffeine exposed patients with ≥3 segments with reversible defects at MPI-2, 21/23 had fewer detected at MPI-3. Both the 200 and 400 mg doses of caffeine significantly reduced the number of segments with reversible defects detected by regadenoson stress MPI.

ASNC imaging guidelines for SPECT nuclear cardiology procedures: Stress, protocols, and tracers

“…64 Regadenoson-induced hyperemic myocardial blood flow measured by PET was not affected by caffeine ingestion, 65 but reversible defects on SPECT myocardial perfusion imaging were smaller with caffeine consumption. 66 Patients should abstain from caffeinated products for at least 12 hours, which allows for selection of any of the three vasodilator stressors.…”

Cardiovascular imaging 2014 in the International Journal of Cardiovascular Imaging

“…Data regarding caffeine use and regadenoson stress testing are however limited. Tejani et al [18] conducted a multicenter, double-blind, randomized study to assess the effect of caffeine on regadenoson stress myocardial perfusion imaging (MPI). Subjects with a high likelihood of CAD underwent a rest SPECT MPI on day 1 (MPI-1) and a stress MPI with regadenoson on day 3 (MPI-2).…”

The judgement of the eye

“…Potential probability curves estimating the impact of caffeine ingestion on vasodilation perfusion SPECT imaging from three papers cited by the discussants. 11,13,14 The height of the curve is a reflection of the sample size with the peak corresponding to the mean probability estimate of the impact of caffeine on SPECT clinical imaging, and the width reflecting the confidence interval of the prediction. Each curve is cumulative from the previous such that the final curve includes probability estimates from that study plus the estimate of the impact of the two prior studies combined.…”

“…A hypothetical graphic of that approach is shown in Figure 1. 11,13,14 Bayesian analysis places the accumulated data in perspective with a final estimate of the impact of caffeine on MBF with a confidence interval of that estimate. This could be done with the studies cited in the arguments for the impact of caffeine ingestion prior to vasodilation stress.…”