Impact of caffeine on myocardial perfusion reserve assessed by semiquantitative adenosine stress perfusion cardiovascular magnetic resonance

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.

Significant Impact of Coffee Consumption on MR-Based Measures of Cardiac Function in a Population-Based Cohort Study without Manifest Cardiovascular Disease

“…Several other studies reported on the effects of coffee intake on cardiac MRI measures yet with the focus on perfusion measurements on stress cardiac MRI [ 69 , 70 , 71 ]. Interestingly, Greulich et al showed that two cups of coffee one hour before the examination caused a significant decrease in the ischemic stress, compared to caffeine-naïve adenosine stress cardiac MRI, probably due to coronary hyperemia [ 72 ].…”

Caffeine as a Factor Influencing the Functioning of the Human Body—Friend or Foe?

“…Seitz et al [165] in their study showed that caffeine reduced the myocardial perfusion reserve index (MPRI). The authors examined 25 patients (84% male, median age 69 years) with substantial myocardial ischemia and coffee addiction (3-4 cups per day), who underwent repeat adenosine stress perfusion imaging by cardiovascular magnetic resonance after a prior intake of two cups of coffee (about 200 mg of caffeine) 1 h before examination, which confirmed the need for abstinence from caffeine [165].…”

“…As a nonselective competitive inhibitor of A 2A Rs, caffeine might attenuate the vasodilator effect of adenosine, and increase sympathetic activity, yielding to capillary de-recruitment and leading to decreased myocardial perfusion reserve [47,164]. Seitz et al [165] in their study showed that caffeine reduced the myocardial perfusion reserve index (MPRI). The authors examined 25 patients (84% male, median age 69 years) with substantial myocardial ischemia and coffee addiction (3-4 cups per day), who underwent repeat adenosine stress perfusion imaging by cardiovascular magnetic resonance after a prior intake of two cups of coffee (about 200 mg of caffeine) 1 h before examination, which confirmed the need for abstinence from caffeine [165].…”

2020 - State of our JCMR

“…J Cardiovasc Magn Reson. 2019 Jun 24;21(1):33 [ 17 ] Shusterman et al High-energy external defibrillation and transcutaneous pacing during MRI: feasibility and safety [ 18 ] Thompson et al . * Quantification of lung water in heart failure using cardiovascular magnetic resonance imaging [ 10 ] Walheim et al Multipoint 5D flow cardiovascular magnetic resonance—accelerated cardiac- and respiratory-motion resolved mapping of mean and turbulent velocities [ 19 ] * 2020 Pohost Award Winner ** 2020 Pohost Award Runner-up …”