The judgement of the eye

Christian, Timothy F.

doi:10.1007/s12350-016-0412-8

Journal of Nuclear Cardiology

2016

DOI: 10.1007/s12350-016-0412-8

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The judgement of the eye

Timothy F. Christian

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Cited by 3 publications

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“…17 The significance of prior caffeine consumption on regadenosoninduced coronary hyperemia and the diagnostic sensitivity of MPI for detection of perfusion abnormalities have been recently debated in the Journal. [18][19][20][21][22] Our view is that moderate caffeine consumption (i.e., B2 cups of coffee more than 1 hour prior to presentation to the stress laboratory) does not alter coronary flow reserve to such an extent to significantly impact myocardial perfusion pattern on MPI. In line with this view, the recently released American Society of Nuclear Cardiology imaging guidelines for SPECT nuclear cardiology procedures: Stress protocols and tracers states that ingestion of caffeinated foods or beverages within the last 12 hours prior to regadenoson MPI (or other vasodilator stress agents) should be avoided but downgraded this from an absolute to a relative contraindication.…”

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confidence: 93%

Effect of aminophylline administration on the diagnostic yield of vasodilator myocardial perfusion imaging

Daya

Hage

2017

Journal of Nuclear Cardiology

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The last few decades have witnessed a steady increase in the proportion of myocardial perfusion imaging (MPI) tests that utilize pharmacologic stress instead of exercise. 1 Currently regadenoson, a pyrazole derivative of adenosine selective for the A 2A receptor, is the most commonly used vasodilator agent accounting for more than 80% of all pharmacological stress tests performed in the USA. 2 The widespread utilization of regadenoson is supported by multiple factors including its similar diagnostic and prognostic performance to adenosine when used for MPI, the simpler and more rapid infusion protocol, and the better safety profile in specific patient groups. 3-6 Although better tolerated by patients, regadenoson shares with adenosine similar adverse effects such as flushing, headaches, and gastrointestinal symptoms. 3,7 Aminophylline, a nonselective adenosine receptor antagonist, has been available on the market for decades and used to reverse the adverse effects of dipyridamole and adenosine and more recently been shown to be safe and effective for use with regadenoson. 8,9 In this issue of the Journal, Fughhi et al. 10 address the concern that use of aminophylline to ameliorate the adverse effects of regadenoson may reverse its effects on coronary vasodilation and subsequent myocardial hyperemia reducing the sensitivity of MPI for detecting perfusion abnormalities. The data for the current study were pooled from two double-blinded, placebo-controlled randomized clinical trials, the ASSUAGE and ASSUAGE-CKD trials, 9,11 which demonstrated the effectiveness of aminophylline in attenuating the adverse effects associated with regadenoson in patients undergoing MPI. In both trials, patients were randomized to receive 75 mg of intravenous aminophylline or placebo administered at 90 seconds after radioisotope injection (*2 minutes following regadenoson). The primary end point of the current report was the degree of reversibility of the perfusion defect on imaging as measured by the semi-quantitative summed difference score (SDS). The secondary end point was the presence of myocardial ischemia as defined by SDS C2. The authors also examined the effect of aminophylline use on the prognostic value of myocardial ischemia detection by MPI for cardiac events including cardiac death, myocardial infarction (MI), and coronary revascularization over a follow-up period of 29 ± 14 months.The myocardial ischemic burden (primary outcome) and the presence of myocardial ischemia (secondary outcome) on MPI were similar between the two groups. However, there was a trend towards a higher proportion of abnormal perfusion (summed stress score, SSS C4, 34% vs 27%, P = .08) in the placebo group that the authors attributed to the significantly higher rate of prior MI (20% vs 13%, P = .03) in this group. To account for this imbalance, the authors performed a sensitivity analysis in patients without clinical or MPI evidence (summed rest score, SRS C4) of prior MI, and demonstrated similar prevalence of myocardial ischemia and abnormal perfusio...

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Effect of aminophylline administration on the diagnostic yield of vasodilator myocardial perfusion imaging

Daya

Hage

2017

Journal of Nuclear Cardiology

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“…3 While we feel that this debate highlights the controversy on this practical issue that is frequently encountered in the stress laboratory, several common threads emerge from these three articles that can help us move forward: (1) caffeine is an adenosine receptor antagonist. It is therefore possible that caffeine intake may alter the sensitivity of vasodilator MPI in some patients.…”

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confidence: 99%

Caffeine intake and myocardial perfusion imaging

Saab

Bajaj

Hage

2016

Journal of Nuclear Cardiology

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Assessing if adequate hyperemic response to pharmacologic stress in Rb-82 PET myocardial perfusion imaging is achieved: are biomarkers helpful?

Smith

2022

Journal of Nuclear Cardiology

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The judgement of the eye

Cited by 3 publications

References 12 publications

Effect of aminophylline administration on the diagnostic yield of vasodilator myocardial perfusion imaging

Effect of aminophylline administration on the diagnostic yield of vasodilator myocardial perfusion imaging

Caffeine intake and myocardial perfusion imaging

Assessing if adequate hyperemic response to pharmacologic stress in Rb-82 PET myocardial perfusion imaging is achieved: are biomarkers helpful?

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