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

Dirkjan Kuijpers, Niek H Prakken, Rozemarijn Vliegenthart, Paul R M van Dijkman, Pim van der Harst, Matthijs Oudkerk, Dirkjan Kuijpers, Niek H Prakken, Rozemarijn Vliegenthart, Paul R M van Dijkman, Pim van der Harst, Matthijs Oudkerk

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.

Keywords: Biomarkers; Caffeine; Cardiovascular MRI; T1-mapping.

Figures

Fig. 1
Fig. 1
Rest-stress T1 mapping analysis with adenosine perfusion CMR
Fig. 2
Fig. 2
Myocardial T1 values at rest and during adenosine stress CMR
Fig. 3
Fig. 3
Comparison of T1 reactivity (∆T1) between the different patient groups
Fig. 4
Fig. 4
Comparison of T1 reactivity (∆T1) between ischemic, infarcted and remote myocardial tissue
Fig. 5
Fig. 5
Comparison of T1 values in ischemic and infarct area versus remote myocardial tissue (septum)

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