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Daily Caffeine Consumption Is Associated with Decreased Incidence of Symptoms and Hemodynamic Changes During
Michael I Posch1, Matthew D Kay2, Ahmed A Harhash3
1Department of Medical Imaging, University of Arizona, Tucson, Arizona michaelianposch@gmail.com.
Insights
Caffeine consumption is common and safe during regadenoson stress tests for myocardial perfusion imaging. Caffeine users experienced fewer symptoms like chest pain and required less aminophylline, indicating a potentially smoother testing experience.
Area of Science:
- Cardiology
- Pharmacology
- Nuclear Medicine
Background:
- Regadenoson is a common adenosine A2A receptor agonist for myocardial perfusion imaging.
- Caffeine, an adenosine receptor antagonist, is typically withheld before regadenoson stress tests.
- The impact of habitual caffeine intake on regadenoson stress testing is not well understood.
Purpose of the Study:
- To assess the effects of daily caffeine intake on patient symptoms and hemodynamic responses during regadenoson stress myocardial perfusion imaging.
Main Methods:
- Patients undergoing regadenoson stress tests reported daily caffeine intake.
- Data collected included demographics, comorbidities, and stress test parameters (symptoms, aminophylline use, heart rate, blood pressure, arrhythmias).
- Statistical analysis involved chi-squared tests and ANOVA to compare outcomes across caffeine intake categories (<200, 200-400, >400 mg/day).
Main Results:
- 89% of 101 patients consumed caffeine, with 13% being heavy consumers (>400 mg/day).
- Caffeine users reported less chest pain and required less aminophylline compared to non-users.
- Caffeine intake was associated with lower resting and peak heart rates and a blunted diastolic blood pressure response, but not arrhythmias or systolic blood pressure changes.
Conclusions:
- Regadenoson stress testing is safe and common in caffeine consumers.
- Caffeine intake is associated with a reduced incidence of certain symptoms, specifically chest pain.
- Caffeine consumption may lead to a more favorable hemodynamic profile during regadenoson stress testing, with less need for aminophylline.
Abstract:
Regadenoson is an adenosine A2A receptor agonist widely used as a pharmacologic stress agent for myocardial perfusion imaging. Approximately 3.4 million regadenoson pharmacologic stress tests were performed annually as of 2011. Caffeine is a competitive antagonist of all adenosine receptor subtypes; thus, caffeine is typically withheld 12-24 h before stress with regadenoson. However, the effects of daily caffeine intake on regadenoson stress are unknown. This study assessed the effects of daily caffeine intake on symptoms and hemodynamic changes during stress testing with regadenoson. Methods: Patients presenting for regadenoson stress myocardial perfusion imaging were asked their amounts of daily caffeine intake. Chart review was used to collect data on demographics, comorbidities, and use of β-blockers. Data collected from the regadenoson stress test included symptoms, administration of aminophylline, heart rate, blood pressure, and arrhythmias. χ2 testing and ANOVA were used to analyze data divided into 3 categories of caffeine intake (<200, 200-400, and >400 mg daily). χ2 testing was used for nominal data, and unpaired t testing was used for continuous data. Results: In total, 101 patients were enrolled: 53% men and 47% women. Of the 101 patients, 89% reported caffeine intake, with 13% reporting heavy caffeine intake (>400 mg daily). The last intake of caffeine was at least 12 h before the test. During the test, 63% of patients reported symptoms, but the test was completed successfully in all patients. Compared with those who do not use caffeine, intake for caffeine users was associated with less chest pain (P = 0.0013), less aminophylline administration (P = 0.0371), lower resting and peak heart rate (P = 0.0497 and 0.0314, respectively), and lower diastolic blood pressure response (P = 0.0468). No associations were found between caffeine intake and arrhythmia or systolic blood pressure response. Conclusion: The use of regadenoson stress for myocardial perfusion imaging in caffeine consumers is very common, safe, and associated with a lower incidence of certain symptoms than in non-caffeine consumers. Specifically, caffeine intake was associated with less aminophylline use and chest pain.
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