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High-dose adenosine overcomes the attenuation of myocardial perfusion reserve caused by caffeine.
- Source :
-
Journal of the American College of Cardiology [J Am Coll Cardiol] 2008 Dec 09; Vol. 52 (24), pp. 2008-16. - Publication Year :
- 2008
-
Abstract
- Objectives: We studied whether an increase in adenosine dose overcomes caffeine antagonism on adenosine-mediated coronary vasodilation.<br />Background: Caffeine is a competitive antagonist at the adenosine receptors, but it is unclear whether caffeine in coffee alters the actions of exogenous adenosine, and whether the antagonism can be surmounted by increasing the adenosine dose.<br />Methods: Myocardial perfusion scintigraphy (MPS) was used to assess adenosine-induced hyperemia in 30 patients before (baseline) and after coffee ingestion (caffeine). At baseline, patients received 140 microg/kg/min of adenosine combined with low-level exercise. For the caffeine study, 12 patients received 140 microg/kg/min of adenosine (standard) and 18 patients received 210 microg/kg/min (high dose) after caffeine intake (200 mg). Myocardial perfusion was assessed semiquantitatively and quantitatively, and perfusion defect was characterized according to the presence of reversibility.<br />Results: Caffeine reduced the magnitude of perfusion abnormality induced by standard adenosine as measured by the summed difference score (SDS) (12.0 +/- 4.4 at baseline vs. 4.1 +/- 2.1 after caffeine, p < 0.001) as well as defect size (18% [3% to 38%] vs. 8% [0% to 22%], p < 0.01), whereas it had no effect on the abnormalities caused by high-dose adenosine (SDS, 7.7 +/- 4.0 at baseline vs. 7.8 +/- 4.2 after caffeine, p = 0.7). There was good agreement between baseline and caffeine studies for segmental defect category (kappa = 0.72, 95% confidence interval: 0.65 to 0.79) in the high-dose group. An increase in adenosine after caffeine intake was well tolerated.<br />Conclusions: Caffeine in coffee attenuates adenosine-induced coronary hyperemia and, consequently, the detection of perfusion abnormality by adenosine MPS. This can be overcome by increasing the adenosine dose without compromising test tolerability.
- Subjects :
- Adenosine administration & dosage
Aged
Caffeine blood
Central Nervous System Stimulants blood
Coffee
Coronary Artery Disease diagnostic imaging
Drug Interactions
Female
Humans
Hyperemia chemically induced
Male
Middle Aged
Myocardial Infarction drug therapy
Myocardial Perfusion Imaging
Prospective Studies
Receptors, Purinergic P1 drug effects
Vasodilation drug effects
Vasodilator Agents administration & dosage
Adenosine therapeutic use
Caffeine pharmacology
Central Nervous System Stimulants pharmacology
Coronary Artery Disease drug therapy
Coronary Vessels drug effects
Hyperemia physiopathology
Purinergic P1 Receptor Antagonists
Vasodilator Agents therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 1558-3597
- Volume :
- 52
- Issue :
- 24
- Database :
- MEDLINE
- Journal :
- Journal of the American College of Cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 19055993
- Full Text :
- https://doi.org/10.1016/j.jacc.2008.08.052