Gender differences and caffeine impact in adenosine-induced hyperemia

Positron Range Correction Helps Enhance the Image Quality of Cardiac 82Rb PET/CT

The image quality and quantitative accuracy of 82Rb myocardial perfusion imaging (MPI) using PET is challenged by the extensive positron range (PR) effects, with the PR of 82Rb being about 7 mm in soft tissues. This study explored the feasibility of applying postacquisition PR correction (PRC) to routine 82Rb PET/CT MPI acquisitions and assessed its impact on diagnostic accuracy and image quality. Methods: We implemented a PRC method adjusted to 82Rb into a vendor-provided reconstruction toolbox, using tissue-specific corrections for soft tissue, bone, and air/lungs. The PRC was evaluated in 2 cohorts: the first comprised 25 healthy volunteers who underwent repeated 82Rb MPI within 2 wk, and the second included 66 patients with known or suspected coronary artery disease. We measured the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) for the volunteer cohort. In the patient cohort, the impact of PRC was evaluated as changes in the area under the receiver operating characteristic curve (AUC), using fractional flow reserve as the gold standard (values < 80% were considered significantly reduced). We calculated AUCs for stress and ischemic total perfusion deficits. Results: In the volunteer cohort, PRC-based reconstructions (standard reconstruction [STD] + PRC) demonstrated significantly improved SNR and CNR compared with STD, with median increases of 22% and 47% for SNR and CNR, respectively (P < 0.05). For the patient cohort, comparable AUCs were reported for STD- versus PRC-based reconstructions (stress total perfusion deficits, 0.84 vs. 0.83 [P = 0.49]; ischemic total perfusion deficits, 0.87 vs. 0.87 [P = 0.80]). Conclusion: PRC significantly enhances SNR and CNR compared with STD without affecting the diagnostic accuracy of the scans. Given the significantly improved image quality, PRC may be recommended for MPI using 82Rb PET/CT clinical-routine-assessment interpretation of TPD.

Pulmonary blood volume as a marker of adenosine-induced cardiac hyperemia: A Rubidium-82 study

PURPOSE

To investigate the efficacy of pulmonary blood volume (PBV) as a marker of the cardiac hyperemic response to adenosine during myocardial perfusion imaging (MPI).

METHODS

Forty healthy subjects underwent four consecutive Rubidium-82 rest/adenosine-stress MPI: two sessions were conducted without any caffeine consumption (baseline), while the remaining two sessions involved controlled caffeine consumption (arm 1: 100 and 300 mg; arm 2: 200 and 400 mg). We evaluate the ability of the stress-to-rest ratio of PBV (PBV ratio) to identify an adequate cardiac hyperemic response. The adequate hyperemic response was defined as a stress myocardial blood flow >2 mL/g/min and a corresponding myocardial flow reserve >68% of the maximum myocardial flow reserve obtained during the baseline scans.

RESULTS

Based on 126 MPI sessions conducted in 40 subjects, the PBV ratio demonstrated a sensitivity of 78% and a specificity of 74% in detecting adequate cardiac hyperemia. The positive predictive value was 95%, while the negative predictive value was 36%.

CONCLUSION

The PBV ratio permits the identification of adequate hyperemic response with sensitivities and specificities comparable to existing markers.

Impact of physiological and coronary artery disease risk factors on myocardial perfusion in stress computed tomography myocardial perfusion imaging

To analyze the correlation between the main perfusion parameters of the left ventricle and various physiological and coronary artery disease (CAD) risk factors or comorbidities using dynamic stress computed tomography myocardial perfusion imaging (CT-MPI) in patients without obstructive coronary stenosis. This retrospective analysis included 119 patients without obstructive coronary artery stenosis in computed tomography angiography (CTA), and without perfusion defects in CT-MPI. Patients were categorized into groups based on the presence or absence of physiological and CAD risk factors or comorbidities. The global myocardial blood flow (MBF), myocardial blood volume (MBV), and perfused capillary blood volume (PCBV) of the left ventricle were compared between groups, and correlations with continuous variables were analyzed. Multivariate linear regression was used to identify independent factors. Perfusion parameters were higher (MBF, 149.41 ± 26.38 vs. 159.20 ± 21.31 ml/100 ml/min, MBV, 17.09 ± 2.37 vs.18.84 ± 1.89, and PCBV, 9.82 ± 2.21 vs. 11.47 ± 1.79 ml/100 ml [all P < 0.05]) in female patients than in male patients. Hypertension and overweight/obesity resulted in lower perfusion parameters (hypertension vs. normotension: MBF, 148.09 ± 21.15 vs. 161.47 ± 25.13 ml/100 ml/min, PCBV, 10.25 ± 2.23 vs. 11.22 ± 1.96 ml/100 ml; overweight/obesity vs. none: MBF, 148.82 ± 20.98 vs. 159.51 ± 25.44 ml/100 ml/min, PCBV, 10.20 ± 1.93 vs. 11.15 ± 2.22 ml/100 ml [all P < 0.05]). Body surface area (BSA), body mass index, stress heart rate (HR), incremental HR, coronary total plaque volume, and stress systolic blood pressure were significantly correlated with perfusion parameters (all P < 0.05). Stress HR, BSA, and hypertension were independent predictors of MBF, stress HR and sex were independent predictors of MBV, and stress HR and BSA were independent predictors of PCBV. Dynamic stress CT-MPI myocardial perfusion is affected by stress HR, sex, and BSA, and can identify early perfusion distribution in hypertension and obesity/overweight.

Habitual preexercise caffeine supplementation prevents exercise training-induced attenuation of exercising systolic blood pressure and double product

We examined the effect of habitual preexercise caffeine supplementation on training-induced adaptations to exercising systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), heart rate (HR), and double product (DP). Young women (means ± SD; 24 ± 7 yr) were randomized to a caffeine (120 mg) supplement (CAF; n = 17) or placebo (PLA; n = 16) group, completed 6 wk of high-intensity exercise training on three nonconsecutive days per week, and supplemented with CAF or PLA 30-60 min before exercise or else upon waking. Before (PRE) and after (POST) the intervention, SBP, DBP, and HR were measured and PP and DP were calculated, at rest and during fixed-power exercise at 50 and 75 W. Statistical analyses included three-way mixed-factorial ANOVAs with post hoc comparisons as necessary. Group × intensity × time interactions were observed for SBP (P = 0.0105) and DP (P = 0.003). SBP and DP increased with increasing exercise intensity at PRE and POST in both groups. However, although SBP and DP decreased PRE to POST at 50 and 75 W in PLA, SBP and DP did not change at any intensity from PRE to POST in CAF. An intensity × time interaction was observed for DBP (P = 0.006) indicating no change in resting DBP, but reductions from PRE to POST at 50 and 75 W that were independent of group. Main effects of intensity (P < 0.0001) and time (P = 0.03) were observed for HR, and a main effect of intensity was observed for PP (P < 0.0001). Habitual caffeine supplementation blunted training-induced reductions in exercising SBP and DP. Individuals may wish to avoid preexercise supplementation if seeking to maximize the BP-lowering benefits of exercise.NEW & NOTEWORTHY Habitual preexercise caffeine consumption prevented reductions in exercising systolic blood pressure and double product induced by 6 wk of high-intensity exercise in women. Therefore, our findings indicate that habitual preexercise caffeine supplementation may impede beneficial hemodynamic adaptations of exercise training in healthy, young women.

Investigation of the Roles of the Adenosine A(2A) and Metabotropic Glutamate Receptor Type 5 (mGlu5) Receptors in Prepulse Inhibition and CREB Signaling in a Heritable Rodent Model of Psychosis

The metabotropic glutamate receptor type 5 (mGlu5) and adenosine A(2A) receptor form a mutually inhibitory heteromer with the dopamine D2 receptor, where the activation of either mGlu5 or A(2A) leads to reduced D2 signaling. This study investigated whether a mGlu5-positive allosteric modulator (PAM) or an A(2A) agonist treatment could mitigate sensorimotor gating deficits and alter cyclic AMP response element-binding protein (CREB) levels in a rodent neonatal quinpirole (NQ) model of psychosis. F0 Sprague-Dawley rats were treated with neonatal saline or quinpirole (1 mg/kg) from postnatal day 1 to 21 and bred to produce an F1 generation. F1 offspring underwent prepulse inhibition (PPI) testing from postnatal day 44 to 48 to assess sensorimotor gating. The rats were treated with mGlu5 PAM 3-Cyano-N-(1,3-diphenyl-1H-pyrazol-5-yl) benzamide (CDPPB) or A(2A) agonist CGS21680. Rats with at least one NQ-treated parent showed PPI deficits, which were alleviated by both CDPPB and CGS21680. Sex differences were noted across groups, with CGS21680 showing greater efficacy than CDPPB. Additionally, CREB levels were elevated in the nucleus accumbens (NAc), and both CDPPB and CGS21680 reduced CREB expression to control levels. These findings suggest that targeting the adenosinergic and glutamatergic systems alleviates sensorimotor gating deficits and abnormal CREB signaling, both of which are associated with psychosis.

Caffeine: a potential mechanism for anti-obesity

Obesity refers to the excessive accumulation of fat caused by a long-term imbalance between energy intake (EI) and energy expenditure (EE). Over recent years, obesity has become a major public health challenge. Caffeine is a natural product that has been demonstrated to exert anti-obesity effects; however, the mechanisms responsible for the effect of caffeine on weight loss have yet to be fully elucidated. Most obesity-related deaths are due to cardiovascular disease. Recent research has demonstrated that caffeine can reduce the risk of death from cardiovascular disease; thus, it can be hypothesized that caffeine may represent a new therapeutic agent for weight loss. In this review, we synthesize data arising from clinical and animal studies over the last decade and discuss the potential mechanisms by which caffeine may induce weight loss, focusing particularly on increasing energy consumption, suppressing appetite, altering lipid metabolism, and influencing the gut microbiota. Finally, we summarize the major challenges associated with caffeine and anti-obesity research and highlight possible directions for future research and development.

Pulmonary blood volume assessment from a standard cardiac rubidium-82 imaging protocol: impact of adenosine-induced hyperemia

BACKGROUND

This study aimed to assess the feasibility of estimating the pulmonary blood volume noninvasively using standard Rubidium-82 myocardial perfusion imaging (MPI) and characterize the changes during adenosine-induced hyperemia.

METHODS

This study comprised 33 healthy volunteers (15 female, median age = 23 years), of which 25 underwent serial rest/adenosine stress Rubidium-82 MPI sessions. Mean bolus transit times (MBTT) were obtained by calculating the time delay from the Rubidium-82 bolus arrival in the pulmonary trunk to the arrival in the left myocardial atrium. Using the MBTT, in combination with stroke volume (SV) and heart rate (HR), we estimated pulmonary blood volume (PBV = (SV × HR) × MBTT). We report the empirically measured MBTT, HR, SV, and PBV, all stratified by sex [male (M) vs female (F)] as mean (SD). In addition, we report grouped repeatability measures using the within-subject repeatability coefficient.

RESULTS

Mean bolus transit times was shortened during adenosine stressing with sex-specific differences [(seconds); Rest: Female (F) = 12.4 (1.5), Male (M) = 14.8 (2.8); stress: F = 8.8 (1.7), M = 11.2 (3.0), all P ≤ 0.01]. HR and SV increased during stress MPI, with a concomitant increase in the PBV [mL]; Rest: F = 544 (98), M = 926 (105); Stress: F = 914 (182), M = 1458 (338), all P < 0.001. The following test-retest repeatability measures were observed for MBTT (Rest = 17.2%, Stress = 17.9%), HR (Rest = 9.1%, Stress = 7.5%), SV (Rest = 8.9%, Stress = 5.6%), and for PBV measures (Rest = 20.7%, Stress = 19.5%) CONCLUSION: Pulmonary blood volume can be extracted by cardiac rubidium-82 MPI with excellent test-retest reliability, both at rest and during adenosine-induced hyperemia.

Myocardial creep and cardiorespiratory motion correction improves diagnostic accuracy of Rubidium-82 cardiac positron emission tomography

AIM

To evaluate the feasibility of retrospectively detecting and correcting periodical (cardiac and respiratory motion) and non-periodical shifts of the myocardial position (myocardial creep) using only the acquired Rubidium-82 positron emission tomography raw (listmode) data.

METHODS

This study comprised 25 healthy participants (median age = 23 years) who underwent repeat rest/adenosine stress Rubidium-82 myocardial perfusion imaging (MPI) and 53 patients (median age = 64 years) considered for revascularization who underwent a single MPI session. All subjects were evaluated for myocardial creep during MPI by assessing the myocardial position every 200 ms. A proposed motion correction protocol, including corrections for cardiorespiratory and creep motion (3xMC), was compared to a guideline-recommended protocol (StandardRecon). For the volunteers, we report test-retest repeatability using standard error of measurements (SEM). For the patient cohort, we evaluated the area under the receiver operating curve (AUC) for both stress and ischemic total perfusion deficits (sTPD and iTPD, respectively) using myocardial ischemia defined as fractional flow reserve values < 0.8 in the relevant coronary segment as the gold standard.

RESULTS

Test-retest repeatability was significantly improved following corrections for myocardial creep (SEM; sTPD: StandardRecon = 2.2, 3xMC = 1.8; iTPD: StandardRecon = 1.6, 3xMC = 1.2). AUC analysis of the ROC curves revealed significant improvements for iTPD measurements following 3xMC [sTPD: StandardRecon = 0.88, 3xMC = 0.92 (P = .21); iTPD: StandardRecon = 0.88, 3xMC = 0.95 (P = .039)].

CONCLUSION

3xMC has the potential to improve the diagnostic accuracy of myocardial MPI obtained from positron emission tomography. Therefore, its use should be considered both in clinical routine and large-scale multicenter studies.

Acute effects of caffeine supplementation on taekwondo performance: the influence of competition level and sex

The purpose of this study was to assess the effects of acute caffeine supplementation on physical performance and perceived exertion during taekwondo-specific tasks in male and female athletes with varying expertise. In a double-blinded, randomized, placebo-controlled crossover study design, 52 young athletes from elite (n = 32; 16 males and 16 females) and sub-elite competitive level (n = 20; 10 males and 10 females) participated. Athletes performed taekwondo-specific tasks including the taekwondo-specific agility test (TSAT), 10 s frequency speed of kick test (FSKT-10 s) and multi-bout FSKT (FSKT-multi) under the following conditions: (1) Caffeine (CAF; 3 mg kg-1), placebo (PLA), and no supplement control (CON). Session rating of perceived exertion (s-RPE) was determined after the tests. Findings show that regardless of condition, males performed better than females (p < 0.05) and elite athletes had superior performance compared to their sub-elite counterparts (p < 0.05). For the TSAT (p < 0.001), FSKT-10s (p < 0.001), and FSKT-multi (p < 0.001), CAF enhanced performance in elite female athletes compared to sub-elite females. Likewise, CAF ingestion resulted in superior performance in elite males compared to sub-elite males for FSKT-10s (p = 0.003) and FSKT-multi (p < 0.01). The ergogenic potential of CAF during taekwondo-specific tasks appears to be related to a competitive level, with greater benefits in elite than sub-elite athletes.

Reduction of cardiac adipose tissue volume with short-term empagliflozin treatment in patients with type 2 diabetes: A substudy from the SIMPLE randomized clinical trial

OBJECTIVE

Ectopic accumulation of cardiac adipose tissue volume (CAT) has been associated with cardiac remodelling and cardiac dysfunction in type 2 diabetes and may be a future therapeutic target. In this substudy from the SIMPLE-trial, we investigated short-term empagliflozin therapy's effects on CAT in patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS

Between 4 April 2017 and 11 May 2020, we randomized 90 patients with type 2 diabetes and established or high risk of cardiovascular disease to 25 mg empagliflozin or placebo for 13 weeks. The substudy focused on change in CAT evaluated by images acquired during ⁸² Rubidium-positron emissions tomography/computed tomography. The analysis included 78 patients who had at least one scan. Furthermore, we report on the relation to the concurrent effects on left ventricular mass, end-diastolic volume and end-systolic volume, body composition and glucometabolic status.

RESULTS

Mean ± SD baseline CAT was 258.5 ± 117.9 ml. Empagliflozin reduced CAT after 13 weeks by 12.41 ml [95% CI (-23.83 to -0.99), p = .034] as compared with placebo. Similarly, left ventricular mass [-5.16 g, 95% CI (-8.80 to -1.52), p = .006], end-diastolic volume and end-systolic volume decreased with empagliflozin. In addition, significant improvements were observed in body composition, with reduced total fat mass, and in measures of glucose and lipid metabolism. However, no correlation was observed between changes in CAT and changes in cardiac parameters and change in CAT appeared mediated primarily by concurrent change in weight.

CONCLUSIONS

Empagliflozin provides an early reduction of CAT; however, no association was observed with concurrent changes in cardiac volumetrics.

Image-derived and physiological markers to predict adequate adenosine-induced hyperemic response in Rubidium-82 myocardial perfusion imaging

AIMS

This study aimed to investigate the potential of different markers to identify adequate stressing in subjects with and without caffeine intake prior to Rubidium-82 myocardial imaging.

METHODS AND RESULTS

This study comprised 40 healthy subjects who underwent four serial Rubidium-82 rest/adenosine stress MPI; two with 0mg caffeine consumption (baseline MPIs) and two with controlled consumption of caffeine (arm 1: 100 and 300mg, or arm 2: 200 and 400mg). We report the sensitivity and specificity of seven markers ability to predict adequate adenosine-induced hyperemic response: (1) the splenic response ratio (SRR); (2) splenic stress-to-rest intensity ratios (SIR); (3) changes in heart rate (ΔHR); (4) percentwise change in heart rate (Δ%HR); (5) changes in the rate pressure product (ΔRPP); (6) changes in the systolic blood pressure (ΔSBP); and (7) changes in the cardiovascular resistance (ΔCVR). Adequate stressing was determined as stress myocardial blood flow > 3ml/g/min and a corresponding myocardial flow reserve >68% of the individual maximum myocardial flow reserve obtained in the baseline MPIs.

RESULTS

129 MPI sessions (obtained in 39 subjects) were considered for this study. The following sensitivities were obtained: SSR = 72.7%, SIR = 63.6%, ΔHR = 45.5%, Δ%HR = 77.3%, ΔRPP = 54.5%, ΔSBP = 47.7%, and ΔCVR =40.9%, while the specificities were SSR = 80.9%, SIR = 85.0%, ΔHR = 90.4%, Δ%HR = 81.6%, ΔRPP=81.1%, ΔSBP = 86.4%, and ΔCVR =90.4%.

CONCLUSION

The image-derived and physiological markers all provide acceptable sensitivities and specificities when patients follow the caffeine pausation before MPI. However, their use warrants great care when caffeine consumption cannot be ruled out.

Optimization of the left ventricle ejection fraction estimate obtained during cardiac adenosine stress 82Rubidium-PET scanning: impact of different reconstruction protocols

BACKGROUND

Left ventricular ejection fraction (LVEF) estimation using adenosine stress myocardial perfusion imaging (MPI) can be challenging. The short half-life of adenosine and the guideline-recommended adenosine infusion stop during Rubidium-82 acquisition protocol may affect the accuracy and repeatability of the LVEF measures.

METHODS

This study comprised 25 healthy volunteers (median age 23 years) who underwent repeat myocardial perfusion imaging (MPI) sessions employing Rubidium-82 PET/CT. A guideline-recommended reconstruction protocol was used for both rest and adenosine stress MPI (150-360 s post-radiotracer injection, standardrecon). For the stress MPI protocol, two additional reconstruction protocols were considered; one was employing 60 seconds data (150-210 seconds, shortfixed) and the other a dynamic frame window based on the bolus arrival of Rubidium-82 in the heart until 210 seconds (x-210 seconds, shortindividual). We report rest and stress LVEF, the LVEF reserve, and the LVEF reserve repeatability.

RESULTS

Differences in the LVEF assessments were observed between the guideline recommended and alternative reconstruction protocol (LVEF stress MPI: standardrecon = 68 ± 7%, shortfixed = 71 ± 7% (P = .08), shortindividual = 72 ± 7% (P = .04)), and the LVEF reserve was reduced for the guideline-recommended protocol (standardrecon = 7.8 ± 3.5, shortfixed = 10.1 ± 3.7, shortindividual = 10.5 ± 3.6, all P < .001). The best repeatability measures were obtained for the shortindividual protocol (repeatability: standardrecon = 45.3%, shortfixed = 41.2%, shortindividual = 31.7%).

CONCLUSION

We recommend using the shortindividual reconstruction protocol for improved LVEF repeatability and reserve assessment. Alternatively, in centers with limited technical support we recommend the use of the shortfixed protocol.