Association of use of proton pump inhibitors and H 2 antagonists with stomach wall uptake in 99m Tc-methoxy-isobutyl-iso
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Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
Received Jan 15, 2019; accepted Apr 17, 2019 doi:10.1007/s12350-019-01733-9
Background. Stomach wall uptake (SWU) of tracer in 99mTc-MIBI myocardial perfusion imaging (MPI) occasionally leads to imaging artifacts, thereby lowering the diagnostic accuracy. It is less-studied phenomenon for possible link with proton pump inhibitors (PPIs) intake. This prospective work looked for association of SWU with PPI intake and compared its incidence with H2 antagonists (H2A) users and patients not on either gastroprotective medication. Methods. One hundred fifty-six patients undergoing one day stress/rest 99mTc-MIBI SPECT-MPI were distributed into four groups: control group (n = 48, not on any gastroprotective medication), PPI group (n = 47, on PPI treatment), H2A group (n = 19, on H2A therapy), and intervention group (N = 42, PPI discontinued for 3 days before MPI). Poststress planar images were analyzed for clinically relevant SWU. Results. Clinically relevant SWU was seen in 36% of PPI group patients compared to 8% in the control group, 10.5% in the H2A group, and 9.5% in the intervention group, respectively, with statistically significant difference. Only 1/40 patients undergoing exercise stress showed clinically relevant SWU compared to 26/116 patients undergoing adenosine stress (P = .020). Conclusion. Patients on PPIs scheduled for vasodilator stress MPI may discontinue PPIs for 3 days, or replace with H2A to reduce the incidence of clinically relevant SWU associated with PPI therapy. (J Nucl Cardiol 2019) Key Words: Clinically relevant stomach wall uptake Æ SPECT-MPI Æ 99mTc-MIBI Æ proton pump inhibitors Æ H2 antagonists Abbreviations MPI Myocardial perfusion imaging CAD Coronary artery disease MIBI Methoxy-isobutyl-isonitrile SWU Stomach wall uptake PPIs Proton pump inhibitors
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12350-019-01733-9) contains supplementary material, which is available to authorized users. The authors of this article have provided a PowerPoint file, available for download at SpringerLink, which summarizes the contents of the paper and is free for re-use at meetings and presentations. Search for the article DOI on SpringerLink.com.
H2A SPECT TMT DM
H2 antagonists Single photon emission computed tomography Treadmill test Diabetes mellitus
Reprint requests: Ashwani Sood, DNB, Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Sector - 12, Chandigarh, India; [email protected] 1071-3581/$34.00 Copyright Ó 2019 American Society of Nuclear Cardiology.
Singh et al Association of use of proton pump inhibitors
INTRODUCTION Myocardial perfusion imaging (MPI) is widely used modality for evaluation of patients with suspected or known coronary artery disease (CAD) and assessment of myocardial viability. MPI has unique ability to assess perfusion at cellular level both during peak stress (a
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