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Interaction between the effects of proton pump inhibitors and aspirin on gastric wall sestamibi uptake on myocardial perfusion imaging

  • David S. RoseEmail author
  • Brittany Robinson
  • Shanthi Kannan
  • Joseph C. Lee
Original Article

Abstract

Background

Increased gastric wall activity on myocardial perfusion imaging (MPI) is associated with proton pump inhibitor (PPI) therapy; however, the mechanism is unknown. We proposed a role for gastric mucosal prostaglandin synthesis and asked whether concurrent use of aspirin would antagonize this effect.

Methods

An observational study was performed of 319 patients undergoing technetium-99m sestamibi (MIBI) rest/stress MPI. We assessed the effects of taking PPIs, aspirin and their interaction on the principle outcome of clinically significant gastric wall activity.

Results

The outcome was observed in 13% of patients taking neither a PPI nor aspirin, 22% of those taking aspirin only, 51% taking a PPI only and 33% of those taking both. Adjusted odd ratios (95% confidence intervals) were 6.3 (CI 2.8-14.0; p < .001) for taking a PPI only, 1.8 (CI 0.8-3.9; p = .16) for taking aspirin only, and 3.0 (CI 1.4-6.5; p = .005) for taking the combination of a PPI and aspirin. There was evidence of negative statistical interaction between the two drug effects using additive (p = .006) and multiplicative (p = .016) scales.

Conclusions

PPI use was strongly associated with enhanced gastric wall activity on MPI; however, concurrent aspirin appears to reduce the effect. Enhanced local prostaglandin synthesis may mediate the PPI effect.

Keywords

Myocardial perfusion imaging Sestamibi Proton pump inhibitors Aspirin Gastric wall Prostaglandin Artifact 

Abbreviations

MIBI

Methoxy-isobutyl-isonitrile (sestamibi)

MPI

Myocardial perfusion imaging

SPECT

Single photon emission computerized tomography

PPI

Proton pump inhibitor

NSAID

Non-steroidal anti-inflammatory drug

COX-1, COX-2

COX-1 and COX-2 isoenzyme of cyclooxygenase

PGE2

Prostaglandin E2

OR

Odds ratio

Notes

Disclosures

David S. Rose, Brittany Robinson, Shanthi Kannan and Joseph C. Lee have no conflicts of interest to declare.

Supplementary material

12350_2019_1951_MOESM1_ESM.pptx (1.4 mb)
Supplementary material 1 (PPTX 1403 kb)
12350_2019_1951_MOESM2_ESM.m4a (6.9 mb)
Supplementary material 2 (M4A 7064 kb)

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Copyright information

© American Society of Nuclear Cardiology 2019

Authors and Affiliations

  • David S. Rose
    • 1
    Email author
  • Brittany Robinson
    • 2
  • Shanthi Kannan
    • 1
    • 3
  • Joseph C. Lee
    • 1
    • 3
  1. 1.Department of Medical ImagingThe Prince Charles HospitalChermsideAustralia
  2. 2.Department of Nuclear MedicineRoyal Brisbane and Womens’ HospitalHerstonAustralia
  3. 3.Faculty of MedicineThe University of QueenslandHerstonAustralia

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