David S Rose1, Brittany Robinson2, Shanthi Kannan3,4, Joseph C Lee3,4. 1. Department of Medical Imaging, The Prince Charles Hospital, Ground Floor, Rode Road, Chermside, QLD, 4032, Australia. David.rose@health.qld.gov.au. 2. Department of Nuclear Medicine, Royal Brisbane and Womens' Hospital, Herston, QLD, Australia. 3. Department of Medical Imaging, The Prince Charles Hospital, Ground Floor, Rode Road, Chermside, QLD, 4032, Australia. 4. Faculty of Medicine, The University of Queensland, Herston, QLD, Australia.
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.
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.
Authors: Sanjay Divakaran; Avinainder Singh; Ersilia M DeFilippis; Timothy W Churchill; Sarah Cuddy; Yin Ge; Ivan K Ip; Wunan Zhou; Hicham Skali; Viviany R Taqueti; Sharmila Dorbala; James Spalding; Yanqing Xu; Ramin Khorasani; Marcelo F Di Carli; Maria A Yialamas; Ron Blankstein Journal: J Nucl Cardiol Date: 2019-11-18 Impact factor: 3.872