Association of use of proton pump inhibitors and H 2 antagonists with stomach wall uptake in 99m Tc-methoxy-isobutyl-isonitrile (MIBI) myocardial perfusion imaging

• Published in: Journal of nuclear cardiology 2020-10, Vol.27 (5), p.1611
• Main Authors: Singh, Harpreet, Mittal, Bhagwant Rai, Sood, Ashwani, Bollampally, Neeraja, Gorla, Arun Kumar Reddy, Dasagrandhi, Vaishnavi, Parmar, Madan
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - metabolism; Female; Gastric Mucosa - metabolism; Histamine H2 Antagonists - therapeutic use; Humans; Male; Middle Aged; Myocardial Perfusion Imaging; Prospective Studies; Proton Pump Inhibitors - therapeutic use; Radiopharmaceuticals - pharmacokinetics; Single Photon Emission Computed Tomography Computed Tomography; Technetium Tc 99m Sestamibi - pharmacokinetics
• ISSN: 1532-6551

Stomach wall uptake (SWU) of tracer in Tc-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 H antagonists (H A) users and patients not on either gastroprotective medication. One hundred fifty-six patients undergoing one day stress/rest Tc-MIBI SPECT-MPI were distributed into four groups: control group (n = 48, not on any gastroprotective medication), PPI group (n = 47, on PPI treatment), H A group (n = 19, on H A therapy), and intervention group (N = 42, PPI discontinued for 3 days before MPI). Poststress planar images were analyzed for clinically relevant SWU. Clinically relevant SWU was seen in 36% of PPI group patients compared to 8% in the control group, 10.5% in the H A 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). Patients on PPIs scheduled for vasodilator stress MPI may discontinue PPIs for 3 days, or replace with H A to reduce the incidence of clinically relevant SWU associated with PPI therapy.