{
  "abstract": "Introduction Rb-82 PET myocardial perfusion imaging (MPI) is used to investigate coronary artery disease. Gastric tracer uptake is the commonest artifact, hindering accurate inferior myocardial contouring and LVEF quantification. Unlike SPECT MPI, the short half-life of Rb-82 precludes reacquisition after interventions to reduce gastric uptake. Proton pump inhibitors (PPIs) have been associated with high gastric uptake.Purpose To assess the relationship between PPI use and gastric uptake, and whether temporary pre-scan PPI cessation reduces it.Methods A serial cross-sectional study was conducted. The pre-intervention audit included 9,588 scans (62% male, mean age 65.1±12.0y); the post-intervention re-audit included 1,452 scans (67% male, mean age 65.3±11.2y). The primary outcome, ‘high gastric uptake’, was identified via validated rules-based text mining of reports. Analyses included chi-square tests, t-tests, Wilcoxon rank-sum tests, and logistic regression (figure 1).Results In the pre-intervention audit, 54.8% of patients were on a PPI. Gastric uptake was more common in PPI users (15.1%) than non-users (7.9%) (OR 2.07, 95% CI 1.81–2.36; p<0.001), with no differences between individual PPIs (p=0.77), confirming a class effect. Male sex was an independent risk factor both on (OR 1.61, p<0.001) and off PPIs (OR 2.19, p<0.001). Post-intervention, adherence to PPI cessation (41.5%) was associated with lower gastric uptake rates (19.1% vs. 28.1%; OR 0.60, 95% CI 0.44–0.82; p=0.002), with NNT=12 (figures 2–5).Conclusion PPI use and male sex are independent predictors of gastric uptake on Rb-82 PET MPI. Temporary pre-scan PPI cessation significantly reduces this artifact, with male sex identified as a novel independent risk factor. Which of the following best describes the effect of proton pump inhibitor (PPI) use on gastric tracer uptake in Rb-82 PET myocardial perfusion imaging?A. PPI use doubles the risk of gastric uptake, with omeprazole carrying significantly greater risk than other PPIsB. PPI use is associated with significantly higher gastric uptake, with consistent risk across all PPI agents (CORRECT)C. PPI use increases gastric uptake only in female patients, with no significant effect in malesAbstract 9 Figure 5Abstract 9 Figure 4Abstract 9 Figure 3Abstract 9 Figure 2Abstract 9 Figure 1D. PPI use has a modest but non-significant association with gastric uptake when controlling for sex",
  "authors": [
    {
      "affiliations": [
        "Barts Health NHS Trust, London, United Kingdom"
      ],
      "name": "Sofiane Kouadria"
    },
    {
      "affiliations": [
        "Barts Health NHS Trust, London, United Kingdom"
      ],
      "name": "Rio Estoroque"
    },
    {
      "affiliations": [
        "Barts Health NHS Trust, London, United Kingdom"
      ],
      "name": "Susana Lousada"
    },
    {
      "affiliations": [
        "Barts Health NHS Trust, London, United Kingdom"
      ],
      "name": "Chris Orongan"
    },
    {
      "affiliations": [
        "Barts Health NHS Trust, London, United Kingdom"
      ],
      "name": "Nélio Fernandes"
    },
    {
      "affiliations": [
        "Barts Health NHS Trust, London, United Kingdom"
      ],
      "name": "Shane Cashin"
    },
    {
      "affiliations": [
        "Barts Health NHS Trust, London, United Kingdom"
      ],
      "name": "Idris Badreddine"
    },
    {
      "affiliations": [
        "Barts Health NHS Trust, London, United Kingdom"
      ],
      "name": "Tahir Hussain"
    },
    {
      "affiliations": [
        "Barts Health NHS Trust, London, United Kingdom"
      ],
      "name": "Leon Menezes"
    },
    {
      "affiliations": [
        "Barts Health NHS Trust, London, United Kingdom"
      ],
      "name": "George Benjamin Collins"
    }
  ],
  "title": "9 Temporary pre-scan proton pump inhibitor cessation reduces gastric tracer uptake in patients undergoing Rb-82 PET myocardial perfusion imaging",
  "uid": "30b5e92a-6976-5486-8b6c-2352a8d4d875"
}