Narendra C. Bhalodkar

Association of heart rate response with scan and left ventricular function on adenosine myocardial perfusion imaging

To evaluate the association of heart rate (HR) response with abnormal scan and/or left ventricular (LV) function in patients undergoing adenosine myocardial perfusion imaging, we retrospectively studied 188 consecutive patients who underwent a standard adenosine stress test (without exercise) and myocardial perfusion imaging (MPI) using technetium-99m sestamibi radioisotope. Change in HR was calculated by subtracting HR at rest from peak HR. The percentage change in HR was calculated. All patients underwent stress and resting single-photon emission computed tomography (SPECT) imaging. LV ejection fraction (EF) was calculated using gated SPECT. Mean age was 60 +/- 12 years and 135 of the patients (72%) were women. We divided the patients into 2 groups: group 1 (142 patients, 75%) had normal scans and group 2 (46 patients, 25%) had abnormal scans; abnormal scans were defined as presence of either fixed defects, reversible defects, or both. Average HR increased by 29 beats/min in the normal scan group compared with 19 beats/min in the abnormal scan group (p = 0.0004). Forty-seven patients (25%) had reduced EF (<45%). This group had an average HR and percentage HR increase of 20 beats/min (29%) compared with an increase of 29 beats/min (44%) in patients with normal EF (p = 0.002 and p = 0.002, respectively). Thus, a diminished HR response had a significant association with both an abnormal scan and reduced EF on adenosine MPI.

Clopidogrel With Proton Pump Inhibitors: Safe or Not?

Gastrointestinal (GI) bleeding is a serious complication associated with use of antiplatelet therapy, and proton pump inhibitors (PPIs) are known to be beneficial in decreasing such risk. Several studies in the recent past have suggested concerns regarding interaction between clopidogrel and PPIs, presumably due to inhibition of clopidogrel activity and thus attenuation of its antiplatelet activity. A web‐based literature and guidelines search was done using the keywords “clopidogrel,” “omeprazole,” “proton pump inhibitors” and “interaction.” Of the available results, relevant studies (n = 11) were then systematically reviewed and summarized. The studies were categorized based on their retrospective or prospective nature. Most of the retrospective, observational studies suggested a link between the 2; however, recent prospective studies have shown no interaction, as well as a positive influence of PPIs in preventing the GI side effects of antiplatelet therapy. There is currently insufficient clinical evidence to suggest interaction between clopidogrel and PPIs and decision to add PPI therapy to clopidogrel should be guided by its clinical indications rather than as a routine prophylactic measure.

C006: Combination of hypertension and relative lymphocytopenia predicts mortality in patients with acute myocardial infarction in an inner city hospital

Background: Lymphocytopenia (LP) is common in patients with acute myocardial infarction (AMI). In addition the incidence of hypertension (HTN) is higher in Blacks and Hispanics than white. Our purpose was to study the effects of LP and HTN on mortality in the patients with AMI in an inner city hospital. Methods: We conducted a restropective chart review of 206 consecutive patients admitted with AMI in an inner city hospital serving mostly Black, and Hispanics of diverse nationality. An automated CBC drawn at the time of admission was reviewed for lymphocyte %. LP was defined as lymphocyte % , 20. Patients (N 5 40) with comorbid conditions such as fulminant infection, septicemia or acute surgical conditions that can cause LP were excluded. History of hypertension and/or on antihypertensive treatment made up the HTN group, others made up the NHTN group. The effect of HTN and LP on mortality was examined separately and in combination. Results: Out of 166 patients 65 were Blacks 93 were Hispanics and 78 were females. LP was present in 58% of all patients and it occurred with same frequency in Blacks, Hispanics, HTN, NHTN as well as both genders. Overall 67% of patients had HTN and it occurred with same frequency in Blacks, Hispanics, both genders, diabetics, smokers. HTN were older compared to NHTN (mean age 68 Vs 59, P 5 0.001). On an univariate analysis, both HTN (P 5 0.03) and LP (P 5 0.01) were significant predictors of mortality (9 of 166). However, on both stratified analysis and multivariate logistic regression analysis only those patients with both HTN and LP were at significant risk of mortality compared with those who had only one or none of these risk factors. Other factors (i.e.: age, sex, race, smoking, hypercholesterolemia, diabetes, HOMI, Q MI, peak CPK) were not independent predictors of mortality. Among the excluded patients although the mortality rate was higher (73%), there was no association between HTN/LP combination and death. Conclusion: In an inner city hospital population in patients with AMI, LP and HTN is common. Among all the factors included in the multivariate analysis only interaction between HTN and LP was significant predictors of mortality. This was an unexpected finding and the mechanism of this interaction in not understood.