Added value of myocardial blood flow using 18F-flurpiridaz PET to diagnose coronary artery disease: The flurpiridaz 301 trial

18F-Flurpiridaz is a promising investigational radiotracer for PET myocardial perfusion imaging with favorable properties for quantification of myocardial blood flow (MBF). We sought to validate the incremental diagnostic value of absolute MBF quantification in a large multicenter trial against quan...

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Bibliographic Details
Published in:Journal of nuclear cardiology 2021-10, Vol.28 (5), p.2313-2329
Main Authors: Moody, Jonathan B., Poitrasson-Rivière, Alexis, Hagio, Tomoe, Buckley, Christopher, Weinberg, Richard L., Corbett, James R., Murthy, Venkatesh L., Ficaro, Edward P.
Format: Article
Language:English
Subjects:
18F-flurpiridaz
Absolute flow
Cardiac PET
Cardiology
Cardiovascular disease
Coronary artery disease
Coronary vessels
Flow reserve
Imaging
Kinetic modeling
Medical imaging
Medicine
Medicine & Public Health
Nuclear Medicine
Original Article
Patients
Radiology
Vein & artery diseases
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Summary:18F-Flurpiridaz is a promising investigational radiotracer for PET myocardial perfusion imaging with favorable properties for quantification of myocardial blood flow (MBF). We sought to validate the incremental diagnostic value of absolute MBF quantification in a large multicenter trial against quantitative coronary angiography. We retrospectively analyzed a subset of patients (N = 231) from the first phase 3 flurpiridaz trial (NCT01347710). Dynamic PET data at rest and pharmacologic stress were fit to a previously validated 2-tissue-compartment model. Absolute MBF and myocardial flow reserve (MFR) were compared with coronary artery disease severity quantified by invasive coronary angiography on a per-patient and per-vessel basis. Stress MBF per-vessel accurately identified obstructive disease (c-index 0.79) and progressively declined with increasing stenosis severity (2.35 ± 0.71 in patients without CAD; 1.92 ± 0.49 in non-obstructed territories of CAD patients; and 1.54 ± 0.50 in diseased territories, P < 0.05). MFR similarly declined with increasing stenosis severity (3.03 ± 0.94; 2.69 ± 0.95; and 2.33 ± 0.86, respectively, P < 0.05). In multivariable logistic regression modeling, stress MBF and MFR provided incremental diagnostic value beyond patient characteristics and relative perfusion analysis. Clinical myocardial blood flow measurement with 18F-flurpiridaz cardiac PET shows promise for routine application.
ISSN:1071-3581
1532-6551
DOI:10.1007/s12350-020-02034-2