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The Potential of F-18 Flurpiridaz PET/CT Myocardial Perfusion Imaging for Precision Imaging

  • Nuclear Cardiology (V Dilsizian, Section Editor)
  • Published:
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Abstract

Purpose of the Review

Myocardial perfusion imaging (MPI) with single photon emission computed tomography (SPECT) has been the main method for assessing patients with known or suspected coronary artery disease (CAD) for decades. Based on a strong and growing evidence base, positron emission tomography (PET) MPI is increasingly favored when it is available. However, currently available PET perfusion tracers have limitations that have hampered broad utilization.

Recent Findings

F-18 flurpiridaz is a novel PET MPI agent that is nearing completion of studies necessary to obtain regulatory approval. It has unique capabilities that will facilitate further expansion of PET MPI utilization. In addition, it has characteristics that may define it as the best MPI agent to date, in terms of the potential to equalize accuracy independent of patient size, gender, complexity, or ability to perform exercise stress.

Summary

The combination of excellent image quality and accurate absolute blood flow quantification hold the potential of its being an ideal precision tool for non-invasive assessment of myocardial blood flow and entire spectrum of ischemic heart disease.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Hirschfeld CB, Mercuri M, Pascual TNB, Karthikeyan G, Vitola JV, Mahmarian JJ, et al. Worldwide variation in the use of nuclear cardiology camera technology, reconstruction software, and imaging protocols. JACC Cardiovasc Imaging. 2021;14(9):1819–28.

    Article  Google Scholar 

  2. Bateman TM. Reducing radiation while improving the quality and efficiency of nuclear cardiology procedures. JACC Cardiovasc Imaging. 2021;14(9):1829–31.

    Article  Google Scholar 

  3. Desiderio MC, Lundbye JB, Baker WL, Farrell MB, Jerome SD, Heller GV. Current status of patient radiation exposure of cardiac positron emission tomography and single-photon emission computed tomographic myocardial perfusion imaging. Circ Cardiovasc Imaging. 2018;11(12): e007565.

    Article  Google Scholar 

  4. Nakazato R, Berman DS, Alexanderson E, Slomka P. Myocardial perfusion imaging with PET. Imaging Med. 2013;5(1):35.

    Article  CAS  Google Scholar 

  5. Murthy VL, Bateman TM, Beanlands RS, Berman DS, Borges-Neto S, Chareonthaitawee P, et al. Clinical quantification of myocardial blood flow using PET: joint position paper of the SNMMI Cardiovascular Council and the ASNC. J Nucl Cardiol Off Publ Am Soc Nucl Cardiol. 2018;25(1):269–97.

    Google Scholar 

  6. Dilsizian V, Bacharach SL, Beanlands RS, Bergmann SR, Delbeke D, Dorbala S, et al. ASNC imaging guidelines/SNMMI procedure standard for positron emission tomography (PET) nuclear cardiology procedures. J Nucl Cardiol Off Publ Am Soc Nucl Cardiol. 2016;23(5):1187–226.

    Google Scholar 

  7. Rauch B, Helus F, Grunze M, Braunwell E, Mall G, Hasselbach W, et al. Kinetics of 13N-ammonia uptake in myocardial single cells indicating potential limitations in its applicability as a marker of myocardial blood flow. Circulation. 1985;71(2):387–93.

    Article  CAS  Google Scholar 

  8. Kaufmann PA, Gnecchi-Ruscone T, Yap JT, Rimoldi O, Camici PG. Assessment of the reproducibility of baseline and hyperemic myocardial blood flow measurements with 15O-labeled water and PET. J Nucl Med Off Publ Soc Nucl Med. 1999;40(11):1848–56.

    CAS  Google Scholar 

  9. Pieper J, Patel VN, Escolero S, Nelson JR, Poitrasson-Rivière A, Shreves CK, et al. Initial clinical experience of N13-ammonia myocardial perfusion PET/CT using a compact superconducting production system. J Nucl Cardiol Off Publ Am Soc Nucl Cardiol. 2021;28(1):295–9.

    Google Scholar 

  10. Maddahi J, Czernin J, Lazewatsky J, Huang S-C, Dahlbom M, Schelbert H, et al. Phase I, first-in-human study of BMS747158, a novel 18F-labeled tracer for myocardial perfusion PET: dosimetry, biodistribution, safety, and imaging characteristics after a single injection at rest. J Nucl Med Off Publ Soc Nucl Med. 2011;52(9):1490–8.

    CAS  Google Scholar 

  11. Li Y, Zhang W, Wu H, Liu G. Advanced tracers in PET imaging of cardiovascular disease. BioMed Res Int. 2014;2014: 504532.

    PubMed  PubMed Central  Google Scholar 

  12. Huisman MC, Higuchi T, Reder S, Nekolla SG, Poethko T, Wester H-J, et al. Initial characterization of an 18F-labeled myocardial perfusion tracer. J Nucl Med. 2008;49(4):630–6.

    Article  Google Scholar 

  13. • Maddahi J, Bengel F, Czernin J, Crane P, Dahlbom M, Schelbert H, et al. Dosimetry, biodistribution, and safety of flurpiridaz F 18 in healthy subjects undergoing rest and exercise or pharmacological stress PET myocardial perfusion imaging. J Nucl Cardiol Off Publ Am Soc Nucl Cardiol. 2019 Dec;26(6):2018–30. This was the first in-human study of F-18 flurpiridaz evaluating the dosimetry, biodistribution, and safety of tracer in healthy human subjects.

  14. Nekolla SG, Reder S, Saraste A, Higuchi T, Dzewas G, Preissel A, et al. Evaluation of the novel myocardial perfusion positron-emission tomography tracer 18F-BMS-747158-02: comparison to 13N-ammonia and validation with microspheres in a pig model. Circulation. 2009;119(17):2333–42. https://doi.org/10.1161/CIRCULATIONAHA.108.797761 (Epub 2009 Apr 20).

    Article  CAS  PubMed  Google Scholar 

  15. Sherif HM, Nekolla SG, Saraste A, Reder S, Yu M, Robinson S, et al. Simplified quantification of myocardial flow reserve with flurpiridaz F 18: validation with microspheres in a pig model. J Nucl Med Off Publ Soc Nucl Med. 2011;52(4):617–24.

    CAS  Google Scholar 

  16. Berman DS, Maddahi J, Tamarappoo BK, Czernin J, Taillefer R, Udelson JE, et al. Flurpiridaz F 18 PET: phase II safety and clinical comparison with SPECT myocardial perfusion imaging for detection of coronary artery disease. J Am Coll Cardiol. 2013;61(4):469.

    Article  CAS  Google Scholar 

  17. •• Maddahi J, Lazewatsky J, Udelson JE, Berman DS, Beanlands RSB, Heller GV, et al. Phase-III clinical trial of fluorine-18 flurpiridaz positron emission tomography for evaluation of coronary artery disease. J Am Coll Cardiol. 2020;76(4):391–401. The findings of this first phase III study demonstrate superior diagnostic performance, higher sensitivity, and similar specificity of flurpiridaz PET compared to SPECT in 795 patients with suspected or known CAD overall, and in subgroups of women, obese patients, and those undergoing pharmacological stress testing.

  18. Bourque JM, Hanson CA, Agostini D, Bateman TM, Bax JJ, Beanlands RSB, et al. Assessing myocardial perfusion in suspected coronary artery disease: rationale and design of the second phase 3, open-label multi-center study of flurpiridaz (F-18) injection for positron emission tomography (PET) imaging. J Nucl Cardiol Off Publ Am Soc Nucl Cardiol. 2021;28(3):1105–16.

    Google Scholar 

  19. • Packard RRS, Huang S-C, Dahlbom M, Czernin J, Maddahi J. Absolute quantitation of myocardial blood flow in human subjects with or without myocardial ischemia using dynamic flurpiridaz F 18 PET. J Nucl Med Off Publ Soc Nucl Med. 2014;55(9):1438–44. The findings of this study demonstrated the feasibility of absolute myocardial blood flow quantitation with flurpiridaz PET in presence or absence of stress-induced perfusion abnormality.

  20. Otaki Y, Van Kriekinge SD, Wei C-C, Kavanagh P, Singh A, Parekh T, et al. Improved myocardial blood flow estimation with residual activity correction and motion correction in 18F-flurpiridaz PET myocardial perfusion imaging. Eur J Nucl Med Mol Imaging. 2021 Dec 30;

  21. • Packard RRS, Votaw JR, Cooke CD, Van Train KF, Garcia EV, Maddahi J. 18F-flurpiridaz positron emission tomography segmental and territory myocardial blood flow metrics: incremental value beyond perfusion for coronary artery disease categorization. Eur Heart J - Cardiovasc Imaging. 2021;jeab267. This study showed improvement in epicardial CAD detection with stress myocardial blood flow quantitation with flurpiridaz PET compared to perfusion assessment.

  22. Depuey EG, Mahmarian JJ, Miller TD, Einstein AJ, Hansen CL, Holly TA, et al. Patient-centered imaging. J Nucl Cardiol Off Publ Am Soc Nucl Cardiol. 2012;19(2):185–215.

    Google Scholar 

  23. Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2012;126(25):e354-471.

    PubMed  Google Scholar 

  24. Bateman T, Maddahi J, Udelson J, Beanlands R, Knuuti J, Heller G, et al. Improved assessment of CAD in obese subjects with flurpiridaz F18 PET myocardial perfusion imaging: a subset analysis of the flurpiridaz F18 301 phase 3 study. J. Am. Coll. Cardiol. 2016;67(13_Supplement):1578-.;

  25. Taqueti VR, Dorbala S, Wolinsky D, Abbott B, Heller GV, Bateman TM, et al. Myocardial perfusion imaging in women for the evaluation of stable ischemic heart disease—state-of-the-evidence and clinical recommendations. J Nucl Cardiol Off Publ Am Soc Nucl Cardiol. 2017;24(4):1402.

    Google Scholar 

  26. Bateman TM, Heller GV, McGhie AI, Friedman JD, Case JA, Bryngelson JR, et al. Diagnostic accuracy of rest/stress ECG-gated Rb-82 myocardial perfusion PET: comparison with ECG-gated Tc-99m sestamibi SPECT. J Nucl Cardiol. 2006;13(1):24–33.

    Article  Google Scholar 

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Author information

Author notes

  1. Krishna K. Patel and Annapoorna Singh contributed equally and are co-first authors

Authors and Affiliations

  1. Department of Medicine (Cardiology) and Population Health Science and Policy, The Zena and Michael A. Wiener Cardiovascular Institute, Blavatnik Women’s Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Krishna K. Patel

  2. University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA

    Annapoorna Singh & Timothy M. Bateman

  3. Saint Luke’s Mid America Heart Institute, Kansas City, MO, USA

    Annapoorna Singh & Timothy M. Bateman

Authors
  1. Krishna K. Patel
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  2. Annapoorna Singh
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  3. Timothy M. Bateman
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Corresponding author

Correspondence to Krishna K. Patel.

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Conflict of Interest

Dr. Bateman receives research grant support from Bracco, Jubilant Drax Image, Spectrum Dynamics, and GE Healthcare. He serves as a consultant to AIM, AstraZeneca, Curium, and GE Healthcare. He has an equity interest in Cardiovascular Imaging Technologies. He has intellectual property rights for Imagen PET and SPECT software. The other authors have no disclosures.

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Patel, K.K., Singh, A. & Bateman, T.M. The Potential of F-18 Flurpiridaz PET/CT Myocardial Perfusion Imaging for Precision Imaging. Curr Cardiol Rep 24, 987–994 (2022). https://doi.org/10.1007/s11886-022-01713-5

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