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

  • ORIGINAL ARTICLE
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

Clinical myocardial blood flow measurement with 18F-flurpiridaz cardiac PET shows promise for routine application.

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Abbreviations

PET:

Positron emission tomography

MBF:

Myocardial blood flow

MFR:

Myocardial flow reserve

CAD:

Coronary artery disease

ICA:

Invasive coronary angiography

SPECT:

Single photon emission computed tomography

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Acknowledgements

The authors thank Felicia Friend for assistance with data collection, and Francois Tranquart and Matt Morrison for helpful discussions.

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Author notes

  1. Venkatesh L. Murthy and Edward P. Ficaro have equal contribution as co-senior authors.

Authors and Affiliations

  1. INVIA Medical Imaging Solutions, 3025 Boardwalk Street, Suite 200, Ann Arbor, MI, 48108, USA

    Jonathan B. Moody PhD, Alexis Poitrasson-Rivière PhD, Tomoe Hagio PhD & Edward P. Ficaro PhD

  2. GE Pharmaceutical Diagnostics R&D, Amersham, UK

    Christopher Buckley PhD

  3. Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA

    Richard L. Weinberg MD, PhD, James R. Corbett MD, Venkatesh L. Murthy MD, PhD & Edward P. Ficaro PhD

  4. Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA

    James R. Corbett MD

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  1. Jonathan B. Moody PhD
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Correspondence to Jonathan B. Moody PhD.

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Disclosure

J.B. Moody, A. Poitrasson-Rivière, and T. Hagio are employees of INVIA. R.L. Weinberg has nothing to declare. E.P. Ficaro and J.R. Corbett are stockholders of INVIA, which produces 4DM, a clinical software package for cardiac PET analysis. V.L. Murthy declares research support from INVIA. He has received research grants and speaking honoraria from Siemens Medical Imaging. He has served as an advisor to Covidien and Ionetix. He has provided expert witness testimony on behalf of Jubilant DraxImage. He owns stock General Electric and Cardinal Health and stock options in Ionetix.

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Moody, J.B., Poitrasson-Rivière, A., Hagio, T. et al. Added value of myocardial blood flow using 18F-flurpiridaz PET to diagnose coronary artery disease: The flurpiridaz 301 trial. J. Nucl. Cardiol. 28, 2313–2329 (2021). https://doi.org/10.1007/s12350-020-02034-2

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  • DOI: https://doi.org/10.1007/s12350-020-02034-2

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