INVIA Medical Imaging Solutions, 3025 Boardwalk Street, Suite 200, Ann Arbor, MI, 48108, USA.
GE Pharmaceutical Diagnostics R&D, Amersham, UK.
J Nucl Cardiol. 2021 Oct;28(5):2313-2329. doi: 10.1007/s12350-020-02034-2. Epub 2020 Jan 30.
F-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 F-flurpiridaz cardiac PET shows promise for routine application.
F-氟吡拉达是一种很有前途的正电子发射断层扫描（PET）心肌灌注成像研究示踪剂，具有量化心肌血流（MBF）的良好特性。我们旨在通过一项大型多中心试验，验证绝对 MBF 定量相对于定量冠状动脉造影术的增量诊断价值。
我们回顾性分析了首个 3 期氟吡拉达试验（NCT01347710）的亚组患者（N=231）。采用先前验证的 2 组织室模型拟合静息和药物负荷状态下的动态 PET 数据。根据每例患者和每支血管的侵入性冠状动脉造影，对绝对 MBF 和心肌血流储备（MFR）与冠状动脉疾病严重程度进行比较。
每支血管的应激 MBF 准确识别出阻塞性疾病（c 指数为 0.79），且随着狭窄严重程度的增加而逐渐降低（CAD 患者无阻塞性病变的患者为 2.35±0.71；CAD 患者非阻塞性病变区域为 1.92±0.49；病变区域为 1.54±0.50，P<0.05）。MFR 也随着狭窄严重程度的增加而降低（3.03±0.94；2.69±0.95；2.33±0.86，P<0.05）。在多变量逻辑回归模型中，应激 MBF 和 MFR 提供了除患者特征和相对灌注分析之外的增量诊断价值。
F-氟吡拉达心脏 PET 检测的临床心肌血流测量具有常规应用的潜力。
