Abstract：
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.
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.
摘要：
18F-Flurpiridaz是用于PET心肌灌注成像的有前途的研究性放射性示踪剂，具有定量心肌血流量（MBF）的良好特性。我们试图在一项针对定量冠状动脉造影的大型多中心试验中验证绝对MBF定量的增量诊断价值。
我们回顾性分析了来自Flurpiridaz第一阶段3期试验（NCT01347710）的一部分患者（N=231）。静息时的动态PET数据和药理学应激与先前验证的2-组织区室模型拟合。在每个患者和每个血管的基础上，将绝对MBF和心肌血流储备（MFR）与通过侵入性冠状动脉造影量化的冠状动脉疾病严重程度进行比较。
每条血管的压力MBF准确识别出阻塞性疾病（c指数0.79），并随着狭窄严重程度的增加而逐渐下降（无CAD患者为2.35±0.71；CAD患者的非阻塞区域为1.92±0.49；患病区域为1.54±0.50，P<0.05)。MFR同样随着狭窄严重程度的增加而下降(分别为3.03±0.94;2.69±0.95;和2.33±0.86,P<0.05)。在多变量逻辑回归模型中，应激MBF和MFR提供了超越患者特征和相对灌注分析的增量诊断价值.
使用18F-flurpiridaz心脏PET进行临床心肌血流测量显示出常规应用的希望。
我们回顾性分析了来自Flurpiridaz第一阶段3期试验（NCT01347710）的一部分患者（N=231）。静息时的动态PET数据和药理学应激与先前验证的2-组织区室模型拟合。在每个患者和每个血管的基础上，将绝对MBF和心肌血流储备（MFR）与通过侵入性冠状动脉造影量化的冠状动脉疾病严重程度进行比较。
每条血管的压力MBF准确识别出阻塞性疾病（c指数0.79），并随着狭窄严重程度的增加而逐渐下降（无CAD患者为2.35±0.71；CAD患者的非阻塞区域为1.92±0.49；患病区域为1.54±0.50，P<0.05)。MFR同样随着狭窄严重程度的增加而下降(分别为3.03±0.94;2.69±0.95;和2.33±0.86,P<0.05)。在多变量逻辑回归模型中，应激MBF和MFR提供了超越患者特征和相对灌注分析的增量诊断价值.
使用18F-flurpiridaz心脏PET进行临床心肌血流测量显示出常规应用的希望。
