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.
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。