Phase-III Clinical Trial of Fluorine-18 Flurpiridaz Positron Emission Tomography for Evaluation of Coronary Artery Disease

Maddahi, Jamshid; Lazewatsky, Joel; Udelson, James E.; Berman, Daniel S.; Beanlands, Rob; Heller, Gary V.; Bateman, Timothy M.; Knuuti, Juhani; Orlandi, Cesare

doi:10.1016/j.jacc.2020.05.063

Cited by 78 publications

(50 citation statements)

References 28 publications

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“…A novel PET tracer, [ 18 F]-flurpiridaz, is promising in assessing perfusion defects and myocardial blood flow. 25 The positron range is low, which enables its use in small rodents, with great contrast between infarcted and healthy myocardium. However, so far [ 18 F]-flurpiridaz is not commercially available and was thus not usable in our study.…”

Section: Myocardial Infarctionmentioning

confidence: 99%

Myocardial perfusion recovery induced by an α-calcitonin gene-related peptide analogue

Bentsen

Sams

Hasbak

et al. 2022

Journal of Nuclear Cardiology

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Background Endogenous calcitonin gene-related peptide (CGRP) induces cardioprotective effects through coronary vasodilation. However, the systemic administration of CGRP induces peripheral vasodilation and positive chronotropic and inotropic effects. This study aims to examine the net effect on coronary perfusion of the systemically administered α-calcitonin gene-related peptide analogue, SAX, in rats during myocardial infarction. Methods Forty Sprague-Dawley rats underwent myocardial infarction. Following left anterior descending artery occlusion, [99mTc]Tc-sestamibi was administered to determine the myocardial perfusion before treatment. Twenty minutes, 24 and 48 h after [99mTc]Tc-sestamibi injection, the rats were treated with either SAX or placebo. Final infarct size was determined three weeks later by [99mTc]Tc-sestamibi SPECT/CT scan. Results Thirty-one rats survived the surgery and 20 completed the follow-up SPECT/CT scan (SAX n = 12; Placebo n = 8). At baseline, there was no difference in size of perfusion defect between the groups (P = .88), but at follow-up the SAX group had improved myocardial recovery compared to the placebo group (P = .04), corresponding to a relative perfusion recovery of 55% in SAX-treated rats. Conclusion The CGRP analogue, SAX, has a cardioprotective effect in this rat model of myocardial infarction, improving myocardial perfusion recovery after chronic occlusion of the coronary artery.

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Section: Myocardial Infarctionmentioning

confidence: 99%

Myocardial perfusion recovery induced by an α-calcitonin gene-related peptide analogue

Bentsen

Sams

Hasbak

et al. 2022

Journal of Nuclear Cardiology

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“…For example, several groups have reported methods and success in using singlephoton emission computerized tomography (SPECT)/CT technology for dynamic imaging and MBF quantification. [165][166][167][168][169][170] Additionally, Flurpiridaz (GE Healthcare) is a F18-based tracer which is currently undergoing phase III clinical trials 171 and would provide a commercially available perfusion PET radiotracer, making such imaging accessible to all centers with a PET/CT scanner. It has been used to quantify erythrocyte velocities in the cerebral, renal, intestinal, cardiac, and skeletal muscle microcirculations.…”

Section: F I G U R E 4 Positron Emissionmentioning

confidence: 99%

Advances in translational imaging of the microcirculation

et al. 2021

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Since Johan Christophorous first described nailfold capillaroscopy in 1663 and Giovanni Rasori and Maurice Raynaud studied capillary changes in inflammation and ischemia in the 18th and 19th centuries, 1 interest in the microcirculation has grown significantly.Advances in imaging technologies over the past several decades have enabled clinicians and researchers to visualize and interrogate the microcirculation directly, or measure parameters, traces or indices that reflect the structural and functional status of the microcirculation. Several of these imaging technologies provide quantitative "readouts" that may directly or indirectly be employed as biomarkers. 2,3 Such noninvasive, imaging biomarkers have the potential to improve clinical assessment of the microcirculation and disease diagnosis, and enable long-term monitoring of treatment response. 4

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“…21 Assessment of myocardial perfusion with positron emission tomography (PET) using various tracers allows for quantification of rest and stress myocardial blood flow to compute coronary flow reserve (CFR ¼ stress myocardial blood flow/rest myocardial blood flow) in addition to semiquantitative analysis of ischemia and scar. 22 In the non-CKD population, sensitivity of flurpiridaz PET for detection of CAD with $50% stenosis on angiography was higher than single-photon emission computed tomography (71.9% vs. 53.7%), with improved image quality, diagnostic certainty, and lower radiation exposure 23 ; nonetheless, this comparison has not been performed in the CKD population. Compared with patients with preserved kidney function, PET-CFR is lower in early stage CKD, without further decrement in stage 5 or dialysis-dependent ESKD.…”

Section: Functional Testing and Noninvasive Imagingmentioning

confidence: 99%

Invasive Management of Coronary Artery Disease in Advanced Renal Disease

Galougahi

Chadban

Mehran

et al. 2021

Kidney International Reports

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Coronary artery disease (CAD) is highly prevalent in chronic kidney disease (CKD). CKD modifies the effects of traditional risk factors on atherosclerosis, with CKD-specific mechanisms, such as inflammation and altered mineral metabolism, playing a dominant pathophysiological role as kidney function declines. Traditional risk models and cardiovascular screening tests perform relatively poorly in the CKD population, and medical treatments including lipid-lowering therapies have reduced efficacy. Clinical presentation of cardiac ischemia in CKD is atypical, whereas invasive therapies are associated with higher rates of complications than in with patients with normal or near normal kidney function. The main focus of the present review is on the invasive approach to management of CAD in late-stage CKD, with an in-depth discussion of the findings of the International Study of Comparative Health Effectiveness With Medical and Invasive Approaches (ISCHEMIA)-CKD trial, and their implications for therapeutic approach and future research in this area. We also briefly discuss the existing evidence in the epidemiology, pathogenesis, diagnosis, and medical management of CAD in late-stage CKD, end-stage kidney disease (ESKD), and kidney transplant recipients. We enumerate the evidence gap left by the frequent exclusion of patients with CKD from randomized controlled trials and highlight the priority areas for future research in the CKD population.

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Phase-III Clinical Trial of Fluorine-18 Flurpiridaz Positron Emission Tomography for Evaluation of Coronary Artery Disease

Cited by 78 publications

References 28 publications

Myocardial perfusion recovery induced by an α-calcitonin gene-related peptide analogue

Myocardial perfusion recovery induced by an α-calcitonin gene-related peptide analogue

Advances in translational imaging of the microcirculation

Invasive Management of Coronary Artery Disease in Advanced Renal Disease

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