Automation in Nuclear Cardiology: Time for Flurpiridaz to Join the Club
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King Abdulaziz Cardiac Center, Riyadh, Kingdom of Saudi Arabia King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX
Received Sep 20, 2020; accepted Sep 21, 2020 doi:10.1007/s12350-020-02421-9
See related article, https://doi.org/10.10 07/s12350-020-02335-6. Positron emission tomography (PET) is currently the most accurate modality for myocardial perfusion assessment in patients with known or suspected coronary artery disease (CAD).1 Notwithstanding its robust diagnostic and prognostic performance as an imaging technology, utilization of PET for myocardial perfusion imaging (MPI) remains low, with widespread adoption likely hampered by many factors, including limited access to PET radiotracers. Most PET radioisotopes have a short half-life, and therefore cannot be obtained from regional radio-pharmacies. Additionally, most laboratories performing PET MPI do not have access to an on-site cyclotron, which makes utilization of 13Nammonia or 15O-water (both cyclotron-produced PET tracers) for perfusion assessment logistically challenging2. Lastly, whereas relying on 82Rb generator may improve tracer availability, the cost of the generator remains prohibitive for many low-volume laboratories3. Therefore, there currently exists a need for newer PET radiotracers with superior kinetic properties (half-life, first-pass extraction rate, positron range, etc.) that will not only improve tracer availability, but also avoid the
Reprint requests: Mouaz H. Al-Mallah, MD, MSc, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX 77030; [email protected] J Nucl Cardiol 1071-3581/$34.00 Copyright Ó 2020 American Society of Nuclear Cardiology.
pitfalls of current tracers and allow performance of PET MPI in conjunction with exercise. Flurpiridaz, an 18F-labeled PET radioisotope, has several favorable tracer characteristics that was introduced with the potential to fill the gaps with current tracers.4 Due to its high affinity to mitochondrial complex-1, Flurpiridaz has a high first-pass extraction rate, and therefore may be suited for more accurate quantification of myocardial blood flow.5 Furthermore, with a half-life of 110 minutes, Flurpiridaz can be made available in unit doses from regional sources, increasing tracer availability and, more importantly, allowing performance of PET MPI with exercise stress. Early studies have demonstrated the safety and tolerability of Flurpiridaz in addition to superior image quality and diagnostic performance in comparison to Tc-99m single photon emission computed tomography (SPECT) MPI.6,7 More recently, Flurpiridaz PET was found to have superior image quality, lower radiation exposure and improved detection of severe coronary stenoses compared with Tc-99m SPECT,
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