Update of ¹⁸F-flurpiridaz

Abstract

The novel positron emission tomography (PET) myocardial perfusion imaging tracer, 18 F-flurpiridaz (flurpiridaz), was discussed in 2023 at the Annals of Nuclear Cardiology. In a Phase III trial in 2020 by Maddahi et al., flurpiridaz demonstrated higher sensitivity (71.9%) than 99m Tc-labeled single photon emission computed tomography (SPECT) (53.7%) for detecting ≥50% coronary artery stenosis but did not meet the non-inferiority criterion in specificity. This led to a second Phase III trial, the AURORA trial, which showed flurpiridaz PET to be more sensitive (80.3%) and not inferior (63.8%) in specificity compared to SPECT. The trial highlighted flurpiridaz's superior diagnostic accuracy, especially in women and obese patients. The tracer's ability to measure coronary blood flowreserve suggests its potential future use in clinical practice, possibly offering more accurate functional ischemia diagnostics and predicting cardiac events. The findings indicate that 18 F-flurpiridaz could be a significant advancement in coronary artery disease diagnosis.