Diagnostic performance of ¹⁸F-flurpiridaz PET myocardial perfusion imaging with total perfusion deficit...

To assess the diagnostic performance of ¹⁸F-flupiridaz positron emission tomography (PET) myocardial perfusion imaging (MPI) for coronary artery disease detection using total perfusion deficit (TPD), an automated metric of combined disease extent and severity.

Flurpiridaz relative perfusion images and quantitative coronary angiography data from the initial phase III trial were evaluated using receiver operating characteristic analysis at separate endpoints of ≥70% stenosis and ≥50% stenosis, to determine the diagnostic performance of TPD at per-patient (global LV) and per-vessel levels. TPD results at both endpoints were compared with the performance of visual scores and defect extent values available from two previous publications.

Using a normal perfusion database that was created with the data of 25 patients from the flurpiridaz trial population, TPD was calculated in the remaining 729 trial patients. At the threshold of ≥70% stenosis, TPD was observed to have similar (P ≥ .05) per-patient diagnostic performance (74% accuracy) to visual scoring from previous publications (75%, 71%), as well as defect extent (72%). At the per-vessel level, the TPD achieved similar performance to defect extent in the left anterior descending artery (LAD) and left circumflex artery (LCx) (79%, 74% vs 80%, 72% accuracy) with slightly higher accuracy in the right coronary artery (RCA) (77% vs 72%, P = .03), and similar performance to visual scoring in the LAD and RCA (77, 79% vs 76%, 76% accuracy) with marginally lower performance in the LCx (74% vs 79%, P = .03). Similar results were observed at the ≥50% obstructive disease endpoint.

Automated TPD demonstrated similar diagnostic performance for global and regional flurpiridaz PET MPI, respectively, to visual scoring and defect extent quantification.