ASNC president-elect predicts unprecedented innovation in nuclear cardiology
Numerous advances in cardiac nuclear imaging led American Society of Nuclear Cardiology (ASNC) President-elect Panithaya Chareonthaitawee, MD, to predict that "we are on the edge of a new journey in nuclear cardiology, and the opportunities before us are just as vast as they are exciting and promising."
She spoke at the ASNC 2024 opening session last weekend in Austin, Texas, where she said imagers should be excited about the new innovations that will change clinical practice in the near future. These include several new radiotracers, new and improved imaging systems and artificial intelligence (AI).
Chareonthaitawee is director of nuclear cardiology, professor of medicine and chair of education and diversity co-chair for the Department of Cardiovascular Medicine at Mayo Clinic, Rochester, Minnesota. She will take over in January 2025, following current ASNC President Lawrence Phillips, MD, FASNC, associate professor of medicine, Division of Cardiology, NYU Langone.
"I believe we are now on the brink of another remarkable journey, one filled with unprecedented opportunities for innovation and discoveries with the potential to redefine how we diagnose, treat, and care for our patients," Chareonthaitawee explained.
These innovations include novel radio tracers that offer more precise information to diagnose patients, new generation positron emission tomography (PET) and single photon emission computed tomography (SPECT) scanners with higher image resolution and faster scan times, and cardiac PET with myocardial flow quantification. She said nuclear cardiology is also at the forefront of infection and inflammation imaging, while amyloid imaging also offers new services for complex diseases beyond perfusion imaging. Artificial intelligence is also being adopted by nuclear cardiology to enhance workflows and image quality. And a future technology area in development is theranostics, where imaging and therapy will be combined, which may have application in imaging and treating cardiac amyloidosis.
New radiotracers may pave the way for further nuclear cardiology innovation
Chareonthaitawee pointed to the FDA granting its breakthrough therapy designation for the tracer I-124 evuzamitide, which is the only diagnostic imaging agent with BTD status for cardiac amyloidosis. She said the tracer detects diverse types of amyloidosis in multiple organs and has yielded a 100% sensitivity for identifying cardiac amyloid in three different studies. The agent is expected to begin a phase 3 trial in 2025.
Another promising development in amyloid imaging is the novel SPECT 99MTc-labeled peptide p5+14 for the detection of cardiopulmonary amyloidosis using SPECT/CT. She said the agent is easily produced and offers a rapid screening option in the community. She said a phase 1 study showed high-quality and readily interpretable images at both one and three hours post injection.
Research is also ongoing in the use of water-based O-15 as perfusion imaging agent to identify coronary artery disease. Chareonthaitawee is involved with the multi-center RAPID-WATER-FLOW trial, which is a Phase 3, prospective PET trial that uses an automated point-of-care system for producing, dosing and injecting O-15 water to simplify the use of oxygen imaging, which previously required an onsite cyclotron.
Previous studies have shown O-15 has a very high first-pass extraction that allows accurate quantification of myocardial blood flow and detection of flow-limiting CAD. The study is enrolling 215 patients with suspected CAD at approximately 10 study sites in North America and Europe. The imaging will be compared to invasive coronary angiography with fractional flow reserve (FFR), instantaneous wave-Free Ratio (iFR), or coronary computed tomography angiography (CCTA).
After three decades with no new myocardial perfusion tracers, three F-18 PET tracers are currently in trials, led by the agent flurpiridaz.
She said there is a new chapter opening for nuclear cardiology with new innovations that hold promise in redefining how we diagnosis, treat and care for patients.
"All of these developments mark a truly exciting time for our field," she said "It is time for all of us to get excited, because we have so much to be excited about."
ASNC expanding support for innovation
Chareonthaitawee outlined her goals for ASNC in 2025. First is expanding support for innovation in nuclear cardiology. She said ASNC has committed $100,000 for research funding, and there will be a push to strengthen its Imaging Trials Network. She also wants ASNC to build on the Molecular Imaging Task Force and grow its AI task force.
Second, she said the rapid advancements in the field merit broadening the educational activities in nuclear cardiology with more frequent educational engagements such as webinars and on-demand content.
Third, with all the rapid developments "we will definitely need help to translate our innovations into practice," Chareonthaitawee explained.
This includes maintaining strong advocacy, upholding and enhancing quality standards, development of more procedural documents and guidelines to keep pace with advancements. Yo do these things she said there will need to be more people and more collaboration.
"There will be plenty of work to go around and we need you and your participation," she told ASNC members.
More cardiac PET resources are coming to help centers start new programs
PET has seen wider adoption at centers the past few years because it offers better image quality and additional perfusion quantification to make more precise diagnoses. When Philips came into the ASNC presidency, he called on nuclear cardiology programs to update their aging imaging technology with more modern equipment and software. This included a call for programs to seriously consider adopting PET because it offers several advantages over SPECT.
Phillips said ASNC is working on resources for the rapidly expanding area of PET, with a soon-to-be launched cardiac PET launch kit to help centers get PET programs started. The society also created a series of videos on training and education for PET, the clinical value of PET and how to report results of PET perfusion studies.
"The cardiac PET tool kit is coming out soon and will offer soup-to-nuts on the technical aspects of starting a lab," Philips explained.
Before the end of the year, Philips said ASNC plans to publish its quality metrics for cardiac amyloid imaging and PET practice points for myocardial blood flow assessments. In early 2025, he said ASNC will also publish new core guidelines, including stress testing in SPECT and PET, protocols and tracers in SPECT, and ASNC/SNNMI protocols and tracers in PET cardiac imaging.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: dfornell@innovatehealthcare.com