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Enrolling by invitationNCT07761728FLAREUpdated Aug 17, 2026

The FLARE (Flurpiridaz vs. Rubidium Evaluation) Trial

An observational study in Coronary Artery Disease and Coronary Microvascular Disease, sponsored by University of California, Los Angeles. Enrolling by invitation at 1 site in United States. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2026-08-17.

Sponsored by University of California, Los Angeles · Observational

Study type
Observational
Model
Cohort
Time perspective
Prospective
Enrollment
60
Ages
18 Years and older
Sex
All
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Study summary

This study seeks to evaluate if the diagnostic performance of 18F-flurpiridaz positron emission tomography (PET) myocardial perfusion imaging (MPI), given the radiotracer's properties, is non-inferior to the currently most widely utilized PET MPI radiopharmaceutical, 82Rb-chloride.

Read the detailed description
  • Patients will undergo a clinically indicated rest/stress 82Rb-chloride positron emission tomography (PET) myocardial perfusion imaging (MPI) and will return to the nuclear cardiology laboratory within 1-30 days to undergo a 18F-flurpiridaz PET MPI and coronary CT angiogram. A rest 18F-flurpiridaz PET MPI will be acquired first, followed by a stress 18F-flurpiridaz PET MPI. The waiting period between the rest and stress 18F-flurpiridaz PET acquisitions will be ≥ 30 minutes. The rest dose will be 2.5-3.0 mCi, and the pharmacological stress dose will be 6.0-6.5 mCi. All PET MPI studies will be conducted using regadenoson as the pharmacologic stress agent.
  • 18F-flurpiridaz and 82Rb-chloride PET MPI scans will be interpreted by three expert visual readers in a blinded manner. Both Image quality and diagnostic certainty will be classified using a five-point scale. If the study is abnormal, the perfusion defect will further be categorized as reversible or fixed. Relative perfusion and myocardial blood flow quantification will be obtained using validated software methods.
  • Coronary CT angiograms will similarly be analyzed in a blinded manner by a core lab. Coronary segments with a diameter ≥1.5 mm will be included in the analysis. Each segment will be evaluated for the presence or absence of coronary atherosclerosis, defined as any tissue structure >1 mm\^2 within the coronary artery wall differentiated from the surrounding epicardial tissue, epicardial fat, or the vessel lumen itself. Maximal stenosis ratios as well as atherosclerotic plaque characteristics and CT-derived fractional flow reserve (FFR) will be obtained in each coronary territory.
  • The paired difference between 18F-flurpiridaz and 82Rb-chloride PET MPI will be evaluating by calculating the receiver operating characteristic area under the curve (ROC AUC) for the sensitivity and specificity of blinded visual reads, automated relative perfusion quantitation, and myocardial blood flow quantification, as well as for image quality and diagnostic certainty assessment.
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Conditions studied

  • Coronary Artery Disease
  • Coronary Microvascular Disease

Keywords

  • Myocardial Perfusion Imaging
  • Nuclear Cardiology
  • Positron Emission Tomography
  • Cardiac CT
03

In context

Coronary Artery Disease

4,857 studies on the registry are indexed under Coronary Artery Disease; 890 are open to participants now.

This study's planned enrollment of 60 is below the median of 320 across 1,687 observational studies indexed under Coronary Artery Disease.

Browse Coronary Artery Disease studies →

Lead sponsor

University of California, Los Angeles is the lead sponsor of 1,170 studies on the registry; 195 are open to participants now.

Of its 95 completed or terminated interventional studies of FDA-regulated products, 70 (74%) have results posted.

Counted across the registry records on this site, refreshed daily.

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Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No
Sampling method
Non-probability sample

Study population

Patients scheduled for a clinically indicated 82Rb-Chloride PET MPI at the West Los Angeles Veterans Affairs Medical Center / Greater Los Angeles Veterans Affairs Healthcare System.

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  • Patient scheduled for a clinically indicated 82Rb-chloride PET MPI
  • Age ≥ 18 years
  • Ability to provide consent

Exclusion criteria

Exclusion Criteria:

  • Previous participation in a 18F-flurpiridaz clinical trial
  • Prior myocardial infarction
  • Prior coronary revascularization (percutaneous coronary intervention and/or coronary artery bypass grafting)
  • History of orthotopic heart transplantation
  • Inability to control heart rate \< 65 bpm
  • Frequent ventricular or atrial ectopy leading to irregular cardiac rhythm
  • Creatinine ≥ 1.4 mg/dL
  • Pregnant or breast-feeding status
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Study design

Observational model
Cohort
Time perspective
Prospective
Enrollment
60 participants (estimated)
Patient registry
No

Groups and cohorts

  • Patients Undergoing Myocardial Perfusion Imaging

    Patients scheduled for a clinically indicated myocardial perfusion imaging study with 82Rb-chloride who subsequently undergo MPI with 18F-flurpiridaz as well as a CT coronary angiogram.

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What researchers measure

Primary outcomes

  1. 18F-Flurpiridaz Diagnostic Performance

    The diagnostic performance of 18F-flurpiridaz compared to 82Rb-chloride PET myocardial perfusion imaging by expert readers using coronary CT angiography as the reference standard * Diagnostic performances will be analyzed on a per-vessel and a per-patient basis using coronary artery disease (CAD) ≥50% and ≥70% stenoses as significance cutoffs and CT-based fractional flow-reserve (FFR) ≤0.80 at the lesion level and at the distal vessel level

    Time frame: From enrollment to completion of CT coronary angiography, an average of 10 days

Secondary outcomes

  1. Relative Perfusion Analysis

    Comparison of automated relative perfusion quantitation markers (summed stress score, summed difference score, total perfusion deficit) between 18F-flurpiridaz and 82Rb-chloride PET MPI using validated software methods

    Time frame: From enrollment to completion of 18F-flurpiridaz PET MPI, an average of 10 days

  2. Myocardial Blood Flow Quantification

    Comparison of myocardial blood flow and myocardial flow reserve quantification between 18F-flurpiridaz and 82Rb-chloride PET MPI using validated software methods

    Time frame: From enrollment to completion of 18F-flurpiridaz PET MPI, an average of 10 days

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Study locations

1 site
  • West Los Angeles Veterans Affairs Medical Center
    Los Angeles, California 90073, United States
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References and documents

Publications

  • Chen M, Almeida SO, Sayre JW, Karlsberg RP, Packard RRS. Distal-vessel fractional flow reserve by computed tomography to monitor epicardial coronary artery disease. Eur Heart J Cardiovasc Imaging. 2024 Jan 29;25(2):163-172. doi: 10.1093/ehjci/jead229. PubMed 37708371 ↗
  • Sonck J, Nagumo S, Norgaard BL, Otake H, Ko B, Zhang J, Mizukami T, Maeng M, Andreini D, Takahashi Y, Jensen JM, Ihdayhid A, Heggermont W, Barbato E, Mileva N, Munhoz D, Bartunek J, Updegrove A, Collinsworth A, Penicka M, Van Hoe L, Leipsic J, Koo BK, De Bruyne B, Collet C. Clinical Validation of a Virtual Planner for Coronary Interventions Based on Coronary CT Angiography. JACC Cardiovasc Imaging. 2022 Jul;15(7):1242-1255. doi: 10.1016/j.jcmg.2022.02.003. Epub 2022 Apr 13. PubMed 35798401 ↗
  • Griffin WF, Choi AD, Riess JS, Marques H, Chang HJ, Choi JH, Doh JH, Her AY, Koo BK, Nam CW, Park HB, Shin SH, Cole J, Gimelli A, Khan MA, Lu B, Gao Y, Nabi F, Nakazato R, Schoepf UJ, Driessen RS, Bom MJ, Thompson R, Jang JJ, Ridner M, Rowan C, Avelar E, Genereux P, Knaapen P, de Waard GA, Pontone G, Andreini D, Earls JP. AI Evaluation of Stenosis on Coronary CTA, Comparison With Quantitative Coronary Angiography and Fractional Flow Reserve: A CREDENCE Trial Substudy. JACC Cardiovasc Imaging. 2023 Feb;16(2):193-205. doi: 10.1016/j.jcmg.2021.10.020. Epub 2022 Feb 16. PubMed 35183478 ↗
  • Abbara S, Blanke P, Maroules CD, Cheezum M, Choi AD, Han BK, Marwan M, Naoum C, Norgaard BL, Rubinshtein R, Schoenhagen P, Villines T, Leipsic J. SCCT guidelines for the performance and acquisition of coronary computed tomographic angiography: A report of the society of Cardiovascular Computed Tomography Guidelines Committee: Endorsed by the North American Society for Cardiovascular Imaging (NASCI). J Cardiovasc Comput Tomogr. 2016 Nov-Dec;10(6):435-449. doi: 10.1016/j.jcct.2016.10.002. Epub 2016 Oct 12. PubMed 27780758 ↗
  • Bourque JM, Hanson CA, Agostini D, Bateman TM, Bax JJ, Beanlands RSB, Berman DS, Garcia EV, Heller GV, Knuuti J, Tamaki N, Udelson JE, Maddahi J. Assessing myocardial perfusion in suspected coronary artery disease: rationale and design of the second phase 3, open-label multi-center study of flurpiridaz (F-18) injection for positron emission tomography (PET) imaging. J Nucl Cardiol. 2021 Jun;28(3):1105-1116. doi: 10.1007/s12350-021-02527-8. Epub 2021 Jan 31. PubMed 33521873 ↗
  • Packard RRS, Lazewatsky JL, Orlandi C, Maddahi J. Diagnostic Performance of PET Versus SPECT Myocardial Perfusion Imaging in Patients with Smaller Left Ventricles: A Substudy of the 18F-Flurpiridaz Phase III Clinical Trial. J Nucl Med. 2021 Jun 1;62(6):849-854. doi: 10.2967/jnumed.120.252007. Epub 2020 Nov 27. PubMed 33246979 ↗
  • Maddahi J, Bengel F, Czernin J, Crane P, Dahlbom M, Schelbert H, Sparks R, Phelps M, Lazewatsky J. Dosimetry, biodistribution, and safety of flurpiridaz F 18 in healthy subjects undergoing rest and exercise or pharmacological stress PET myocardial perfusion imaging. J Nucl Cardiol. 2019 Dec;26(6):2018-2030. doi: 10.1007/s12350-018-01484-z. Epub 2018 Nov 28. PubMed 30488323 ↗
  • Packard RRS, Cooke CD, Van Train KF, Votaw JR, Sayre JW, Lazewatsky JL, Champagne KM, Orlandi C, Garcia EV, Maddahi J. Development, diagnostic performance, and interobserver agreement of a 18F-flurpiridaz PET automated perfusion quantitation system. J Nucl Cardiol. 2022 Apr;29(2):698-708. doi: 10.1007/s12350-020-02335-6. Epub 2020 Sep 7. PubMed 32895856 ↗
  • Packard RRS, Votaw JR, Cooke CD, Van Train KF, Garcia EV, Maddahi J. 18F-flurpiridaz positron emission tomography segmental and territory myocardial blood flow metrics: incremental value beyond perfusion for coronary artery disease categorization. Eur Heart J Cardiovasc Imaging. 2022 Nov 17;23(12):1636-1644. doi: 10.1093/ehjci/jeab267. PubMed 34928321 ↗
  • Packard RR, Huang SC, Dahlbom M, Czernin J, Maddahi J. Absolute quantitation of myocardial blood flow in human subjects with or without myocardial ischemia using dynamic flurpiridaz F 18 PET. J Nucl Med. 2014 Sep;55(9):1438-44. doi: 10.2967/jnumed.114.141093. Epub 2014 Jul 28. PubMed 25071096 ↗
  • Maddahi J, Czernin J, Lazewatsky J, Huang SC, Dahlbom M, Schelbert H, Sparks R, Ehlgen A, Crane P, Zhu Q, Devine M, Phelps M. Phase I, first-in-human study of BMS747158, a novel 18F-labeled tracer for myocardial perfusion PET: dosimetry, biodistribution, safety, and imaging characteristics after a single injection at rest. J Nucl Med. 2011 Sep;52(9):1490-8. doi: 10.2967/jnumed.111.092528. Epub 2011 Aug 17. PubMed 21849402 ↗
  • Chen J, Ding Y, Chen M, Gau J, Jen N, Nahal C, Tu S, Chen C, Zhou S, Chang CC, Lyu J, Xu X, Hsiai TK, Packard RRS. Displacement analysis of myocardial mechanical deformation (DIAMOND) reveals segmental susceptibility to doxorubicin-induced injury and regeneration. JCI Insight. 2019 Apr 18;4(8):e125362. doi: 10.1172/jci.insight.125362. eCollection 2019 Apr 18. PubMed 30996130 ↗
  • Packard RRS, Luo Y, Abiri P, Jen N, Aksoy O, Suh WM, Tai YC, Hsiai TK. 3-D Electrochemical Impedance Spectroscopy Mapping of Arteries to Detect Metabolically Active but Angiographically Invisible Atherosclerotic Lesions. Theranostics. 2017 Jun 22;7(9):2431-2442. doi: 10.7150/thno.19184. eCollection 2017. PubMed 28744325 ↗
  • Packard RR, Li D, Budoff MJ, Karlsberg RP. Fractional flow reserve by computerized tomography and subsequent coronary revascularization. Eur Heart J Cardiovasc Imaging. 2017 Feb;18(2):145-152. doi: 10.1093/ehjci/jew148. Epub 2016 Jul 28. PubMed 27469588 ↗
  • Maddahi J, Packard RRS. PET should replace SPECT in cardiac imaging for diagnosis and risk assessment of patients with known or suspected CAD: Pro. J Nucl Cardiol. 2017 Dec;24(6):1955-1959. doi: 10.1007/s12350-015-0300-7. Epub 2017 Apr 10. No abstract available. PubMed 28397181 ↗
  • Takx RA, Blomberg BA, El Aidi H, Habets J, de Jong PA, Nagel E, Hoffmann U, Leiner T. Diagnostic accuracy of stress myocardial perfusion imaging compared to invasive coronary angiography with fractional flow reserve meta-analysis. Circ Cardiovasc Imaging. 2015 Jan;8(1):e002666. doi: 10.1161/CIRCIMAGING.114.002666. PubMed 25596143 ↗
  • Mc Ardle BA, Dowsley TF, deKemp RA, Wells GA, Beanlands RS. Does rubidium-82 PET have superior accuracy to SPECT perfusion imaging for the diagnosis of obstructive coronary disease?: A systematic review and meta-analysis. J Am Coll Cardiol. 2012 Oct 30;60(18):1828-37. doi: 10.1016/j.jacc.2012.07.038. Epub 2012 Oct 3. PubMed 23040573 ↗
  • Maddahi J, Lazewatsky J, Udelson JE, Berman DS, Beanlands RSB, Heller GV, Bateman TM, Knuuti J, Orlandi C. Phase-III Clinical Trial of Fluorine-18 Flurpiridaz Positron Emission Tomography for Evaluation of Coronary Artery Disease. J Am Coll Cardiol. 2020 Jul 28;76(4):391-401. doi: 10.1016/j.jacc.2020.05.063. PubMed 32703509 ↗
  • Berman DS, Maddahi J, Tamarappoo BK, Czernin J, Taillefer R, Udelson JE, Gibson CM, Devine M, Lazewatsky J, Bhat G, Washburn D. Phase II safety and clinical comparison with single-photon emission computed tomography myocardial perfusion imaging for detection of coronary artery disease: flurpiridaz F 18 positron emission tomography. J Am Coll Cardiol. 2013 Jan 29;61(4):469-477. doi: 10.1016/j.jacc.2012.11.022. Epub 2012 Dec 19. PubMed 23265345 ↗
  • Packard RRS. The clinical promise of 18F-flurpiridaz PET imaging heralds a new frontier in the diagnosis and management of coronary artery disease. Nat Cardiovasc Res. 2025 Jan;4(1):1-4. doi: 10.1038/s44161-024-00587-w. No abstract available. PubMed 39825085 ↗

Individual participant data

Plan to share: No

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Timeline

Tracking since Sep 25, 2026
ElapsedEstimatedEstimated, not yet reachedSimilar studies: half by the dot; the band is the middle halfHalf of similar studies reached it by the dot; the band is the middle half, from a quarter to three quarters

Started Aug 2025 (actual). Primary completion is estimated for Dec 2026, 16 months after the start.

Of 634 non-industry observational studies under Coronary Artery Disease, half reached primary completion within 48 months of starting (the median), counting those still running; a quarter within 23 and three quarters within 122. This study's planned 16 months is below that.

Counting every sponsor, half of 759 studies reached it within 40 months; a quarter within 21 and three quarters within 87.

How these figures are worked out, and which studies are left out of them.

Registered
Jul 26, 2026
First posted
Aug 12, 2026
StartActual
Aug 13, 2025
Primary completionEst.
Dec 2026
CompletionEst.
Jan 2027
Last update
Aug 17, 2026
What these dates mean
Start.
When the first participant enrolled; while estimated, when the study expects to open to recruitment.
Primary completion.
When the last participant was examined or treated to collect data for the study's main question, its primary outcome. A study that stopped early gives the date its data collection stopped.
Completion.
When the last participant's last visit took place, for every outcome, secondary ones and side effects included: the end of the study. Often later than primary completion, sometimes the same day.
Actual and Est.
Actual means the registry says the date has happened. Est. (estimated) is a date the sponsor plans or expects. It can still move, and the sponsor is expected to change it to actual once it has passed.
No changes since tracking began. The registry record was last updated on Aug 17, 2026, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
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Registry details

Key details

Study ID
NCT07761728
Collaborators
VA Greater Los Angeles Healthcare System
Responsible party
Rene R. Sevag Packard, MD, PhD (Associate Professor-in-Residence, Departments of Medicine (Cardiology) and Physiology, University of California, Los Angeles) — Principal investigator
First posted
Aug 12, 2026
Start date
Aug 13, 2025
Primary completion
Dec 2026 (estimated)
Completion
Jan 2027 (estimated)
Last update
Aug 17, 2026

Oversight

FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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