University Hospitals

James V Cireddu MD, FACC is Medical Director of Harrington Heart and Vascular Institute of University Hospitals Bedford and Richmond Campuses, System Director of Nuclear Cardiology and Stress Testing for University Hospitals of Cleveland, and Clinical Associate Professor of Medicine at Case Western Reserve University.  He is an invasive cardiologist, physician scientist, and founder of TeleHealth Care Solutions developing innovative virtual care tools with support from the National Science Foundation.  Dr. Cireddu collaborates extensively with academic and industry partners to develop and clinically validate advances in cardiac imaging.

Jasmine A. Clough has a Bachelor of Arts in Biomedical Humanities graduate from Hiram College. She is a Research Assistant at TeleHealth Care Solutions LLC and a Patient Care Nursing Assistant at University Hospitals of Cleveland. Ms. Clough works with Dr. James Cireddu MD’s research and digital health lab supporting data collection, organization, and training materials for digital health heart failure care in underserved populations as well as advances in cardiac imaging. She plans to pursue a career in medicine with a focus on primary care, integrating digital health innovation with compassionate, patient-centered care.

University Hospitals of Cleveland Harrington Heart and Vascular Ins is leading the way in heart care with the launch of Flyrcado (flurpiridaz F 18), a next-generation PET myocardial perfusion imaging (MPI) tracer now available to patients undergoing cardiac stress tests. This milestone makes UH the first hospital in Ohio to clinically administer Flyrcado, marking a major advancement in how coronary artery disease (CAD) is detected and diagnosed.

CAD is the most common type of heart disease in the U.S. and the leading cause of death for both men and women. Caused by plaque buildup in coronary arteries, CAD often develops silently and may not present symptoms until a serious cardiac event, like a heart attack, occurs. That is exactly why accurate, early diagnosis is so critical and where imaging plays a life-saving role.

Cardiac stress tests, which evaluate how blood flows to the heart under stress, are a key part of CAD detection. PET MPI, is a type of nuclear imaging that produces detailed, 3D images of the heart, offering better resolution and greater accuracy than traditional SPECT scans. But until now, its use has been limited by access to radiotracers with short half-lives and complex on-site production requirements.

Flyrcado redefines what is possible. Built on a fluorine-18 (F-18) base, this advanced radiopharmaceutical offers a half-life of 109 minutes, which is almost ten times longer than current cardiac PET tracers. This extended shelf life allows for more flexible manufacturing and distribution. PET MPI can now be offered at hospitals that previously lacked the necessary infrastructure.

According to a recent review in the Journal of Cardiovascular Imaging, 18F-based radiotracers like Flyrcado offer advantages beyond availability and distribution. The short positron range of fluorine-18 contributes to high spatial resolution, which significantly improves image quality in cardiac PET/CT applications (Packard et al., 2025).

The technology behind Flyrcado does not just improve access, it also enhances quality. Flyrcado’s shorter positron range and high (96%) myocardial extraction enable sharper images with improved resolution, even for patients who are typically difficult to image, such as those with high BMI or dense tissue.

Clinicians have also gained greater flexibility in how they conduct these tests. Flyrcado can be used during cardiac stress tests whether the patient exercises or receives medication to simulate stress. Flyrcado also allows for rescanning during the same appointment if needed, reducing the need for repeat visits and ensuring a more efficient workflow.

Additionally, as highlighted by the FDA, Flyrcado is the first F-18–labeled MPI agent approved specifically for the evaluation of myocardial ischemia and infarction in adults with known or suspected CAD. This tracer has been shown to deliver robust diagnostic performance, with sensitivity ranging from 63% to 89% and specificity between 53% and 86%, based on large-scale clinical trials (FDA, 2024).

Its ability to be used with both exercise and pharmacologic stress agents also sets it apart from other PET tracers like 13N-ammonia and 82Rb-chloride, which are generally limited to pharmacologic protocols (Packard et al., 2025). This flexibility greatly enhances patient-centered care by accommodating a broader range of individuals, including those who may not be physically able to undergo treadmill-based testing.

Dr. James Cireddu, MD, FACC, Cardiologist and System Director of Nuclear Cardiology at UH Harrington Heart & Vascular Institute, discussed the future of PET MPI, stating, “This will enhance our ability to visualize blood flow within the heart muscle and more accurately assess the presence, severity, and extent of coronary artery disease.” He added, “As early adopters of this technology, our goal is to extract deeper insights from these studies and offer patients a potentially more precise diagnosis closer to home.”

Expanding access to PET MPI is a major step forward in improving heart disease diagnosis and care across Northeast Ohio. Dr. Cireddu stated, “We believe expanding access to PET MPI across Northeast Ohio will greatly enhance the diagnostic accuracy for coronary artery disease and make this advanced technology more accessible by eliminating geographic barriers to care.” Currently available at UH Cleveland Medical Center, plans are underway to extend this advanced imaging service to several UH community hospitals, bringing critical, life saving diagnostics closer to more patients and our communities.

These advancements signal a broader transformation in how cardiac disease is diagnosed and understood. With the introduction of Flyrcado and the continued development of other fluorine-18–based tracers, PET/CT imaging is emerging as a key tool, not only in detecting ischemia and perfusion issues, but also in uncovering more complex or subtle cardiac conditions such as sarcoidosis, amyloidosis, and fibrosis. These are often difficult to identify using traditional imaging alone. By bringing molecular-level detail into clinical focus, hospitals like UH are helping to redefine cardiovascular care—moving toward earlier detection, more accurate diagnosis, and a future of truly personalized cardiac medicine.