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Lu NH, Liu YS, Liu KI, Hsu SY, Huang YH, Sun CK, Chen TB. Questionable necessity of nitroglycerin for diagnostic coronary artery examination using 320-row multi-detector computed tomography. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2020; 28:989-999. [PMID: 32741800 DOI: 10.3233/xst-200652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE This study aims to analyze and compare the diagnostic effectiveness of 320-row multi-detector computed tomography for coronary artery angiography (MDCTA) in subjects with and without sublingual vasodilator (nitroglycerin). MATERIALS AND METHODS From September 2015 to September 2016, 70 individuals without history of major cardiovascular diseases who underwent MDCTA for health examination were retrospectively categorized into sublingual nitroglycerin (NTG) and non-NTG groups. Medical history, CT dose index (CTDI), and multi-slice CT images were compared between two groups. A diameter of coronary artery (DA, mm) was computed and analyzed. RESULTS A total of 41 males and 29 females (mean age: 55.43±8.84 years, range: 34- 76) were reviewed. Normal and abnormal MDCTA findings were noted in 54 and 16 participants, respectively, with the detection rate of coronary artery disease being 23%. There was no significant difference in inter-observer variability of coronary CTA image quality and diagnosis between the NTG and non-NTG groups among three experienced radiologists. Although the percentage dilatation of left anterior descending branch (LAD), right coronary artery (RCA) and left circumflex branch (LCX) following in the NTG group were 12.4%, 12.8% and 25.3%, respectively (p < 0.01), there was no significant difference in image quality and diagnosis between the two groups. CONCLUSIONS Despite the recommendation of routine nitroglycerin use for subjects undergoing computed tomography for coronary artery angiography, our results showed no significant advantage of its use in improving image quality and rate of diagnosis accuracy.
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Affiliation(s)
- Nan-Han Lu
- Department of Pharmacy, Tajen University, Pingtung, Taiwan
- Department of Radiology, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
- Department of Medical Imaging and Radiological Sciences, I-Shou University, Kaohsiung, Taiwan
| | - Yi-Shan Liu
- Department of Pharmacy, Tajen University, Pingtung, Taiwan
- Department of Dermatology, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
| | - Ko-In Liu
- Department of Medical Imaging and Radiological Sciences, I-Shou University, Kaohsiung, Taiwan
- Department of Radiology, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan
- Department of Information Engineering, I-Shou University, Kaohsiung, Taiwan
| | - Shih-Yen Hsu
- Department of Medical Imaging and Radiological Sciences, I-Shou University, Kaohsiung, Taiwan
- Department of Radiology, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan
- Department of Information Engineering, I-Shou University, Kaohsiung, Taiwan
| | - Yung-Hui Huang
- Department of Medical Imaging and Radiological Sciences, I-Shou University, Kaohsiung, Taiwan
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan
- School of Medicine for International Students, I-Shou University, Kaohsiung, Taiwan
| | - Tai-Been Chen
- Department of Medical Imaging and Radiological Sciences, I-Shou University, Kaohsiung, Taiwan
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Coronary vasodilation by the use of sublingual nitroglycerin using 64-slice dual-source coronary computed tomography angiography. J Cardiol 2014; 65:230-6. [PMID: 24994019 DOI: 10.1016/j.jjcc.2014.05.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 05/23/2014] [Accepted: 05/28/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND Sublingual nitroglycerin capsules or spray is routinely used to treat anginal attacks and to maximally dilate the epicardial coronary arteries during coronary angiography. These dilated coronary vessels have an advantage, but increased heart rates were disadvantageous for coronary computed tomography angiography (CTA). PURPOSE The influence of applying nitroglycerin was analyzed regarding the coronary diameter, coronary luminal attenuation, evaluable number of coronary segments, heart rate (HR), HR variability, the optimal reconstruction phase, and image scoring of CTA in the same patients using a 64-slice dual-source CT. METHODS AND SUBJECTS Fifty-two patients with atypical chest pain underwent coronary CTA before and after the administration of sublingual nitroglycerin without heart rate control. The coronary diameter and luminal attenuation were measured on short-axial images in each coronary segment. The coronary vasodilation ratios (VRs) were calculated from the coronary diameters at the same location before and after the use of nitroglycerin. The local institutional review board approved this study and written informed consent was obtained from all the patients. RESULTS No significant differences were noted in the HR variability or optimal reconstruction phase, despite an increase in HR after the use of nitroglycerin. Nitroglycerin significantly enlarged the coronary artery diameter, and VRs of each coronary segment ranged from 7.54% to 22.26%. As compared with baseline coronary diameter, VRs of minor segments (16.91%) were significantly larger than those of major segments (11.35%), and the magnitude of VR correlated with the baseline coronary diameter (r=-0.48, p<0.001). Coronary luminal attenuation significantly increased due to additional administration of contrast material after the use of nitroglycerin (p<0.01), but no significant difference was noted in the image quality after the use of nitroglycerin. CONCLUSION Sublingual nitroglycerin significantly enlarged the coronary diameters, especially in peripheral small coronary arteries, and increased the evaluable number of coronary segments on coronary CTA.
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Leipsic J, Labounty TM, Hague CJ, Mancini GJ, O’Brien JM, Wood DA, Taylor CM, Cury RC, Earls JP, Heilbron BG, Ajlan AM, Feuchtner G, Min JK. Effect of a novel vendor-specific motion-correction algorithm on image quality and diagnostic accuracy in persons undergoing coronary CT angiography without rate-control medications. J Cardiovasc Comput Tomogr 2012; 6:164-71. [DOI: 10.1016/j.jcct.2012.04.004] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Revised: 02/29/2012] [Accepted: 04/03/2012] [Indexed: 01/05/2023]
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Influence of applying nitroglycerin in whole-heart free-breathing 3D coronary MR angiography. AJR Am J Roentgenol 2010; 194:927-32. [PMID: 20308493 DOI: 10.2214/ajr.09.3330] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE The purpose of our study was to assess the impact of sublingual nitroglycerin (NTG) spray on free-breathing 3D whole-heart coronary MR angiography (MRA). SUBJECTS AND METHODS We compared the timing parameters; measured the lumen diameter of the major coronary arteries; calculated coronary vasodilation, apparent signal-to-noise ratio (SNR), and apparent contrast-to-noise ratio (CNR); and evaluated the image quality on pre- and post-NTG coronary MRA in 15 volunteers. Statistical analysis was performed with p value less than 0.05 considered significant. RESULTS The mean trigger delay and optimal acquisition window were shortened significantly and the mean scanning time was prolonged statistically after NTG administration. There was no significant alteration in terms of apparent SNR and apparent CNR. The lumen diameters were significantly larger in coronary MRA post-NTG than in that of pre-NTG, with an average 25.35% +/- 6.51% (SD) increase, and the left circumflex coronary artery (LCX) had slightly lower vasodilation in comparison with the right coronary artery. Image quality scores of 53 (39.3%, 53/135) segments were increased and 15 segments (11.1%, 15/135) decreased after NTG administration, and the remaining 67 segments (49.6%, 67/135) were unchanged. CONCLUSION In general, sublingual NTG is useful for improving visualization of the coronary artery lumen and alleviating the impact of artifact. However, several alterations and disadvantages should be taken into consideration in view of the disturbed assessment of vasodilatory response in the LCX and the impaired quality in a minority of segments after NTG administration. Further studies are needed to evaluate the effect of beta-blockade on eliminating the disadvantages of sublingual NTG.
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Kantor B, Nagel E, Schoenhagen P, Barkhausen J, Gerber TC. Coronary computed tomography and magnetic resonance imaging. Curr Probl Cardiol 2009; 34:145-217. [PMID: 19269527 DOI: 10.1016/j.cpcardiol.2008.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Cardiac computed tomography and magnetic resonance are relatively new imaging modalities that can exceed the ability of established imaging modalities to detect present pathology or predict patient outcomes. Coronary calcium scoring may be useful in asymptomatic patients at intermediate risk. Computed tomographic coronary angiography is a first-line indication to evaluate congenitally abnormal coronary arteries and, along with stress magnetic resonance myocardial perfusion imaging, is useful in symptomatic patients with nondiagnostic conventional stress tests. Cardiac magnetic resonance is indicated for visualizing cardiac structure and function, and delayed enhancement magnetic resonance is a first-line indication for assessing myocardial viability. Imaging plaque and molecular mechanisms related to plaque rupture holds great promise for the presymptomatic detection of patients at risk for coronary events but is not yet suitable for routine clinical use.
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Achenbach S, Ropers U, Kuettner A, Anders K, Pflederer T, Komatsu S, Bautz W, Daniel WG, Ropers D. Randomized comparison of 64-slice single- and dual-source computed tomography coronary angiography for the detection of coronary artery disease. JACC Cardiovasc Imaging 2009; 1:177-86. [PMID: 19356426 DOI: 10.1016/j.jcmg.2007.11.006] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2007] [Revised: 11/15/2007] [Accepted: 11/19/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The purpose of this study was to analyze the influence of a systematic approach to lower heart rate for coronary computed tomography (CT) angiography on diagnostic accuracy of 64-slice single- and dual-source CT. BACKGROUND Coronary CT angiography is often impaired by motion artifacts, so that routine lowering of heart rate is usually recommended. This is often conceived as a major limitation of the technique. It is expected that higher temporal resolution, such as with dual-source 64-slice CT, would allow diagnostic imaging even without systematic pre-treatment for lowering the heart rate. METHODS Two hundred patients with suspected coronary artery disease were first randomized to either 64-slice single-source CT (n = 100) or dual-source CT (n = 100) for contrast-enhanced coronary artery evaluation. In each group, patients were further randomized to either receive systematic heart rate control (oral and intravenous beta-blockade for a target heart rate < or =60 beats/min) or receive no premedication. Evaluability of datasets and diagnostic accuracy were compared between groups against the results obtained from invasive angiography. RESULTS Systematic pre-treatment lowered heart rate during CT coronary angiography by 10 beats/min. Heart rate control significantly improved evaluability in single-source CT (93% vs. 69% on a per-patient basis, p = 0.005), whereas it did not in dual-source CT (96% vs. 98%). In evaluable patients, sensitivity to detect the presence of at least 1 coronary stenosis by single-source CT was 86% and 79%, respectively, with and without heart rate control (p = NS). For dual-source CT, it was 100% and 95%, respectively (p = NS). The rate of correctly classified patients, defined as evaluable and correct classification as to the presence or absence of at least 1 coronary artery stenosis, was significantly improved by heart rate control in single-source CT (78% vs. 57%, p = 0.04), whereas there was no such influence in dual-source CT (87% vs. 93%). CONCLUSIONS Systematic heart rate control significantly improves image quality for coronary visualization by 64-slice single-source CT, whereas image quality and diagnostic accuracy remain unaffected in dual-source CT angiography. Improved temporal resolution obviates the need for heart rate control.
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Tuncer C, Gokce M, Sokmen G. An anomalous left main coronary artery with coronary torsion originating from the right sinus Valsalva. Int J Cardiol 2008; 124:115-7. [PMID: 17346823 DOI: 10.1016/j.ijcard.2006.11.198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2006] [Accepted: 11/18/2006] [Indexed: 11/19/2022]
Abstract
A 52-year old woman developed inferior ST elevation myocardial infarction and was found to have both an anomalous left coronary artery originating from the right sinus of Valsalva, and total atherosclerotic occlusion of the proximal right coronary artery. Coronary angiography showed the torsion of left main coronary artery. Multislice computed tomography was used to assess the left main coronary artery.
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Effects of sublingual nitroglycerin on coronary lumen diameter and number of visualized septal branches on 64-MDCT angiography. AJR Am J Roentgenol 2008; 190:219-25. [PMID: 18094315 DOI: 10.2214/ajr.07.2648] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE This article describes the influence of sublingual nitroglycerin spray on the lumen diameter, number of side branches visualized, contrast-to-noise ratio (CNR), and signal-to-noise ratio (SNR) of the coronary arteries with MDCT angiography. SUBJECTS AND METHODS Forty-two patients were prospectively included in this study: 21 were examined without sublingual nitroglycerin (group A), and 21 were examined after the administration of sublingual nitroglycerin (group B). CT angiography was performed using a 64-MDCT scanner. Two blinded observers quantitatively assessed lumen diameter and volume in the left anterior descending artery (LAD) and the right coronary artery (RCA). The number of septal branches was counted. The SNR and CNR in the LAD and RCA were calculated in both groups. The number of clinical side effects was evaluated. RESULTS The lumen diameters and the average volumes were significantly larger in group B than in group A. The number of septal branches visualized in group B was significantly higher than in group A. No statistically significant difference in SNR and CNR between the groups was shown. The number of side effects in the two groups was not significantly different. CONCLUSION Sublingual nitroglycerin spray significantly dilates the coronary arteries and allows more septal branches to be visualized at coronary CT angiography without diminishing image quality or increasing the number of side effects.
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Favilli S, Pasanisi E, Casolo G, Santoro G, Zuppiroli A, Bini RM. Usefulness of integrated imaging in the diagnosis of a rare coronary artery anomaly in a young athlete. J Cardiovasc Med (Hagerstown) 2007; 8:527-30. [PMID: 17568287 DOI: 10.2459/01.jcm.0000278439.36000.4c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Congenital coronary artery anomalies are a rare cause of major cardiovascular events in adolescents who practise sports activities. Therefore, symptoms suggestive of cardiac ischaemia should always be carefully considered and subjects should undergo a complete cardiovascular assessment. We describe the case of a young non-competitive athlete, referring episodes of exertional chest pain and syncope, in whom multiple imaging techniques allowed the diagnosis of intramural course of the left anterior descending coronary artery.
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Affiliation(s)
- Silvia Favilli
- Division of Paediatric Cardiology, Anna Meyer Hospital, Florence, Italy.
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Hoe JWM, Toh KH. A practical guide to reading CT coronary angiograms--how to avoid mistakes when assessing for coronary stenoses. Int J Cardiovasc Imaging 2006; 23:617-33. [PMID: 17186138 DOI: 10.1007/s10554-006-9173-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2006] [Accepted: 09/29/2006] [Indexed: 01/02/2023]
Abstract
There are now many physicians, both radiologists and cardiologists who are reporting CT coronary angiography (CTCA) scans who may not be aware that there are many pitfalls present. For the inexperienced reader a significant stenosis in a coronary artery can be easily missed or a moderate stenosis overcalled as significant. Artifacts can also be misinterpreted as representing a significant lesion. It is important that the studies are correctly interpreted, especially as the reported high negative predictive value of CTCA scans is a major strength of this imaging technique. The learning curve of reading these scans is steep and access to conventional coronary catheterisation results is essential for feedback and to improve the readers results. We have developed some rules to aid beginners avoid some of the pitfalls that can occur as these studies are not as easy to read as they may appear initially.
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Affiliation(s)
- John W M Hoe
- Medi-Rad Associates Ltd, CT Centre, Mt Elizabeth Hospital, 3 Mt Elizabeth, Singapore 288185, Singapore.
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Busch S, Johnson TRC, Nikolaou K, von Ziegler F, Knez A, Reiser MF, Becker CR. Visual and automatic grading of coronary artery stenoses with 64-slice CT angiography in reference to invasive angiography. Eur Radiol 2006; 17:1445-51. [PMID: 17180326 DOI: 10.1007/s00330-006-0512-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2006] [Revised: 08/25/2006] [Accepted: 10/16/2006] [Indexed: 01/21/2023]
Abstract
The aim of this study was to assess the performance of a software tool for quantitative coronary artery analysis of computed tomography coronary angiography (CT-QCA) in comparison with invasive coronary angiography with quantitative analysis (CAG-QCA) as standard of reference. Two radiologists reviewed the CT angiography data sets (Siemens Sensation 64) of 25 patients, grading coronary artery stenoses visually and with a software tool (Circulation, Siemens). Twenty-three data sets with sufficient image quality were included in the final analysis. CAG revealed a total of 30 wall irregularities and 28 stenoses, of which 17 were graded as moderate and nine as hemodynamically significant. CT-QCA showed a better agreement to CAG-QCA, with a systematic overestimation of the degree of stenosis of 6.1% and limits of agreement of +36.1% and -23.9; the correlation coefficient was 0.82 (p < 0.0001). Using CT-QCA, sensitivity, specificity, and positive and negative predictive value were 89%, 100%, 89%, and 100%, respectively, for significant area stenoses greater than 75%. The positive predictive value for the visual assessment amounted to 53%. Interobserver variability between CT-QCA and visual assessment showed a kappa value of 0.72. In conclusion, software-supported CT-QCA makes it possible to quantify significant coronary artery stenoses automatically, with good agreement to CAG-QCA.
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Affiliation(s)
- Stephanie Busch
- Department of Clinical Radiology, University of Munich, Marchioninistr. 15, 81377 Munich, Germany.
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Tuncer C, Batyraliev T, Yilmaz R, Gokce M, Eryonucu B, Koroglu S. Origin and distribution anomalies of the left anterior descending artery in 70,850 adult patients: Multicenter data collection. Catheter Cardiovasc Interv 2006; 68:574-85. [PMID: 16969852 DOI: 10.1002/ccd.20858] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To present the clinical and angiographic properties of the left anterior descending artery anomalies. BACKGROUND Coronary artery anomalies are discovered in less than 1% of angiography series. Since the number of angiographies and coronary bypass operations are increasing significantly every day, these anomalies are of clinical importance. However, data about left anterior descending artery anomalies in literature is still scarce. METHODS We reviewed the records of 70,850 patients who had undergone coronary angiographies at 4 different cardiology center from 1999 to 2005 years. RESULTS Major congenital coronary anomalies were discovered in 171 of these cases (0,24%). The mean age of these patients was 61 +/- 11 (18-84) years. Ninety nine patients (58%) were male. Left anterior descending artery was involved in 12 patients (0.017%). In nine patients with the anomalous LAD there were concomittant congenital coronary artery anomalies. Concurrent coronary artery anomalies encountered were double left anterior descending artery type 4 (2 cases), double left anterior descending artery type 4 with double right coronary artery (1), double right coronary artery (1), double circumflex artery with anomalous left anterior descending artery (1), circumflex artery from right sinus of Valsalva (1), separate septal perforator and myocardial bridging of posterior descending artery (1), intercoronary communication, and ostial atresia of the left anterior descending artery and anomalous circumflex artery (1). CONCLUSION Our series is the biggest series where relatively sufficient clinical and angiographic information about the LAD anomalies were provided.
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Affiliation(s)
- Cemal Tuncer
- Cardiology Department, Faculty of Medicine, Kahramanmaras Sutcuimam University, Kahramanmaras, Turkey.
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