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Yoon GS, Choi SH, Kwon SW, Park SD, Woo SI. A prospective double-blinded randomized study on drug-eluting stent implantation into nitrate-induced maximally dilated vessels in patients with coronary artery disease. Trials 2023; 24:460. [PMID: 37464355 DOI: 10.1186/s13063-023-07497-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/06/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) has been developed using drug-eluting stents (DES); however, stent implantation is associated with concerns of stent thrombosis and target vessel revascularization (TVR). The stent diameter is a critical factor in TVR and clinical events. The nitrate administration in coronary angiography can dilate the reference vessel diameter, enabling accurate vessel size measurement and optimal stent implantation support. This study was designed to evaluate the effect of stent implantation in the maximally dilated coronary artery in patients with coronary artery disease (CAD). METHODS This prospective double-blinded randomized (1:1) study is designed to compare the efficacy and safety between DES implantation into the nitrate-induced maximally dilated vessels and conventional DES implantation in patients with CAD. A total of 400 patients who underwent PCI with a sirolimus-eluting stent will be enrolled. The primary endpoint is the mean diameter of the deployed stents. Secondary endpoints include cardiac death, myocardial infarction, stent thrombosis, or ischemia-driven TVR 1 year after the procedure. DISCUSSION This study will be the first randomized controlled trial to evaluate the effect of DES implantation on nitrate-induced maximally dilated vessels in patients with CAD. TRIAL REGISTRATION The trial was registered on 18 June 2021 as Effect of Ultimaster Stents Treated to the Most Dilated Coronary Vessels (ClinicalTrials.gov Identifier: NCT04931784).
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Affiliation(s)
- Gwang-Seok Yoon
- Division of Cardiology, Department of Internal Medicine, Inha University College of Medicine, 27, Inhang-Ro, Jung-Gu, Incheon, 22332, Republic of Korea
| | - Seong-Huan Choi
- Division of Cardiology, Department of Internal Medicine, Inha University College of Medicine, 27, Inhang-Ro, Jung-Gu, Incheon, 22332, Republic of Korea
| | - Sung Woo Kwon
- Division of Cardiology, Department of Internal Medicine, Inha University College of Medicine, 27, Inhang-Ro, Jung-Gu, Incheon, 22332, Republic of Korea
| | - Sang-Don Park
- Division of Cardiology, Department of Internal Medicine, Inha University College of Medicine, 27, Inhang-Ro, Jung-Gu, Incheon, 22332, Republic of Korea.
| | - Seong-Ill Woo
- Division of Cardiology, Department of Internal Medicine, Inha University College of Medicine, 27, Inhang-Ro, Jung-Gu, Incheon, 22332, Republic of Korea
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Soschynski M, Hagar MT, Taron J, Krauss T, Ruile P, Hein M, Nührenberg T, Russe MF, Bamberg F, Schlett CL. Update for the Performance of CT Coronary Angiography. ROFO-FORTSCHR RONTG 2022; 194:613-624. [PMID: 35231938 DOI: 10.1055/a-1747-3554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Coronary CT angiography (cCTA) is a class 1 recommendation in the current guidelines by the European Society of Cardiology (ESC) for excluding significant coronary artery stenosis. To achieve optimal image quality at a low radiation dose, the imaging physician may choose different acquisition modes. Therefore, the consensus guidelines by the Society of Cardiovascular Computed Tomography (SCCT) provide helpful guidance for this procedure. METHOD The article provides practical recommendations for the application and acquisition of cCTA based on the current literature and our own experience. RESULTS AND CONCLUSION According to current ESC guidelines, cCTA is recommended in symptomatic patients with a low or intermediate clinical likelihood for coronary artery disease. We recommend premedication with beta blockers and nitrates prior to CT acquisition under certain conditions even with the latest CT scanner generations. The most current CT scanners offer three possible scan modes for cCTA acquisition. Heart rate is the main factor for selecting the scan mode. Other factors may be coronary calcifications and body mass index (BMI). KEY POINTS · CCTA is a valid method to exclude coronary artery disease in patients with a low to intermediate clinical likelihood.. · Even with the latest generation CT scanners, premedication with beta blockers and nitrates can improve image quality at low radiation exposure.. · Current CT scanners usually provide retrospective ECG gating and prospective ECG triggering. Dual-source scanners additionally provide a "high pitch" scan mode to scan the whole heart during one heartbeat, which may also be achieved using single-source scanners with broad detectors in some cases.. · Besides the available scanner technology, the choice of scan mode primarily depends on heart rate and heart rate variability (e. g., arrhythmia).. CITATION FORMAT · Soschynski M, Hagar MT, Taron J et al. Update for the Performance of CT Coronary Angiography. Fortschr Röntgenstr 2022; DOI: 10.1055/a-1747-3554.
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Affiliation(s)
- Martin Soschynski
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Germany
| | - Muhammad Taha Hagar
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Germany
| | - Jana Taron
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Germany.,Cardiac MR PET CT Program, Massachusetts General-Hospital, Harvard Medical School, Boston, United States
| | - Tobias Krauss
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Germany
| | - Philipp Ruile
- Department of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Germany
| | - Manuel Hein
- Department of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Germany
| | - Thomas Nührenberg
- Department of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Germany
| | - Maximilian Frederik Russe
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Germany
| | - Christopher L Schlett
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Germany
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Dhanalakshmi B, Shijith KP, Sharma P. A prospective interventional study to assess the advantage of premedication with sublingual nitroglycerin in evaluation of peripheral vascular disease with computed tomography peripheral angiography. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2022. [DOI: 10.4103/mjdrdypu.mjdrdypu_527_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Nitrates administered by spray versus tablet: comparison of coronary vasodilation on CT angiography. Eur Radiol 2020; 31:515-524. [PMID: 32785771 DOI: 10.1007/s00330-020-07104-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 05/04/2020] [Accepted: 07/22/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To compare the coronary vasodilation effects of spray with those induced by tablet administration in coronary CT angiography (CCTA). METHODS A total of 2024 patients who underwent CCTA were identified for this retrospective study, including 828 patients with spray (spray group) and 1169 with tablets (tablet group). Of these, 93 patients underwent CCTA at least twice using both spray and tablets. The number of measurable segments and diameters of all 18 segments was measured. The number of measurable segments was compared between groups. RESULTS No statistically significant differences were evident between these two groups in terms of clinical characteristics. All coronary segments except the ramus intermedius (RI) and left posterior descending artery (L-PDA) were significantly larger in the spray group than in the tablet group (all p < 0.001). In peripheral and branch vessels, as well as in central and main coronary arteries, the diameters were significantly larger in the spray group than in the tablet group (all p < 0.001). Although not always statistically significant, all coronary segments tended to be more measurable on CCTA with spray than with tablet. In the subgroup that underwent CCTA twice using both spray and tablets, all coronary segments except the RI, obtuse marginal artery 2 (OM2), and L-PDA were significantly larger in the spray group than in the tablet group (all p < 0.05). CONCLUSION Lingual isosorbide dinitrate (ISDN) spray was more efficacious than sublingual nitroglycerin (NTG) tablets in coronary vasodilation for CCTA. Therefore, lingual ISDN spray should be preferred over sublingual NTG tablets for CCTA. KEY POINTS • Lingual ISDN spray was more efficacious than sublingual NTG tablet for coronary vasodilation in coronary CT angiography, even in elderly patients. • The diameters of all coronary segments except RI and L-PDA were significantly larger, and there were significantly more coronary segments greater than 1.5 mm, except RI and L-PDA, in the spray group than in the tablet group in the whole study group. • Even in peripheral and branch vessels, the diameters of coronary arteries were significantly larger in the spray group than in the tablet group, and they were also larger in elderly patients.
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Sand NPR, Veien KT, Nielsen SS, Nørgaard BL, Larsen P, Johansen A, Hess S, Deibjerg L, Husain M, Junker A, Thomsen KK, Rohold A, Jensen LO. Prospective Comparison of FFR Derived From Coronary CT Angiography With SPECT Perfusion Imaging in Stable Coronary Artery Disease: The ReASSESS Study. JACC Cardiovasc Imaging 2018; 11:1640-1650. [PMID: 29909103 DOI: 10.1016/j.jcmg.2018.05.004] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 05/04/2018] [Accepted: 05/09/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVES This study sought to compare the per-patient diagnostic performance of coronary computed tomography angiography (CTA)-derived fractional flow reserve (FFRCT) with that of single-photon emission computed tomography (SPECT), using a fractional flow reserve (FFR) value of ≤0.80 as the reference for diagnosing at least 1 hemodynamically significant stenosis in a head-to-head comparison of patients with intermediate coronary stenosis as determined by coronary CTA. BACKGROUND No previous study has prospectively compared the diagnostic performance of FFRCT and myocardial perfusion imaging by SPECT in symptomatic patients with intermediate range coronary artery disease (CAD). METHODS This study was conducted at a single-center as a prospective study in patients with stable angina pectoris (N = 143). FFRCT and SPECT analyses were performed by core laboratories and were blinded for the personnel responsible for downstream patient management. FFRCT ≤0.80 distally in at least 1 coronary artery with a diameter ≥2 mm classified patients as having ischemia. Ischemia by SPECT was encountered if a reversible perfusion defect (summed difference score ≥2) or transitory ischemic dilation of the left ventricle (ratio >1.19) were found. RESULTS The per-patient diagnostic performance for identifying ischemia (95% confidence interval [CI]), FFRCT versus SPECT, were sensitivity of 91% (95% CI: 81% to 97%) versus 41% (95% CI: 29% to 55%; p < 0.001); specificity of 55% (95% CI: 44% to 66%) versus 86% (95% CI: 77% to 93%; p < 0.001); negative predictive value of 90% (95% CI: 82% to 98%) versus 68% (95% CI: 59% to 77%; p = 0.001); positive predictive value of 58% (95% CI: 48% to 68%) versus 67% (95% CI: 51% to 82%; p = NS); and accuracy of 70% (95% CI: 62% to 77%) versus 68% (95% CI: 60% to 75%; p = NS) respectively. CONCLUSIONS In patients with stable chest pain and CAD as determined by coronary CTA, the overall diagnostic accuracy levels of FFRCT and SPECT were identical in assessing hemodynamically significant stenosis. However, FFRCT demonstrated a significantly higher diagnostic sensitivity than SPECT.
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Affiliation(s)
- Niels Peter Rønnow Sand
- Department of Cardiology, Hospital of Southwest Denmark, Esbjerg, Denmark; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| | | | - Søren Steen Nielsen
- Department of Nuclear Medicine, Aalborg University Hospital, Aalborg, Denmark
| | | | - Pia Larsen
- Department of Epidemiology, Biostatistics and Bioinformatics, University of Southern Denmark, Odense, Denmark
| | - Allan Johansen
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | - Søren Hess
- Department of Radiology and Nuclear Medicine, Hospital of Southwest Denmark, Esbjerg, Denmark
| | - Lone Deibjerg
- Department of Cardiology, Hospital of Southwest Denmark, Esbjerg, Denmark
| | - Majed Husain
- Department of Cardiology, Hospital of Southwest Denmark, Esbjerg, Denmark
| | - Anders Junker
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Allan Rohold
- Department of Cardiology, Hospital of Southwest Denmark, Esbjerg, Denmark
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Sublingual Nitroglycerin Administration in Coronary Computed Tomography Angiography: a Systematic Review. Eur Radiol 2015; 25:3536-42. [PMID: 25994194 PMCID: PMC4636517 DOI: 10.1007/s00330-015-3791-3] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Revised: 03/30/2015] [Accepted: 04/09/2015] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To systematically investigate the literature for the influence of sublingual nitroglycerin administration on coronary diameter, the number of evaluable segments, image quality, heart rate and blood pressure, and diagnostic accuracy of coronary computed tomography (CT) angiography. METHODS A systematic search was performed in PubMed, EMBASE and Web of Science. The studies were evaluated for the effect of sublingual nitroglycerin on coronary artery diameter, evaluable segments, objective and subjective image quality, systemic physiological effects and diagnostic accuracy. Due to the heterogeneous reporting of outcome measures, a narrative synthesis was applied. RESULTS Of the 217 studies identified, nine met the inclusion criteria: seven reported on the effect of nitroglycerin on coronary artery diameter, six on evaluable segments, four on image quality, five on systemic physiological effects and two on diagnostic accuracy. Sublingual nitroglycerin administration resulted in an improved evaluation of more coronary segments, in particular, in smaller coronary branches, better image quality and improved diagnostic accuracy. Side effects were mild and were alleviated without medical intervention. CONCLUSION Sublingual nitroglycerin improves the coronary diameter, the number of assessable segments, image quality and diagnostic accuracy of coronary CT angiography without major side effects or systemic physiological changes. KEY POINTS • Sublingual nitroglycerin administration results in significant coronary artery dilatation. • Nitroglycerin increases the number of evaluable coronary branches. • Image quality is improved the most in smaller coronary branches. • Nitroglycerin increases the diagnostic accuracy of coronary CT angiography. • Most side effects are mild and do not require medical intervention.
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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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Chan GK, Zhu KY, Chou DJ, Guo AJ, Dong TT, Tsim KW. Surveillance of nitrite level in cubilose: Evaluation of removal method and proposed origin of contamination. Food Control 2013. [DOI: 10.1016/j.foodcont.2013.06.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Yarlioglues M, Tasdemir K, Kaya MG, Kalay N. Aortic and coronary artery dissection during percutaneous coronary intervention: a case report and review article. Clin Cardiol 2011; 34:283-6. [PMID: 21538385 DOI: 10.1002/clc.20890] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Accepted: 12/30/2010] [Indexed: 11/06/2022] Open
Abstract
Coronary artery dissection is an uncommon but potentially serious complication in percutaneous coronary interventions. We treated a 53-year-old female patient with right coronary spasm, which was misdiagnosed as a coronary lesion. The coronary spasm resolved with nitrate administration, but proximal coronary dissection developed during angiography. It progressed anterograde and led to inferior myocardial infarction and severe hemodynamic instability due to right coronary artery occlusion. Percutaneous intervention failed, and it was determined that coronary dissection progressed retrograde, across the truncus of the aorta. Ascending aortic grafting and coronary bypass surgery were performed. The patient recovered and was discharged after 10 days. Close cardiothoracic observation is mandatory in patient evaluation and management.
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Affiliation(s)
- Mikail Yarlioglues
- Department of Cardiology, Erciyes University Medical Faculty, Kayseri, Turkey.
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Clarkson WA, Restrepo CS, Bauch TD, Rubal BJ. Using multidetector computed tomography in a swine model to assess the effects of sublingual nitroglycerin and intravenous adenosine on epicardial coronary arteries. Comp Med 2009; 59:573-579. [PMID: 20034433 PMCID: PMC2798844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Revised: 07/06/2009] [Accepted: 08/23/2009] [Indexed: 05/28/2023]
Abstract
This study examines the effects of intravenous infusion of adenosine and sublingual nitroglycerin on coronary angiograms obtained by current-generation multidetector computed tomography. We assessed coronary vasodilation at baseline and after intravenous adenosine (140 microg/kg/min) or sublingual nitroglycerin spray (800 microg) in 7 female swine (weight, 40.9 +/- 1.4 kg) by using electrocardiogram-gated coronary angiography with a 64-detector scanner (rotation time, 400 ms; 120kV; 400 mA) and intravenous contrast (300 mg/mL iohexol, 4.5 mL/s, 2 mL/kg). Cross-sectional areas of segments in the left anterior descending, circumflex, and right coronary arteries were evaluated in oblique orthogonal views. Images were acquired at an average heart rate of 73 +/- 11 beats per minute. Changes in aortic pressure were not significant with nitroglycerin but decreased (approximately 10%) with adenosine. Of the 76 segments analyzed (baseline range, 2 to 39 mm2), 1 distal segment could not be assessed after adenosine. Segment cross-sectional area increased by 11.3% with nitroglycerin but decreased by 9.6% during adenosine infusion. The results of the present study are consistent with the practice of using sublingual nitroglycerin to enhance visualization of epicardial vessels and suggest that intravenous adenosine may hinder coronary artery visualization. This study is the first repeated-measures electrocardiogram-gated CT evaluation to use the same imaging technology to assess changes in coronary cross-sectional area before and after treatment with a vasodilator. The nitroglycerin-associated changes in our swine model were modest in comparison with previously reported human studies.
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Affiliation(s)
- Wesley A Clarkson
- Cardiology Service, Brooke Army Medical Center, Fort Sam Houston, Texas
| | | | - Terry D Bauch
- The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Bernard J Rubal
- Cardiology Service, Brooke Army Medical Center, Fort Sam Houston, Texas
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Multidetector computed tomography coronary angiography: sublingual nitroglycerine improves image quality significantly because of peripheral coronary vasodilatation. J Comput Assist Tomogr 2009; 33:199-203. [PMID: 19346845 DOI: 10.1097/rct.0b013e31817c6b33] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE In this study, we investigated the influence of sublingual nitroglycerine (NTG) on the peripheral diameter, intraluminal contrast agent density, and image quality of coronary arteries during computed tomography coronary angiography (CTCA). MATERIALS AND METHODS Thirty patients with sublingual NTG application were matched to 30 patients without NTG. The diameters of the left anterior descending coronary artery (LAD), the left circumflex coronary artery and the right coronary artery were measured at 1-, 4-, and 8-cm length of each vessel as well as the intraluminal contrast agent density along the LAD. Vessel diameters and contrast attenuation at 4 and 8 cm were referenced against the values at 1 cm and processed as percentage reduction. Image quality of the posterior descending artery was assessed subjectively by 2 independent observers. RESULTS The percentage of peripheral vessel diameter reduction and the peripheral attenuation of contrast agent density for all measured coronary arteries was significantly smaller in the group with NTG administration. The image quality of the posterior descending artery was significantly higher in the group with NTG. CONCLUSIONS Sublingual administration of NTG before CTCA results in improved diagnostic image quality because of a significant dilatation and improved intraluminal contrast agent density of the peripheral vessels.
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Vijayalakshmi K, Kunadian B, Whittaker VJ, Wright RA, Hall JA, Somasundram U, Stewart MJ, Sutton A, Davies A, de Belder MA. Impact of catheter sizes and intracoronary glyceryl trinitrate on the TIMI frame count when digital angiograms are acquired at lower frame rates during elective angiography and PCI. ACTA ACUST UNITED AC 2008; 9:231-8. [PMID: 17851976 DOI: 10.1080/17482940701305417] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
UNLABELLED The TIMI frame count (TFC) is a useful measure of coronary flow. To be widely applicable, the effect of different catheter sizes and the use of intracoronary glyceryl trinitrate (ICGTN) must be determined when films are acquired at lower acquisition rates (12.5 frames/s, f/s). METHODS We compared 6F versus 5F diagnostic catheters (n = 44), 6F versus 7F diagnostic catheters (n = 45) and 6F diagnostic versus 7F guide catheters (n = 44). In the nitrate angiography group (n = 141), coronary angiography was performed before and after 200 micrograms of ICGTN. In the nitrate percutaneous coronary intervention (PCI) group (n = 48), coronary angiography was performed before and after 200 micrograms of ICGTN after the completion of the elective PCI procedure. RESULTS The mean difference in the uncorrected TFC using 6F and 5F was 0.02 (95 % CI -0.5, 0.6; P = 0.9); using 6F and 7F diagnostic catheters it was 0.3 (95% CI -0.49, 1.1; p = 0.4); and using 6F diagnostic and 7F guide catheters it was 0.4 (95% CI -2.6, 3.4; P = 0.7) respectively. In the nitrate angiography group, the uncorrected TFC before and after ICGTN was 13.1+/-6.2 and 15+/-7.5 (equivalent to 31.4+/-14.9 and 36+/-2 at 30 f/s), with a mean difference of 1.9 (95% CI 1.3, 2.5; P = or <0.0001). In the nitrate PCI group, the uncorrected TFC before and after ICGTN administration was 9.2+/-3.7 and 10.3+/-4.2 (equivalent to 22.6+/-9.6 and 25.2+/-11 at 30 f/s) respectively with a mean difference between the two injections of 1.2 (95% CI -0.4, 1.9; P = 0.003). CONCLUSION We have demonstrated that the catheter sizes did not significantly affect the TFC when angiography was performed at 12.5f/s. The use of ICGTN significantly increased the TFC in both normal and diseased coronary arteries. This effect was also observed when ICGTN was administered into the culprit vessels after the completion of the elective PCI procedure. This effect must be considered when investigating the impact of specific treatments or drugs on coronary flow.
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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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Perry R, Joseph MX, De Pasquale CG, Chew DP, Yiu D, Aylward PE, Mangoni AA. High-resolution transthoracic echocardiography of the left anterior descending coronary artery: a novel noninvasive assessment of coronary vasoreactivity. J Am Soc Echocardiogr 2007; 21:134-8. [PMID: 17628418 DOI: 10.1016/j.echo.2007.05.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2007] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The study objective was to determine the effects of salbutamol and nitroglycerin (NTG) on the luminal diameter of the left anterior descending (LAD) coronary artery, as measured noninvasively by the novel technique of high-resolution transthoracic echocardiography (HRTTE). BACKGROUND Invasive studies of the coronary arteries have demonstrated vasodilatation by salbutamol and NTG. By using a novel technique of HRTTE, combined with assessment of augmentation index (AIx, a marker of peripheral arterial stiffness) by means of applanation tonometry from the radial artery (pulse wave analysis), we studied the vasomotion of the proximal LAD in healthy volunteers. METHODS Nineteen male subjects (age 31 +/- 5 years, mean +/- standard deviation) underwent HRTTE measurement of the wall thickness, luminal diameter, and external diameter of the proximal LAD, and AIx at baseline and 5, 10, 15, and 20 minutes after administration of inhaled salbutamol (400 microg) and, after return to baseline, sublingual NTG (300 microg). RESULTS Salbutamol induced a 44% +/- 28% increase in LAD luminal diameter (2.8 +/- 0.8 mm to 3.7 +/- 0.9 mm, P < .001) and a reduction in AIx (-13.4% +/- 6.6%, P < .001). NTG induced greater changes in both parameters (60% +/- 30% increase in luminal diameter from baseline, 2.7 +/- 0.9 mm to 4.4 +/- 1.1 mm, P < .001; and reduction in AIx -24.1% +/- 8.2%, P < .001). Changes in LAD diameter and AIx were related after both salbutamol (r = -0.53, P = .02) and NTG (r = -0.57, P = .01). No significant change was detected in wall thickness. CONCLUSION HRTTE is able to detect the LAD coronary artery vasodilating effects of NTG and salbutamol and correlates with peripheral vascular reactivity to these vasodilators. This approach provides a useful tool for the noninvasive assessment of coronary vasoreactivity.
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Affiliation(s)
- Rebecca Perry
- Cardiac Services, Flinders Medical Centre, Flinders University, Bedford Park, South Australia, Australia.
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