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D’Errico F, Ricci F, Luciano A, Sbordone FP, Laudazi M, Mecchia D, Volpe M, Briganti F, Di Landro A, Muscoli S, Pugliese L, De Stasio V, Di Donna C, Romeo F, Garaci F, Floris R, Chiocchi M. The Impact of Nitroglycerin on the Evaluation of Coronary Stenosis in Coronary-CT: Preliminary Study in 131 Patients. J Clin Med 2023; 12:5296. [PMID: 37629336 PMCID: PMC10455480 DOI: 10.3390/jcm12165296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND The sublingual administration of short-acting nitroglycerin (NTG) before coronary computed tomography (CCT) improves the visualization of coronary arteries, causing vasodilatation. The aim of this study was to evaluate whether and how nitroglycerin can influence the concordance between radiologists and cardiologists in the evaluation of vessel stenosis measured in CCT by the former and during the following coronarography by the latter. METHODS We conducted a retrospective analysis of 131 patients who underwent CCT for cardiac symptoms in 2022, followed by coronarography performed six months later because of significant stenosis revealed by the CCT. First, the patients were divided into two groups: an NTG group who received sublingual nitroglycerin before CCT and a non-NTG group who did not because of contraindications. Second, 254 stenoses were measured by two radiologists after CCT and by two interventional cardiologists during the next coronarography; moreover, stenoses were classified on the basis of their location and plaque pattern (calcific, mixed and lipidic). Third, the strength of agreement was evaluated between the two radiologists, between the two cardiologists and finally between the radiologists and cardiologists in order to evaluate whether and how the interdisciplinary discrepancy in stenosis evaluation could change with or without the use of nitroglycerin before CCT and in relation to the different plaque pattern. RESULTS In the NTG group, the use of nitroglycerine reduced the agreement between radiologists and cardiologists in calcific stenosis but did not change the concordance in the case of mixed or lipidic plaques on the same vessels. CONCLUSIONS The use of sublingual nitroglycerin before CCT may lead to a radiological overestimation of calcific stenosis.
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Affiliation(s)
- Francesca D’Errico
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy; (F.D.); (A.L.); (F.P.S.); (M.L.); (D.M.); (M.V.); (F.B.); (L.P.); (V.D.S.); (C.D.D.); (F.G.); (R.F.); (M.C.)
| | - Francesca Ricci
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy; (F.D.); (A.L.); (F.P.S.); (M.L.); (D.M.); (M.V.); (F.B.); (L.P.); (V.D.S.); (C.D.D.); (F.G.); (R.F.); (M.C.)
| | - Alessandra Luciano
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy; (F.D.); (A.L.); (F.P.S.); (M.L.); (D.M.); (M.V.); (F.B.); (L.P.); (V.D.S.); (C.D.D.); (F.G.); (R.F.); (M.C.)
| | - Francesco Paolo Sbordone
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy; (F.D.); (A.L.); (F.P.S.); (M.L.); (D.M.); (M.V.); (F.B.); (L.P.); (V.D.S.); (C.D.D.); (F.G.); (R.F.); (M.C.)
| | - Mario Laudazi
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy; (F.D.); (A.L.); (F.P.S.); (M.L.); (D.M.); (M.V.); (F.B.); (L.P.); (V.D.S.); (C.D.D.); (F.G.); (R.F.); (M.C.)
| | - Daniele Mecchia
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy; (F.D.); (A.L.); (F.P.S.); (M.L.); (D.M.); (M.V.); (F.B.); (L.P.); (V.D.S.); (C.D.D.); (F.G.); (R.F.); (M.C.)
| | - Maria Volpe
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy; (F.D.); (A.L.); (F.P.S.); (M.L.); (D.M.); (M.V.); (F.B.); (L.P.); (V.D.S.); (C.D.D.); (F.G.); (R.F.); (M.C.)
| | - Flavia Briganti
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy; (F.D.); (A.L.); (F.P.S.); (M.L.); (D.M.); (M.V.); (F.B.); (L.P.); (V.D.S.); (C.D.D.); (F.G.); (R.F.); (M.C.)
| | - Alessio Di Landro
- Unit of Cardiology and Interventional Cardiology, Policlinico Tor Vergata, Viale Oxford 81, 00133 Rome, Italy; (A.D.L.); (S.M.)
| | - Saverio Muscoli
- Unit of Cardiology and Interventional Cardiology, Policlinico Tor Vergata, Viale Oxford 81, 00133 Rome, Italy; (A.D.L.); (S.M.)
| | - Luca Pugliese
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy; (F.D.); (A.L.); (F.P.S.); (M.L.); (D.M.); (M.V.); (F.B.); (L.P.); (V.D.S.); (C.D.D.); (F.G.); (R.F.); (M.C.)
| | - Vincenzo De Stasio
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy; (F.D.); (A.L.); (F.P.S.); (M.L.); (D.M.); (M.V.); (F.B.); (L.P.); (V.D.S.); (C.D.D.); (F.G.); (R.F.); (M.C.)
| | - Carlo Di Donna
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy; (F.D.); (A.L.); (F.P.S.); (M.L.); (D.M.); (M.V.); (F.B.); (L.P.); (V.D.S.); (C.D.D.); (F.G.); (R.F.); (M.C.)
| | - Francesco Romeo
- Faculty of Medicine, UniCamillus International Medical University, 00131 Rome, Italy;
| | - Francesco Garaci
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy; (F.D.); (A.L.); (F.P.S.); (M.L.); (D.M.); (M.V.); (F.B.); (L.P.); (V.D.S.); (C.D.D.); (F.G.); (R.F.); (M.C.)
| | - Roberto Floris
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy; (F.D.); (A.L.); (F.P.S.); (M.L.); (D.M.); (M.V.); (F.B.); (L.P.); (V.D.S.); (C.D.D.); (F.G.); (R.F.); (M.C.)
| | - Marcello Chiocchi
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy; (F.D.); (A.L.); (F.P.S.); (M.L.); (D.M.); (M.V.); (F.B.); (L.P.); (V.D.S.); (C.D.D.); (F.G.); (R.F.); (M.C.)
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Riese N, Smart Y, Bailey M. Asymptomatic retinal emboli and current practice guidelines: a review. Clin Exp Optom 2023; 106:4-9. [PMID: 35109784 DOI: 10.1080/08164622.2022.2033600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Asymptomatic retinal emboli are found in 1-3% of patients on routine fundus examination. As the use of teleretinal imaging for diabetic patients and ocular photography continues to increase, the number of asymptomatic retinal emboli found will also increase. This article will discuss the different aetiologies of retinal emboli and will present an overview of the recommended referrals for further systemic testing and treatment. It is important to communicate well with the primary care physician when asymptomatic retinal emboli are detected to ensure the appropriate investigations are undertaken.
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Affiliation(s)
- Nicole Riese
- Department of Optometry, VA New Jersey Healthcare System, Brick, NJ, USA
| | - Yelena Smart
- Department of Optometry, VA New Jersey Healthcare System, Brick, NJ, USA
| | - Melissa Bailey
- Department of Neurology, University of Miami, Miami, FL, USA
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