Effect of Nitroglycerin on the Performance of MR Coronary Angiography

Heer, Tobias; Reiter, Stephanie; Trissler, Markus; Höfling, Berthold; Knobelsdorff-Brenkenhoff, Florian von und Pilz, Günter (2017): Effect of Nitroglycerin on the Performance of MR Coronary Angiography. In: Journal of Magnetic Resonance Imaging, Bd. 45, Nr. 5: S. 1419-1428

Abstract

Purpose: To systematically investigate the effect of sublingual glyceryl trinitrate (nitroglycerin-nitro-glyceryl trinitrate=GTN=C(3)H(5)N(3)o(9) [NTG]) on the diagnostic performance of MR coronary artery imaging (MRCA) to detect relevant coronary artery disease (CAD). Materials and Methods: Thirty-five healthy volunteers and 25 patients with suspected or proven CAD (all in sinus rhythm) underwent MRCA before and after NTG using a contrast-agent free, three-dimensional, navigator-based, steady state free precession acquisition (voxel size 1.0 x 0.7 x 0.7 mm(3)) at 1.5 Tesla. Target parameters were stenosis detection (>50%), visible vessel length (straightened planar reconstruction) and vessel diameter (curved planar reconstruction, measured proximal/medial/distal). In patients, invasive coronary angiography served as reference. Results: NTG led to increase of the coronary diameter both in healthy volunteers (right coronary artery [RCA]: 3.2 to 3.7 mm, P < 0.001;left anterior descending coronary artery [LAD]: 2.9 to 3.4 mm, P =0.009;left circumflex coronary artery [LCx]: 2.8 to 3.3mm, P <- 0.001) and patients (RCA 3.5 to 4.0 mm, P=0.01;LAD 3.3 to 3.7 mm, P = 0.008;LCx: 2.9 to 3.3 mm, P= 0.03). Visible vessel length increased after NTG for the LAD (volunteers: 72 to 84 mm, P- 0.03;patients: 56 to 78 mm, P=0.01) and for LCx (volunteers: 48 to 60 mm, P=0.02). Sensitivity to detect 50% stenosis improved after NTG from 88.0 to 96%, specificity from 46.5 to 69.8%, diagnostic accuracy from 61.8 to 79.4% and positive/negative predictive value from 48.9 to 64.9% and 87.0 to 96.8%, respectively. Conclusion: Sublingual administration of NTG significantly enhanced the visibility of the coronary arteries and improved the detection of coronary artery stenosis.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 1053-1807
• Sprache: Englisch