Applying Nitroglycerin at Coronary MR Angiography at 1.5 T: Diagnostic Performance of Coronary Vasodilation in Patients with Coronary Artery Disease

Abstract

To evaluate the influence of applying nitroglycerin (NTG) on detecting significant coronary artery disease (CAD) and NTGinduced coronary vasodilation using coronary MR angiography in patients suspected of having CAD. Materials and Methods:In this prospective study conducted from November 2017 to September 2018, 70 consecutive participants suspected of having CAD were recruited. Of those, 57 patients successfully underwent pre-and post-NTG coronary MR angiography, both of which were performed during the end-systolic phase of the cardiac cycle. Significant coronary stenosis was defined at x-ray coronary angiography as stenosis of 50% or more. Participants were divided into a significant CAD group (significant stenosis) and nonsignificant CAD group (no significant stenosis) based on x-ray coronary angiography. Paired and unpaired Student t, generalized linear mixed model, and McNemar tests were used.

Does the Use of Nitroglycerin at MR Angiography Help Diagnose Coronary Artery Disease?

“…Coronary MR angiography, on the other hand, takes much longer to acquire with the same coverage and spatial resolution as that of coronary CT angiography. In this study by Zhao et al, the mean coronary MR angiography acquisition time was approximately 10 minutes (3). An alternative to sublingual nitroglycerin would be to use a longer-acting nitrate, such as isosorbide dinitrate, which Kim et al (2) and Hu et al (9) have reported on previously.…”

“…With regard to diagnostic accuracy, nitroglycerin significantly improved per-segment specificity (from 80% to 94%), positive predictive value (from 43% to 70%), and accuracy (from 82% to 94%), while maintaining very high sensitivity (99%) and negative predictive value (100%) (3). The improvement in diagnostic accuracy of coronary MR angiography with sublingual nitroglycerin is expected, given the literature supporting its beneficial effects at coronary CT angiography (5).…”

3D whole-heart noncontrast coronary MR angiography based on compressed SENSE technology: a comparative study of conventional SENSE sequence and coronary computed tomography angiography

“…Moreover, CMRA does not produce blooming artifacts from coronary calcification [ 9 ]. In previous studies, a free-breathing diaphragm-navigated steady-state free precession sequence was successfully applied in CMRA with the 1.5-T scanner, and a spoiled gradient-echo sequence was more commonly used at 3.0 T magnetic resonance for patients with suspected CAD [ 10 – 12 ].…”