title: Effect of Nitroglycerin on the Performance of MR Coronary Angiography.
abstract: To systematically investigate the effect of sublingual glyceryl trinitrate (nitroglycerin=nitro=glyceryl trinitrate=GTN=C3H5N3O9[NTG]) on the diagnostic performance of MR coronary artery imaging (MRCA) to detect relevant coronary artery disease (CAD).
  
  
  
  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 × 0.7 × 0.7 mm3) 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.
  
  
  
  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 3.3 mm, 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.
  
  
  
  Sublingual administration of NTG significantly enhanced the visibility of the coronary arteries and improved the detection of coronary artery stenosis.
  
  
  
  2 J. MAGN. RESON. IMAGING 2017;45:1419-1428.
authors.affiliation: Clinic Agatharied, Department of Cardiology, Academic Teaching Hospital, University of Munich, Hausham, Germany.|Clinic Munich Schwabing, Department of Cardiology, Academic Teaching Hospital, University of Munich, Munich, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Heer
authors.affiliation: Clinic Agatharied, Department of Cardiology, Academic Teaching Hospital, University of Munich, Hausham, Germany.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Reiter
authors.affiliation: Clinic Agatharied, Department of Cardiology, Academic Teaching Hospital, University of Munich, Hausham, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Trißler
authors.affiliation: Clinic Agatharied, Department of Cardiology, Academic Teaching Hospital, University of Munich, Hausham, Germany.
authors.forename: Berthold
authors.initials: B
authors.lastname: Höfling
authors.affiliation: Clinic Agatharied, Department of Cardiology, Academic Teaching Hospital, University of Munich, Hausham, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: von Knobelsdorff-Brenkenhoff
authors.affiliation: Clinic Agatharied, Department of Cardiology, Academic Teaching Hospital, University of Munich, Hausham, Germany.
authors.forename: Günter
authors.initials: G
authors.lastname: Pilz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media / Q000494:pharmacology; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005260:Female; D064368:Healthy Volunteers; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin / Q000494:pharmacology*; D015203:Reproducibility of Results; D014665:Vasodilator Agents / Q000494:pharmacology*
chemical_list: D003287:Contrast Media; D014665:Vasodilator Agents; D005996:Nitroglycerin
keywords: coronary artery disease; magnetic resonance coronary angiography; nitroglycerine