130 Sublingual nitrates should be used systematically before multislices computered coronary imaging

Background Coronary multislices CT (MDCT) has limited spatial and temporal resolution, which hampered the analysis of coronary artery (CA) segments. By increasing CA geometry the use of nitrates before acquisition could improve analysis quality, which is heart rate (HR) highly dependant. Objective The aim of this study was to evaluate safety, hemodynamic effects and imaging efficacy of systematic use of sublingual nitroglycerin just before a 256 slices CA scanner acquisition. Method Thirty six consecutive patients had a coronary MDCT acquisition after 1 spray of sublingual nitroglycerin (NatisprayR 0.30 mg) (group 1). HR and mean arterial blood pressure (MBP) were measured before and after spray. Global imaging quality assessment, number of analyzable segments according to the syntax score segmentation, mean diameter and area of each segments was done by two blinded observers and compared to a control group of 36 consecutive patients (group 2) examined with the same machine, but without nitrates. Results Both groups were similar considering age, sex ratio, BMI and beta-blocker used. In group 1 nitrates did not change heart rate (62 ± 5 vs. 61 ± 4 bpm) nor MBP (100.7 ± 15 mmHg vs. 94.9 ± 12 mmHg). A total of 536 and 531 segments were analyzed respectively in group 1 and 2. Global imaging quality assessment was equal in both groups (good quality: 93.1% vs. 91.7%, group 1 and 2 respectively). There was Conclusion Sublingual nitroglycerin significantly improves CA geometry and number of assessable segments, especially in smaller secondary segments, with no quality deterioration. Thus, sublingual nitrates should be systematically used before a coronary MDCT.