1.5T冠状动脉磁共振血管造影术中应用硝酸甘油：冠心病患者冠状动脉扩张的诊断性能
Applying Nitroglycerin at Coronary MR Angiography at 1.5 T: Diagnostic Performance of Coronary Vasodilation in Patients with Coronary Artery Disease.
作者信息
Zhao Shi-Hai, Li Chen-Guang, Chen Yin-Yin, Yun Hong, Zeng Meng-Su, Jin Hang
机构信息
Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, No. 180 Fenglin Road, Shanghai 200032, China (S.H.Z., Y.Y.C., H.Y., M.S.Z., H.J.); Department of Medical Imaging, Shanghai Medical School, Fudan University, Shanghai, China (S.H.Z., Y.Y.C., H.Y., M.S.Z., H.J.); and Department of Cardiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Cardiovascular Diseases, Shanghai, China (C.G.L.).
出版信息
Radiol Cardiothorac Imaging. 2020 Apr 23;2(2):e190018. doi: 10.1148/ryct.2020190018. eCollection 2020 Apr.
PURPOSE
To evaluate the influence of applying nitroglycerin (NTG) on detecting significant coronary artery disease (CAD) and NTG-induced 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 , generalized linear mixed model, and McNemar tests were used.
RESULTS
The diagnostic performance of coronary MR angiography was significantly improved after NTG ( < .001). Per-patient for coronary MR angiography, from before to after NTG, respectively, the sensitivity was 97.6% (95% confidence interval [CI]: 85.6%, 99.9%) to 97.6% (95% CI: 85.6%, 99.9%), specificity was 25.0% (95% CI: 8.3%, 52.5%) to 62.5% (95% CI: 35.9%, 83.7%), positive predictive value was 76.9% (95% CI: 62.8%, 87.0%) to 87.0% (95% CI: 73.0%, 94.6%), negative predictive value was 80.0% (95% CI: 29.9%, 98.9%) to 90.9% (95% CI: 57.1%, 99.5%), and accuracy was 77.2% (95% CI: 66.3%, 88.1%) to 87.7% (95% CI: 79.2%, 96.3%). The NTG-induced coronary vasodilation was significantly lower in the significant CAD group compared with the nonsignificant CAD group.
CONCLUSION
Administration of NTG significantly improved the diagnostic performance of coronary MR angiography for detecting significant CAD; however, NTG-induced coronary vasodilation was impaired in patients with significant CAD.© RSNA, 2020See also commentary by François in this issue.
目的
评估应用硝酸甘油（NTG）对疑似患有冠心病（CAD）患者进行冠状动脉磁共振血管造影（CMR）检测显著冠状动脉疾病（CAD）及NTG诱导的冠状动脉血管舒张的影响。
材料与方法
在2017年11月至2018年9月进行的这项前瞻性研究中，连续招募了70名疑似患有CAD的参与者。其中，57例患者成功接受了NTG前后的CMR检查，两者均在心动周期的收缩末期进行。X线冠状动脉造影将显著冠状动脉狭窄定义为狭窄50%或以上。根据X线冠状动脉造影将参与者分为显著CAD组（显著狭窄）和非显著CAD组（无显著狭窄）。采用配对和非配对学生t检验、广义线性混合模型和McNemar检验。
结果
NTG应用后CMR的诊断性能显著提高（P<0.001）。对于CMR，每位患者在NTG前后，敏感性分别为97.6%（95%置信区间[CI]：85.6%，99.9%）至97.6%（95%CI：85.6%，99.9%），特异性为25.0%（95%CI：8.3%，52.5%）至62.5%（95%CI：35.9%，83.7%），阳性预测值为76.9%（95%CI：62.8%，87.0%）至87.0%（95%CI：73.0%，94.6%），阴性预测值为80.0%（95%CI：29.9%，98.9%）至90.9%（95%CI：57.1%，99.5%），准确性为77.2%（95%CI：66.3%，88.1%）至87.7%（95%CI：79.2%，96.3%）。与非显著CAD组相比，显著CAD组中NTG诱导的冠状动脉血管舒张显著降低。
结论
NTG给药显著提高了CMR检测显著CAD的诊断性能；然而，显著CAD患者中NTG诱导的冠状动脉血管舒张受损。©RSNA，2020另见本期François的评论。
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