D'Errico Francesca, Ricci Francesca, Luciano Alessandra, Sbordone Francesco Paolo, Laudazi Mario, Mecchia Daniele, Volpe Maria, Briganti Flavia, Di Landro Alessio, Muscoli Saverio, Pugliese Luca, De Stasio Vincenzo, Di Donna Carlo, Romeo Francesco, Garaci Francesco, Floris Roberto, Chiocchi Marcello
Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy.
Unit of Cardiology and Interventional Cardiology, Policlinico Tor Vergata, Viale Oxford 81, 00133 Rome, Italy.
J Clin Med. 2023 Aug 14;12(16):5296. doi: 10.3390/jcm12165296.
The sublingual administration of short-acting nitroglycerin (NTG) before coronary computed tomography (CCT) improves the visualization of coronary arteries, causing vasodilatation. The aim of this study was to evaluate whether and how nitroglycerin can influence the concordance between radiologists and cardiologists in the evaluation of vessel stenosis measured in CCT by the former and during the following coronarography by the latter.
We conducted a retrospective analysis of 131 patients who underwent CCT for cardiac symptoms in 2022, followed by coronarography performed six months later because of significant stenosis revealed by the CCT. First, the patients were divided into two groups: an NTG group who received sublingual nitroglycerin before CCT and a non-NTG group who did not because of contraindications. Second, 254 stenoses were measured by two radiologists after CCT and by two interventional cardiologists during the next coronarography; moreover, stenoses were classified on the basis of their location and plaque pattern (calcific, mixed and lipidic). Third, the strength of agreement was evaluated between the two radiologists, between the two cardiologists and finally between the radiologists and cardiologists in order to evaluate whether and how the interdisciplinary discrepancy in stenosis evaluation could change with or without the use of nitroglycerin before CCT and in relation to the different plaque pattern.
In the NTG group, the use of nitroglycerine reduced the agreement between radiologists and cardiologists in calcific stenosis but did not change the concordance in the case of mixed or lipidic plaques on the same vessels.
The use of sublingual nitroglycerin before CCT may lead to a radiological overestimation of calcific stenosis.
在冠状动脉计算机断层扫描（CCT）前舌下含服短效硝酸甘油（NTG）可改善冠状动脉的可视化，引起血管扩张。本研究的目的是评估硝酸甘油是否以及如何影响放射科医生和心脏病专家在评估CCT测量的血管狭窄与随后心脏病专家进行的冠状动脉造影之间的一致性。
我们对2022年因心脏症状接受CCT检查的131例患者进行了回顾性分析，由于CCT显示有明显狭窄，6个月后进行了冠状动脉造影。首先，将患者分为两组：CCT前接受舌下硝酸甘油的NTG组和因禁忌症未接受的非NTG组。其次，两名放射科医生在CCT后以及两名介入心脏病专家在随后的冠状动脉造影期间测量了254处狭窄；此外，根据狭窄的位置和斑块类型（钙化、混合和脂质）对狭窄进行分类。第三，评估两名放射科医生之间、两名心脏病专家之间以及最终放射科医生和心脏病专家之间的一致性强度，以评估在CCT前使用或不使用硝酸甘油以及与不同斑块类型相关的情况下，狭窄评估中的跨学科差异是否以及如何变化。
在NTG组中，使用硝酸甘油降低了放射科医生和心脏病专家在钙化狭窄评估中的一致性，但在同一血管的混合或脂质斑块情况下，一致性没有改变。
CCT前使用舌下硝酸甘油可能导致对钙化狭窄的放射学高估。
