The effects of sublingual nitroglycerin administration in coronary computed tomography angiography

The purpose of our study was to compare coronary luminal diameters in patients undergoing coronary computed tomography angiography (CCTA) performed with different sublingual nitroglycerin (NTG) spray regimens.

We retrospectively reviewed CCTA studies performed in two historical groups (Group 1, single dose nitroglycerin 2 min prior to CCTA, and Group 2, single dose 10 min prior), and a current protocol group (Group 3, single dose at 2 and 10 min prior). Thirty patients were evaluated per group. Two blinded readers measured coronary luminal diameters with comparison of diameter measurements. A third blinded reader assessed image quality of coronary artery segments.

Significant group-level differences in median luminal diameters were identified. Higher median diameters (95% CI) across all segments of 0.40 mm (0.20, 0.60) for Group 2 versus 1 and 0.50 mm (0.30, 0.70) for Group 3 versus 1 were recorded (both P < 0.001). No significant differences in median luminal diameters were found between Groups 2 and 3. No significant differences in image quality were found among the groups apart from higher image quality for the distal LAD for both Groups 2 and 3 compared to Group 1.

Sublingual nitroglycerin spray administered as a single dose at 10 minute dilates coronary arteries more than when only administered at 2 min prior to CCTA. Combined two doses at 10 and 2 min prior to CCTA do not yield further dilatation of coronary arteries.