Using Multidetector Computed Tomography in a Swine Model to Assess the Effects of Sublingual Nitroglycerin and Intravenous Adenosine on Epicardial Coronary Arteries

This study examines the effects of intravenous infusion of adenosine and sublingual nitroglycerin on coronary angiograms obtained by current-generation multidetector computed tomography. We assessed coronary vasodilation at baseline and after intravenous adenosine (140 µg/kg/min) or sublingual nitroglycerin spray (800 µg) in 7 female swine (weight, 40.9 ± 1.4 kg) by using electrocardiogram-gated coronary angiography with a 64-detector scanner (rotation time, 400 ms; 120kV; 400 mA) and intravenous contrast (300 mg/mL iohexol, 4.5 mL/s, 2 mL/kg). Cross-sectional areas of segments in the left anterior descending, circumflex, and right coronary arteries were evaluated in oblique orthogonal views. Images were acquired at an average heart rate of 73 ± 11 beats per minute. Changes in aortic pressure were not significant with nitroglycerin but decreased (approximately 10%) with adenosine. Of the 76 segments analyzed (baseline range, 2 to 39 mm²), 1 distal segment could not be assessed after adenosine. Segment cross-sectional area increased by 11.3% with nitroglycerin but decreased by 9.6% during adenosine infusion. The results of the present study are consistent with the practice of using sublingual nitroglycerin to enhance visualization of epicardial vessels and suggest that intravenous adenosine may hinder coronary artery visualization. This study is the first repeated-measures electrocardiogram-gated CT evaluation to use the same imaging technology to assess changes in coronary cross-sectional area before and after treatment with a vasodilator. The nitroglycerin-associated changes in our swine model were modest in comparison with previously reported human studies.Abbreviations: LAD, left anterior descending artery; MDCT, multidetector computed tomographyRecent advances in multidetector computed tomography (MDCT) for coronary angiography, their increased availability, and the pending release of a new generation of CT scanners contribute to this methodology''s potential for revolutionizing the early diagnosis and functional assessment of coronary artery disease.^15,16,25 However, the benefits of methodologic advances do not diminish the need to validate and assess the safety, efficacy, and costs of technology.¹⁵ In this regard, the present study uses an animal model with coronary anatomy analogous to that of humans^11,43 to assess the effects of sublingual nitroglycerin and intravenous adenosine on coronary epicardial vessel visualization by using baseline imaging as a control. The radiation exposure associated with CT procedures precludes human studies that involve repeated measures on the same subjects.Sublingual nitroglycerin is hypothesized to enhance the visualization of epicardial coronary vessels due to its vasodilatory properties.^8-10 Nitroglycerin acts as a nitric oxide generator to induce relaxation of vascular smooth muscle independent of endothelial function.^1,18,20 Current evidence supporting improved coronary visualization with sublingual nitroglycerin is derived from clinical cross-sectional studies that compare results in different groups of patients with heterogeneous coronary lesions.^5,6,16,27,44 A recent survey reported that more than 80% of facilities in the United States routinely use nitroglycerin in cardiac MDCT angiography.²³In contrast to the action of nitroglycerin on epicardial vascular smooth muscle, intravenous adenosine frequently is used as a pharmacologic stress to affect vasodilatation within the coronary microcirculation.²⁰ Although current-generation CT scanners have limited capability to assess myocardial tissue perfusion, research efforts from advanced imaging centers suggest that future-generation CT scanners soon will permit myocardial perfusion imaging.^13,14,29 No studies to date have assessed epicardial vessel changes by MDCT with intravenous doses of adenosine appropriate for myocardial perfusion imaging.The objective of this study was to provide an animal model for MDCT studies that permits repeated measures of epicardial vessels without the limitations of cross-sectional designs or the complications of heterogeneity of vascular lesions within clinical populations. This study used routes of administration of nitroglycerin and adenosine that are consistent with clinical practice.