A drug once off-limits may now improve pre-TAVI scans. New prospective data show that sublingual nitroglycerin — long contraindicated in severe aortic stenosis — is safe and significantly boosts coronary CT image quality before TAVI, reducing false positives and potentially sparing patients an extra invasive procedure.
A drug once off-limits may now improve pre-TAVI scans
Sublingual nitroglycerin has long been avoided in patients with severe aortic stenosis (AS) due to concerns about dangerous drops in blood pressure. But new prospective data presented at the 2026 SCCT annual scientific meeting suggest those fears may have been overstated — at least in carefully selected patients.
In a study of 109 patients with severe AS scheduled for coronary CT angiography (CCTA) before TAVI, all received 0.8 mg of sublingual nitroglycerin prior to imaging. Blood pressure dipped modestly but remained stable, and side effects were mild — mostly headaches (8.2%) and dizziness (7.3%). Compared to a matched control group, the nitroglycerin group showed markedly better image quality and diagnostic accuracy, with fewer false-positive scans and a 27% relative reduction in the need for invasive coronary angiography.
By the Numbers
Why it matters: For patients already heading into a major procedure like TAVI, avoiding an additional invasive coronary angiogram is a meaningful win. These findings could prompt a revision of current SCCT guidelines and shift routine pre-TAVI imaging protocols.
