Skip to main content

Advertisement

Log in

Practical instructions for using drugs in CT and MR cardiac imaging

  • Cardiac radiology
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

The progressive increase in numbers of noninvasive cardiac imaging examinations broadens the spectrum of knowledge radiologists are expected to acquire in the management of drugs during CT coronary angiography (CTCA) and cardiac MR (CMR) to improve image quality for optimal visualization and assessment of the coronary arteries and adequate MR functional analysis. Aim of this review is to provide an overview on different class of drugs (nitrate, beta-blockers, ivabradine, anxiolytic, adenosine, dobutamine, atropine, dipyridamole and regadenoson) that can be used in CTCA and CMR, illustrating their main indications, contraindications, efficacy, mechanism of action, metabolism, safety, side effects or complications, and providing advices in their use.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Miller JM, Rochitte CE, Dewey M et al (2008) Diagnostic performance of coronary angiography by 64-row CT. N Engl J Med 359:2324–2336

    Article  CAS  PubMed  Google Scholar 

  2. Budoff MJ, Dowe D, Jollis JG et al (2008) Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial. J Am Coll Cardiol 52:1724–1732

    Article  PubMed  Google Scholar 

  3. Meijboom WB, Meijs MF, Schuijf JD et al (2008) Diagnostic accuracy of 64-slice computed tomography coronary angiography: a prospective, multicenter, multivendor study. J Am Coll Cardiol 52:2135–2144

    Article  PubMed  Google Scholar 

  4. Marano R, De Cobelli F, Floriani I et al (2009) Italian multicenter, prospective study to evaluate the negative predictive value of 16- and 64-slice MDCT imaging in patients scheduled for coronary angiography (NIMISCAD-Non Invasive Multicenter Italian Study for Coronary Artery Disease). Eur Radiol 19:1114–1123

    Article  PubMed  Google Scholar 

  5. Mowatt G, Cook JA, Hillis GS et al (2008) 64-Slice computed tomography angiography in the diagnosis and assessment of coronary artery disease: systematic review and meta-analysis. Heart 94:1386–1393

    Article  CAS  PubMed  Google Scholar 

  6. Knuuti J, Wijns W, Saraste A et al (2020) 2019 ESC guidelines for the diagnosis and the management of chronic coronary syndromes. Eur Heart J 41(3):407–477

    Article  PubMed  Google Scholar 

  7. Srichai MB, Hecht EM, Kim D et al (2009) Dual-source computed tomography angiography image quality in patients with fast heart rates. J Cardiovasc Comput Tomogr 3:310–311

    Article  Google Scholar 

  8. Sabarudin A, Sun Z (2013) Beta-blocker administration protocol for prospectively ECG-triggered coronary CT angiography. World J Cardiol 5(12):453–458

    Article  PubMed  PubMed Central  Google Scholar 

  9. Ignarro LJ, Napoli C, Loscalzo J (2002) Nitric oxide donors and cardiovascular agents modulating the bioactivity of nitric oxide: an overview. Circ Res 90(1):21–28

    Article  CAS  PubMed  Google Scholar 

  10. Takx RAP, Suchá D, Park J, Leiner T, Hoffmann U (2015) Sublingual Nitroglycerin Administration in Coronary Computed Tomography Angiography: a systematic review. Eur Radiol 25(12):3536–3542

    Article  PubMed  PubMed Central  Google Scholar 

  11. Thadani U, Rodgers T (2006) Side effects of using nitrates to treat angina. Expert Opin Drug Saf 5(5):667–674

    Article  CAS  PubMed  Google Scholar 

  12. Ahmad S (1991) Nitroglycerin and intracranial hypertension. Am Heart J 121:1850–1885

    Article  CAS  PubMed  Google Scholar 

  13. Chun EJ, Lee W, Choi YH et al (2008) Effects of nitroglycerin on the diagnostic accuracy of electrocardiogram-gated coronary computed tomography angiography. J Comput Assist Tomogr 32(1):86–92

    Article  PubMed  Google Scholar 

  14. Kang DK, Noh HW, Park KJ, Choi SY (2007) Assessment of the image quality and diagnostic accuracy of coronary CT angiography: effect of sublingual administration of nitroglycerin. J Korean Radiol Soc 56:127–135

    Article  Google Scholar 

  15. McParland P, Nicol ED, Harden SP (2010) Cardiac drugs used in cross-sectional cardiac imaging: what the radiologist needs to know. Clin Radiol 65(9):677–684

    Article  CAS  PubMed  Google Scholar 

  16. Pannu HK, Alvarez W, Fishman EK (2006) Beta-blockers for cardiac CT: a primer for the radiologist. AJR Am J Roentgenol 186(6 Suppl 2):S341–S345

    Article  PubMed  Google Scholar 

  17. Takakuwa KM, Halpern EJ, Gingold EL, Levin DC, Shofer FS (2009) Radiation dose in a “triple rule-out” coronary CT angiography protocol of emergency department patients using 64- MDCT: the impact of ECG-based tube current modulation on age, sex, and body mass index. AJR Am J Roentgenol 192(4):866–872

    Article  PubMed  Google Scholar 

  18. Bastarrika G, Thilo C, Headden et al (2009) Cardiac CT in the assessment of acute chest pain in the emergency department. AJR Am J Roentgenol 193(2):397–409

    Article  PubMed  Google Scholar 

  19. Maffei E, Palumbo AA, Martini C et al (2009) “In-house” pharmacological management for computed tomography coronary angiography: heart rate reduction, timing and safety of different drugs used during patient preparation. Eur Radiol 19(12):2931–2940

    Article  PubMed  Google Scholar 

  20. Degertekin M, Gemici G, Kaya Z et al (2008) Safety and efficacy of patient preparation with intravenous esmolol before 64-slice computed tomography coronary angiography. Coron Artery Dis 19(1):33–36

    Article  PubMed  Google Scholar 

  21. Shapiro MD, Pena AJ, Nichols JH et al (2008) Efficacy of prescan beta-blockade and impact of heart rate on image quality in patients undergoing coronary multidetector computed tomography angiography. Eur J Radiol 66(1):37–41

    Article  PubMed  Google Scholar 

  22. Roberts WT, Wright AR, Timmis JB, Timmis AD (2009) Safety and efficacy of a rate control protocol for cardiac CT. Br J Radiol 82(976):267–271

    Article  CAS  PubMed  Google Scholar 

  23. Mahabadi AA, Achenbach S, Burgstahler et al (2010) Safety, efficacy, and indications of beta-adrenergic receptor blockade to reduce heart rate prior to coronary CT angiography. Radiology 257(3):614–623

    Article  PubMed  Google Scholar 

  24. Singh J, Daftary A (2008) Iodinated contrast media and their adverse reactions. J Nucl Med Technol 36(2):69–74

    Article  PubMed  Google Scholar 

  25. Elliott WJ, Ram CVS (2011) Calcium channel blockers. J Clin Hypertens Greenwich Conn 13(9):687–689

    Article  CAS  Google Scholar 

  26. Nicol ED, Arcuri N, Rubens MB et al (2008) Considerations when introducing a new cardiac MDCT service. Avoiding the pitfalls. Clin Radiol 63(4):355–369

    Article  CAS  PubMed  Google Scholar 

  27. Koruth JS, Lala A, Pinney S, Reddy VY, Dukkipati SR (2017) The clinical use of Ivabradine. J Am Coll Cardiol 70(14):1777–1784

    Article  PubMed  Google Scholar 

  28. Celik O, Atasoy MM, Ertürk M et al (1987) Single dose ivabradine versus intravenous metoprolol for heart rate reduction before coronary computed tomography angiography (CCTA) in patients receiving long-term calcium channel-blocker therapy. Acta Radiol 55(6):676–681

    Article  Google Scholar 

  29. Ohana M, Sellers SL, Mooney J et al (2018) Prevalence and impact of scan-related anxiety during coronary CT angiography: a prospective cohort study of 366 patients. J Cardiovasc Comput Tomogr 12(5):364–371

    Article  PubMed  Google Scholar 

  30. Di Cesare E, Cademartiri F, Carbone I et al (2013) Clinical indications for the use of cardiac MRI. By the SIRM Study Group on Cardiac Imaging. Radiol Med 118:752–798

    Article  PubMed  Google Scholar 

  31. Marano R, Natale L, Chiribiri A et al (2015) Cardiac MR perfusion imaging: where we are. Radiol Med 120:190–205

    Article  PubMed  Google Scholar 

  32. Wilson RF, Wyche K, Christensen BV et al (1990) Effects of adenosine on human coronary arterial circulation. Circulation 82(5):1595–1606

    Article  CAS  PubMed  Google Scholar 

  33. Fenster MS, Feldman MD, Camarano G et al (1997) Correlation of adenosine thallium 201 perfusion patterns with markers for inducible ischaemia. Am Heart J 133:406–412

    Article  CAS  PubMed  Google Scholar 

  34. Kramer CM, Barkhausen J, Flamm SD et al (2013) Standardized cardiovascular magnetic resonance (CMR) protocols 2013 update. J Cardiovasc Magn Reson 15:91

    Article  PubMed  PubMed Central  Google Scholar 

  35. Cerqueira MD, Verani MS, Schwaiger M et al (1994) Safety profile of adenosine stress perfusion imaging: results from the Adenoscan Multicenter Trial Registry. J Am Coll Cardiol 23(2):384–389

    Article  CAS  PubMed  Google Scholar 

  36. Kobori M, Shida K, Negishi H, Masuda Y, Hosoyamada A (1991) Evaluation of dopamine and dobutamine for use in circulatory depression associated with induced total spinal block. Masui 40(2):190–201

    CAS  PubMed  Google Scholar 

  37. Ruffolo RR Jr (1987) The pharmacology of dobutamine. Am J Med Sci 294(4):244–248

    Article  PubMed  Google Scholar 

  38. Vallet B, Dupuis B, Chopin C (1991) Dobutamine: mechanisms of action and use in acute cardiovascular pathology. Ann Cardiol Angeiol 40(6):397–402

    CAS  Google Scholar 

  39. Iskandrian AS, Verani MS, Heo J (1994) Pharmacologic stress testing: mechanism of action, hemodynamic responses, and results in detection of coronary artery disease. J Nucl Cardiol 1(1):94–111

    Article  CAS  PubMed  Google Scholar 

  40. Nagel E, Lehmkuhl HB, Bocksch W et al (1999) Non invasive diagnosis of ischaemia-induced wall motion abnormalities with the use of high-dose dobutamine stress MRI: comparison with dobutamine stress echocardiography. Circulation 99(6):763–770

    Article  CAS  PubMed  Google Scholar 

  41. Wellnhoffer E, Olariu A, Klein C et al (2004) Magnetic resonance low-dose dobutamine test is superior to scar quantification for the prediction of functional recovery. Circulation 109(18):2172–2174

    Article  Google Scholar 

  42. Takase B, Nagata M, Kihara T et al (2004) Whole-heart dipyridamole stress first pass myocardial perfusion MRI for the detection of coronary artery disease. Jpn Heart J 45:475–486

    Article  PubMed  Google Scholar 

  43. Bodi V, Sanchis J, Lopez-Lereu MP et al (2007) Prognostic value of dipyridamole stress cardiovascular magnetic resonance imaging in patients with known or suspected coronary artery disease. J Am Coll Cardiol 50(12):1174–1179

    Article  PubMed  Google Scholar 

  44. Kazmirczak F, Nijjar PS, Zhang L et al (2019) Safety and prognostic value of regadenoson stress cardiovascular magnetic resonance imaging in heart transplant recipients. J Cardiovasc Magn Reson 21(1):9

    Article  PubMed  PubMed Central  Google Scholar 

  45. Johnson SG, Peters S (2010) Advances in pharmacologic stress agents: focus on regadenoson. J Nucl Med Technol 38(3):163–171

    Article  PubMed  Google Scholar 

  46. Leaker BR, O’Connor B, Hansel TT et al (2008) Safety of regadenoson, an adenosine A2A receptor agonist for myocardial perfusion imaging, in mild asthma and moderate asthma patients: a randomized, double-blind, placebo-controlled trial. J Nucl Cardiol 15:329–336

    Article  PubMed  Google Scholar 

  47. Thomas GS, Tammelin BR, Schiffman GL et al (2008) Safety of regadenoson, a selective adenosine A2A agonist, in patients with chronic obstructive pulmonary disease: a randomized, double- blind, placebo-controlled trial (regcopd trial). J Nucl Cardiol 15:319–328

    Article  PubMed  Google Scholar 

  48. Zhao G, Messina E, Xu X et al (2007) Caffeine attenuates the duration of coronary vasodilation and changes in hemodynamics induced by regadenoson (CVT-3146), a novel adenosine A2A receptor agonist. J Cardiovasc Pharmacol 49:369–375

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

Not applicable

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Riccardo Marano.

Ethics declarations

Conflict of interest

The authors declare no conflict of interest.

Ethics approval

Not applicable

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rovere, G., Meduri, A., Savino, G. et al. Practical instructions for using drugs in CT and MR cardiac imaging. Radiol med 126, 356–364 (2021). https://doi.org/10.1007/s11547-020-01261-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11547-020-01261-4

Keywords

Navigation