Practical instructions for using drugs in CT and MR cardiac imaging
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CARDIAC RADIOLOGY
Practical instructions for using drugs in CT and MR cardiac imaging Giuseppe Rovere1 · Agostino Meduri1 · Giancarlo Savino1 · Francesco Ciriaco Flammia1 · Francesca Lo Piccolo1 · Maria Rachele Pia Carafa1 · Anna Rita Larici1 · Luigi Natale1 · Biagio Merlino1 · Riccardo Marano1 Received: 18 April 2020 / Accepted: 10 August 2020 © Italian Society of Medical Radiology 2020
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. Keywords Computed Tomography Angiography · Coronary Vessels · Magnetic Resonance Imaging · Adrenergic betaAntagonists · Ivabradine · Anti-Anxiety Agents · Adenosine · Dobutamine · Atropine · Dipyridamole · Regadenoson · Contraindications
Introduction The demand for noninvasive cardiac imaging examinations such as CT coronary angiography (CTCA) and cardiac magnetic resonance (CMR) has progressively increased over the past 2 decades and the future trend will be growing further, along with the availability and diffusion of technologically advanced equipments and the higher clinical complexity of the patients that can be studied. In this context, radiologists have to administer drugs to patients, even in complex clinical situations, to improve diagnostic tests quality and that is a task requiring specific adequate training and knowledge acquisition. Purpose of this review is to provide clinical radiologists a comprehensive guide to the most frequently used drugs in noninvasive CT and MR cardiac imaging, in particular focused on their main indications, contraindications, doses, metabolism, interactions and side effects, also suggesting the adequate clinical or instrumental monitoring
* Riccardo Marano [email protected] 1
Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168 Rome, Italy
during and after use. Although those drugs can be safely administered in most patients, their use should be always intended in safe environments equipped with all necessary life support settings.
Drugs in coronary ct angiography CT coronary angiography (CTCA) is a useful tool with very high negative predictive value for coronary artery disease (CAD) [1–5] and recently indicated as Class I for the assessment of patients with stable
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