Introduction
General principles
Field strength considerations
Equipment considerations
CMR scanner
Software/pulse sequences
Accessory hardware
Stress agents
Contraindications
- 2nd degree (type 2) or complete atrioventricular (AV) block
- Systolic blood pressure < 90 mmHg
- Severe systemic arterial hypertension (> 220/120 mmHg)
- Sinus bradycardia (heart rate < 40 bpm)
- Active bronchoconstrictive or bronchospastic disease with regular use of inhalers
- Known hypersensitivity to adenosine, dipyridamole, or regadenoson
- Severe systemic arterial hypertension (≥ 220/120 mmHg)
- Unstable angina pectoris
- Severe aortic valve stenosis (peak aortic valve gradient > 60 mmHg or aortic valve area < 1 cm2)
- Complex cardiac arrhythmias including uncontrolled atrial fibrillation
- Hypertrophic obstructive cardiomyopathy
- Myocarditis, endocarditis, or pericarditis
- Uncontrolled heart failure
- Narrow-angle glaucoma
- Myasthenia gravis
- Obstructive uropathy
- Obstructive gastrointestinal disorders
Patient preparation
- All vasodilating agents: caffeine (coffee, tea, caffeinated beverages or foods - e.g., chocolate, caffeinated medications), theophylline, dipyridamole.
- Dobutamine: ß-blockers and nitrates.Note: There is increasing data that the effects of caffeine and nicotine can be overcome by higher doses of adenosine as well as regadenoson.
Potential adverse effects
Stress and safety equipment
Gadolinium based contrast agent (GBCA) dosing and safety
Indication | Contrast dose (mmol/kg body weight) | Injection rate | Saline chasing bolus | Injection rate |
---|---|---|---|---|
Perfusion | 0.05–0.1 | 3–7 ml/s | 30 ml | 3–7 ml/s |
Late gadolinium enhancement | 0.1–0.2 | 20 ml | ||
Angiography (carotids, renals, aorta) | 0.1–0.2 | 2–3 ml/s | 20 ml | 2–3 ml/s |
Time-resolved angiography | 0.05 | 3–5 ml/s | 30 ml | 3–5 ml/s |
Peripheral angiography | 0.2 | first 10 ml @ 1.5 ml/s, rest @ 0.4–0.8 ml/s | 20 ml | 0.4–0.8 ml/s |