DISCORDANCE study V1.0
Research type
Research Study
Full title
Diagnostic accuracy in left ventricular systolic dysfunction for identifying coronary artery disease with dobutamine versus adenosine non-invasive stress cardiac magnetic resonance evaluation
IRAS ID
252718
Contact name
Jayanth Arnold
Contact email
Sponsor organisation
University of Leicester
Duration of Study in the UK
2 years, 0 months, 0 days
Research summary
Research Summary:
Heart failure is a condition where the heart cannot pump blood effectively. It makes people feel tired, breathless and develop swollen limbs. It is associated with a high risk of disability and death. There are several different conditions that can cause heart failure and it is important to identify the cause because this can affect the treatment needed. One of the best tests to find the cause of heart failure is a cardiac MRI stress test, which is a scan that thoroughly looks at the heart. During a cardiac MRI stress test, for a short time the heart is made to work a little harder by injecting a medication. This allows us to objectively assess how the heart functions during increased activity. There are several different medicines that may be used to “stress” patients’ hearts. But in patients with heart failure, it is unclear which of these medicines is most effective. This could lead to a missed or wrong diagnosis. In this study we will compare two cardiac stress test medicines – adenosine and dobutamine – in 100 patients with heart failure. This will help us decide which is the best medicine and may prevent missed or wrongful diagnoses in the future.
Summary of Results:
Heart scans using magnetic resonance imaging (MRI), known as cardiovascular magnetic resonance (CMR), are often used to detect blocked or narrowed heart arteries (coronary artery disease, or CAD). These scans usually use a drug called adenosine to stress the heart and reveal problems with blood flow. However, in people with heart failure and reduced pumping function (HFrEF), adenosine may not work as well because their blood vessels do not widen as much as expected. Another drug, dobutamine, might be a better alternative in these patients.
In this study, 50 patients with HFrEF underwent detailed heart scans using both adenosine and dobutamine to compare how well each method detects severe coronary artery disease. The results were checked against standard tests that look directly at the heart’s blood vessels.
We found that both drugs performed similarly in identifying significant blockages in the heart arteries. There was no meaningful difference between adenosine and dobutamine in terms of accuracy, sensitivity (ability to detect disease), or specificity (ability to rule out disease).
In conclusion, for patients with heart failure and reduced heart function, using dobutamine does not improve the detection of coronary artery disease compared to the standard adenosine-based scan.
REC name
South Central - Oxford C Research Ethics Committee
REC reference
18/SC/0540
Date of REC Opinion
1 Oct 2018
REC opinion
Further Information Favourable Opinion