Donor cardiac troponin-I: a biochemical surrogate of heart function.
OBJECTIVE
Cardiac troponin-I (cTnI) levels in the potential heart transplant donor may be a marker of heart dysfunction and predictive of recipient outcome. We studied the prevalence of cTnI elevation, its association with heart function and usability and its relationship with the time duration from coning.


METHODS
In a prospective study, cTnI measurement, Swan-Ganz catheterisation and transthoracic echocardiography were performed at initial assessment in 79 potential heart donors (mean age 43 +/- 13.1 years). All donors were then managed according to a strict algorithm to optimise cardiac function, some receiving hormonal therapy as part of a randomised trial. Donor heart suitability for transplantation was assessed after 7 h of management. The association of cTnI with initial functional indices was assessed and outcome compared for donors categorised according to cTnI level < or = 1 microg l(-1) or >1 microg l(-1).


RESULTS
Serum cTnI levels negatively correlated with initial cardiac index (CI) (p = 0.003), right (p < 0.001) and left ventricular ejection fraction (p = 0.001) and positively with LV Tei index (p = 0.003). Serum cTnI was >1 microg l(-1) in 29/79 donors. Higher CVP (10 +/- 5.1 vs 7.9 +/- 2.9; p = 0.026) and PAWP (12 +/- 5.4 vs 8.1 +/- 3.1; p = 0.002), lower cardiac index (2.7 +/- 1.1 vs 3.6 +/- 0.9; p = 0.001) and fractional shortening (p < 0.01) and worse wall motion score index (p < 0.01) were observed in the cTnI >1 microg l(-1) group. CTnI and functional markers correlated with the time duration from coning.


CONCLUSIONS
The donor cTnI level represents a biochemical surrogate of functional donor heart assessment. High cTnI is associated with worse donor heart function and may act as a prompt for detailed assessment and optimisation.
Venkateswaran
Rajamiyer V
RV
Department of Heart and Lung Transplantation, University Hospital Birmingham NHS Trust, Birmingham, UK.
Ganesh
Jegatheesan Saravana
JS
Thekkudan
Joyce
J
Steeds
Richard
R
Wilson
Ian C
IC
Mascaro
Jorge
J
Thompson
Richard
R
Bonser
Robert Stuart
RS
D000328:Adult; D015415:Biomarkers / Q000097:blood; D002302:Cardiac Output; D005260:Female; D006334:Heart Function Tests / Q000379:methods; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D013318:Stroke Volume; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting / Q000379:methods; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood*; D016277:Ventricular Function, Left
D015415:Biomarkers; D019210:Troponin I