Echocardiography in the potential heart donor.
BACKGROUND
The relationship between echocardiographic left ventricular(LV) systolic function (E-function) and pulmonary artery catheter(PAC) assessment of hemodynamic function (H-function) in potential heart donors is ill defined. We investigated this and determined (a) whether optimization could improve abnormal E-function, (b) feasibility and usefulness of repeat transthoracic echocardiography (TTE), and (c) whether thyroid status and therapy affected E-function.


METHODS
Transthoracic E-function imaging was performed at baseline and 4 hr in potential donors (enrolled in a randomized controlled trial of tri-iodothyronine+/-methylprednisolone [MP] therapy) undergoing PAC-guided algorithmic optimization. Images were analyzed post hoc for LV wall thickness, ejection fraction, and Tei index.


RESULTS
The study comprised 66 donors. Both LV ejection fraction (LVEF) and LV-Tei correlated with cardiac index (CI; P<0.001), and LV Tei was most frequently measurable and repeatable(P=0.01). Normal LVEF independently predicted end-assessment H-functional suitability (odds ratio 1.05, 95% confidence interval 1.007-1.088 [P=0.021]) but had poor specificity. Initial subnormal E-function was identified in 29 of 66 of hearts, of which 58% (17/29) achieved H-function suitability criteria. In 52 hearts, repeat E-function assessment was possible. Nineteen of 52 had initially subnormal E-function, which improved in over half (53%). H-function could be manipulated to meet functional suitability criteria for transplant even without E-function change. Neither initial thyroid status nor hormonal therapy affected LV function.


CONCLUSIONS
Echocardiography is possible in most potential heart donors. Normal E-function predicts hemodynamic suitability for transplantation but lacks specificity. More than 50% of hearts with subnormal E-function can attain hemodynamic transplantation criteria after donor management. Repeat echocardiography is feasible but has a limited role. Both initial echocardiography and PAC-guided management should be used routinely.
Venkateswaran
Rajamiyer V
RV
Department of Cardiothoracic Surgery, Queen Elizabeth Hospital, University Hospital Birmingham NHS Trust, Edgbaston, Birmingham, UK.
Townend
Jonathan N
JN
Wilson
Ian C
IC
Mascaro
Jorge G
JG
Bonser
Robert S
RS
Steeds
Richard P
RP
D000328:Adult; D002407:Catheterization, Swan-Ganz; D046148:Donor Selection / Q000379:methods*; D004311:Double-Blind Method; D004452:Echocardiography; D005240:Feasibility Studies; D005260:Female; D006085:Graft Survival; D016027:Heart Transplantation; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013318:Stroke Volume; D013599:Systole; D013960:Thyroid Function Tests; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D016896:Treatment Outcome; D014284:Triiodothyronine / Q000008:administration & dosage; D016277:Ventricular Function, Left / Q000187:drug effects
D014284:Triiodothyronine; D008775:Methylprednisolone