Second-opinion stress tele-echocardiography for the Adonhers (Aged donor heart rescue by stress echo) project.
BACKGROUND
To resolve the current shortage of donor hearts, we established the Adonhers protocol. An upward shift of the donor age cut-off limit (from the present 55 to 65 years) is acceptable if a stress echo screening on the candidate donor heart is normal. This study aimed to verify feasibility of a "second opinion" of digitally transferred images of stress echo results to minimize technical variability in selection of aged donor hearts for heart transplant.


METHODS
The informatics infrastructure was created for a core lab reading with a second opinion from the Pisa stress echo lab. To test the system, simulation standard stress echo cineloops were sent digitally from 5 peripheral labs to the central core lab.Starting January 2009, real marginal donor stress echos were sent via internet to the central core echo lab, Pisa, for a second opinion before heart transplant.


RESULTS
In the simulation protocol, 30 dipyridamole stress echocardiograms were sent from the five peripheral echo labs to the central core lab in Pisa. Both the echo images and reports were correctly uploaded in the web system and sent to the core echo lab; the second opinion evaluation was obtained in all cases (100% feasibility). In the transplant protocol, eight donor cases were sent to the Pisa core lab for the second opinion protocol, and six of them were transplanted in marginal recipients.


CONCLUSIONS
Second-Opinion Stress Tele-Echocardiography can effectively be performed in a network aimed to safely expand the heart donor pool for heart transplant.
Department of Echocardiography and Medical Informatics, Institute of Clinical Physiology, National Research Council, Via Moruzzi 1, Pisa (56124), Italy.
Daniele
D
Franchi
Davide
D
Cini
Giorgio
G
Arpesella
Sonia
S
Gherardi
Italo
I
Calamai
Giuseppe
G
Barletta
Serafina
S
Valente
Emilio
E
Pasanisi
Stefania
S
Sansoni
Caterina
C
Ricci
Walter
W
Serra
Eugenio
E
Picano
Tonino
T
Bombardini
D000368:Aged; D004176:Dipyridamole; D025401:Echocardiography, Stress; D016027:Heart Transplantation; D006801:Humans; D008875:Middle Aged; D012017:Referral and Consultation; D017216:Telemedicine; D014019:Tissue Donors; D014665:Vasodilator Agents
D014665:Vasodilator Agents; D004176:Dipyridamole