title: Is stress cardiomyopathy the underlying cause of ventricular dysfunction associated with brain death?
abstract: Most deaths in the first 30 days after cardiac transplantation are due to failure of the donor heart, often with the clinical picture of right ventricular failure. Indeed, there is a significant reduction in contractility of the human donor heart and loss of contractile reserve before and soon after transplantation. This myocardial insult appears in association with brain death in the donor and follows a "catecholamine storm" associated with a rapidly rising intracranial pressure. Microscopy of the myocardium in organ donors shows a picture typical of catecholamine-induced injury and similar to changes found in endomyocardial specimens of stress cardiomyopathy (catecholamine-induced cardiomyopathy, or Takotsubo cardiomyopathy). There are 3 common features between stress cardiomyopathy and the heart of a brain-dead donor: exposure of the heart to unusually high catecholamine levels, ventricular dysfunction, and prompt recovery. Stress cardiomyopathy is a temporary myocardial dysfunction that has been described after sub-arachnoid hemorrhage, traumatic head injury, pheochromocytoma, acute emotional distress, exogenous administration of catecholamines, and non-related surgery. Given the common features of this catecholamine-mediated myocardial insult, we ask if brain-dead donor heart dysfunction is an extreme variant of stress cardiomyopathy? And, if so is it, like stress cardiomyopathy, reversible? Can we therefore expect recovery of the dysfunctional donor heart over time, thereby permitting increased use of hearts offered for transplantation?
authors.affiliation: Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, UK.
authors.forename: Marius
authors.initials: M
authors.lastname: Berman
authors.forename: Ayyaz
authors.initials: A
authors.lastname: Ali
authors.forename: Euan
authors.initials: E
authors.lastname: Ashley
authors.forename: Darren
authors.initials: D
authors.lastname: Freed
authors.forename: Kieran
authors.initials: K
authors.lastname: Clarke
authors.forename: Steven
authors.initials: S
authors.lastname: Tsui
authors.forename: Jayan
authors.initials: J
authors.lastname: Parameshwar
authors.forename: Stephen
authors.initials: S
authors.lastname: Large
mesh_terms: D001926:Brain Death; D002395:Catecholamines / Q000378:metabolism / Q000633:toxicity; D004562:Electrocardiography; D006333:Heart Failure / Q000473:pathology; D016027:Heart Transplantation / Q000401:mortality*; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D017682:Myocardial Stunning / Q000139:chemically induced; D009929:Organ Size; D013318:Stroke Volume; D054549:Takotsubo Cardiomyopathy / Q000139:chemically induced / Q000150:complications* / Q000473:pathology; D014019:Tissue Donors; D018754:Ventricular Dysfunction / Q000209:etiology*; D018487:Ventricular Dysfunction, Left / Q000150:complications; D018497:Ventricular Dysfunction, Right / Q000150:complications
chemical_list: D002395:Catecholamines