title: Favorable short-term outcome of transplanted hearts selected from marginal donors by pharmacological stress echocardiography.
abstract: BACKGROUND
  Because of the shortage of donor hearts, the criteria for acceptance have been considerably expanded. Abnormal results on pharmacologic stress echocardiography are associated with significant coronary artery disease and/or occult cardiomyopathy on verification by cardiac autopsy. The aim of this study was to establish the feasibility of an approach based on pharmacologic stress echocardiography as a gatekeeper for extended heart donor criteria.
  
  
  METHODS
  From April 2005 to April 2010, 39 "marginal" candidate donors (mean age, 56 ± 6 years; 21 men) were initially enrolled. After legal declaration of brain death, marginal donors underwent rest echocardiography, and if the results were normal, dipyridamole (0.84 mg/kg over 6 min, n = 25) or dobutamine (up to 40 μg/kg/min, n = 3) stress echocardiography.
  
  
  RESULTS
  A total of 19 eligible hearts were found with normal findings. Of these, three were not transplanted because of the lack of a matching recipient, and verification by cardiac autopsy showed absence of significant coronary artery disease or cardiomyopathy abnormalities. The remaining 16 eligible hearts were uneventfully transplanted in marginal emergency recipients. All showed normal (n = 14) or nearly normal (minor single-vessel disease in two) angiographic, intravascular ultrasound, hemodynamic and ventriculographic findings at 1 month. At follow-up (median, 14 months; interquartile range, 4-31 months), 14 patients survived and two had died, one at 2 months from general sepsis and one at 32 months from allograft vasculopathy in recurrent multiple myeloma.
  
  
  CONCLUSIONS
  Pharmacologic stress echocardiography can safely be performed in candidate heart donors with brain death and shows potential for extending donor criteria in heart transplantation.
authors: Institute of Clinical Physiology, National Research Council, Pisa, Italy. bombardini@ifc.cnr.it
authors: Tonino
authors: T
authors: Bombardini
authors: Sonia
authors: S
authors: Gherardi
authors: Giorgio
authors: G
authors: Arpesella
authors: Massimo
authors: M
authors: Maccherini
authors: Walter
authors: W
authors: Serra
authors: Gaia
authors: G
authors: Magnani
authors: Riccarda
authors: R
authors: Del Bene
authors: Eugenio
authors: E
authors: Picano
mesh_terms: D000704:Analysis of Variance; D001926:Brain Death; D002316:Cardiotonic Agents; D016009:Chi-Square Distribution; D004176:Dipyridamole; D004280:Dobutamine; D025401:Echocardiography, Stress / Q000379:methods*; D005260:Female; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009010:Monte Carlo Method; D018579:Patient Selection; D016019:Survival Analysis; D014019:Tissue Donors; D016896:Treatment Outcome; D014665:Vasodilator Agents
chemical_list: D002316:Cardiotonic Agents; D014665:Vasodilator Agents; D004280:Dobutamine; D004176:Dipyridamole