title: Transplant of stunned donor hearts rescued by pharmacological stress echocardiography: a "proof of concept" report.
abstract: BACKGROUND
  Due to the shortage of donor hearts, the criteria for acceptance have been considerably expanded. Hearts with regional or global left ventricular dysfunction are excluded from donation, but stress echo might be useful to identify patients with reversible wall motion abnormalities, potentially eligible for donation.
  
  
  METHODS
  Six marginal candidate donors (mean age, 40 ± 13 years; three men) were enrolled. Resting echocardiography showed in all subjects a LV ejection fraction ≥ 45% (mean 51 ± 5%), but multiple risk factors were present. All donors had either global or discrete wall motion abnormalities: Wall Motion Score Index (WMSI) rest = 1.33 ± 0.25. Stress echocardiography was performed with the dipyridamole high dose of 0.84 mg/kg given over 6 min.
  
  
  RESULTS
  The stress echo results were abnormal in three donors (WMSI rest = 1.51 ± 0.19 vs peak = 1.41 ± 0.30). These hearts were excluded from donation and cardiac pathology verification was available in two cases of confirmed LV myocardial fibrosis and/or severe coronary stenosis. The remaining three hearts improved during stress (WMSI rest = 1.15 ± 0.13 vs peak = 1.04 ± 0.06) and were transplanted uneventfully. Recipients (three males, mean age 53 ± 4 years) underwent post-TX coronary angiography, IVUS and endomyocardial biopsies. No recipient had primary graft failure, and all showed normal coronary angiography and normal LV function (EF = 57 ± 6%; WMSI = 1 ± 0) at 1-month post-TX. The recipients were alive at 12-month median follow-up.
  
  
  CONCLUSIONS
  Dipyridamole stress echo performed in brain-dead potential donors with LV resting global or discrete wall motion abnormalities identifies hearts with severe morphologic abnormalities excluded from donation (with fixed response during stress echo) from hearts eligible for donation, showing improvement in regional wall motion during stress (viability response) and normal function and coronary anatomy following transplantation.
authors.affiliation: CNR, Institute of Clinical Physiology, Pisa, Italy. bombardini@ifc.cnr.it
authors.forename: Tonino
authors.initials: T
authors.lastname: Bombardini
authors.forename: Sonia
authors.initials: S
authors.lastname: Gherardi
authors.forename: Ornella
authors.initials: O
authors.lastname: Leone
authors.forename: Rosa
authors.initials: R
authors.lastname: Sicari
authors.forename: Eugenio
authors.initials: E
authors.lastname: Picano
mesh_terms: D000328:Adult; D004176:Dipyridamole; D004452:Echocardiography / Q000379:methods*; D005080:Exercise Test; D005260:Female; D006084:Graft Rejection / Q000000981:diagnostic imaging* / Q000209:etiology / Q000517:prevention & control; D016027:Heart Transplantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008297:Male; D017682:Myocardial Stunning / Q000150:complications / Q000000981:diagnostic imaging*; D018579:Patient Selection; D010865:Pilot Projects; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014019:Tissue Donors; D014665:Vasodilator Agents; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000000981:diagnostic imaging*
chemical_list: D014665:Vasodilator Agents; D004176:Dipyridamole
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