Longitudinal Strain Stress-Echo Evaluation of Aged Marginal Donor Hearts: Feasibility in the Adonhers Project.
BACKGROUND
The Adonhers (aged donor heart rescue by stress-echo protocol) Project was created to resolve the current shortage of donor hearts. One of the great limits of stress echo is the operator dependency. Speckle-tracking echocardiography (STE), offering a quantitative objective analysis of myocardial deformation, may help to overcome this limit. This study aimed to verify feasibility of a stress-strain echo analysis in selection of aged donor hearts for heart transplant.


METHODS
From February 2014 to October 2015, 22 marginal candidate donors (16 men) ages 58 ± 4 years were initially enrolled. After legal declaration of brain death, all marginal donors underwent bedside echocardiography, with baseline and (when resting echocardiography was normal) dipyridamole (0.84 mg/kg in 6 minutes) stress echo. In all patients, left ventricular (LV) longitudinal myocardial deformation was obtained by STE in the 4-, 2-, and 3-chamber views, obtaining the average global longitudinal strain (GLS). GLS was assessed at baseline and at the peak of stress echo.


RESULTS
Baseline echocardiography showed wall motion abnormalities in 9 patients (excluded from donation). Stress echocardiography was performed in the remaining 13 patients. Results were normal in 8, who were uneventfully transplanted in marginal recipients. Stress results were abnormal in 5 (excluded from donation). STE was obtained in all cases (100% feasibility) and ΔGLS was significantly different between normal and pathological stress-echo (+13.2 ± 5.2 versus -6.1% ± 3.1%, P = .0001, respectively).


CONCLUSIONS
STE showed an excellent feasibility in analysis of LV myocardial longitudinal strain at baseline and at the peak of stress echo of marginal heart donors. Further experience is needed to confirm STE as a valuable additional mean to better interpret stress echo in marginal donors.
Department of Cardiovascular Diseases, University of Siena, Italy. Electronic address: matteo.cameli@yahoo.com.
M
M
Cameli
Institute of Clinical Physiology, National Research Council, Pisa, Italy.
T
T
Bombardini
Department of Cardiac Surgery, University of Siena, Italy.
A
A
Dokollari
Department of Cardiac Surgery, University of Siena, Italy.
C G
CG
Sassi
Department of Cardiovascular Diseases, University of Siena, Italy.
M
M
Losito
Department of Cardiovascular Diseases, University of Siena, Italy.
S
S
Sparla
Department of Cardiac Surgery, University of Siena, Italy.
G
G
Lisi
Department of Cardiac Surgery, University of Siena, Italy.
S
S
Bernazzali
Department of Cardiac Surgery, University of Siena, Italy.
G
G
Davoli
Department of Cardiac Surgery, University of Siena, Italy.
G
G
Capannini
Department of Cardiac Surgery, University of Siena, Italy.
S
S
Andriani
Department of Cardiac Surgery, University of Siena, Italy.
R
R
Martinelli
Department of Cardiac Surgery, University of Siena, Italy.
F
F
Diciolla
Department of Cardiovascular Diseases, University of Siena, Italy.
S
S
Mondillo
Department of Cardiac Surgery, University of Siena, Italy.
M
M
Maccherini
D001926:Brain Death; D004176:Dipyridamole; D004452:Echocardiography; D025401:Echocardiography, Stress; D005240:Feasibility Studies; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016027:Heart Transplantation; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000379:methods*; D014665:Vasodilator Agents
D014665:Vasodilator Agents; D004176:Dipyridamole