Faculty Collaboration Database

Echocardiography in the potential heart donor. Transplantation 2010 Apr 15;89(7):894-901

Date

01/16/2010

Pubmed ID

20075789

DOI

10.1097/TP.0b013e3181cfe8e9

Scopus ID

2-s2.0-77950950173 (requires institutional sign-in at Scopus site)   45 Citations

Abstract

BACKGROUND: The relationship between echocardiographic left ventricular(LV) systolic function (E-function) and pulmonary artery catheter(PAC) assessment of hemodynamic function (H-function) in potential heart donors is ill defined. We investigated this and determined (a) whether optimization could improve abnormal E-function, (b) feasibility and usefulness of repeat transthoracic echocardiography (TTE), and (c) whether thyroid status and therapy affected E-function.

MATERIALS AND METHODS: Transthoracic E-function imaging was performed at baseline and 4 hr in potential donors (enrolled in a randomized controlled trial of tri-iodothyronine+/-methylprednisolone [MP] therapy) undergoing PAC-guided algorithmic optimization. Images were analyzed post hoc for LV wall thickness, ejection fraction, and Tei index.

RESULTS: The study comprised 66 donors. Both LV ejection fraction (LVEF) and LV-Tei correlated with cardiac index (CI; P<0.001), and LV Tei was most frequently measurable and repeatable(P=0.01). Normal LVEF independently predicted end-assessment H-functional suitability (odds ratio 1.05, 95% confidence interval 1.007-1.088 [P=0.021]) but had poor specificity. Initial subnormal E-function was identified in 29 of 66 of hearts, of which 58% (17/29) achieved H-function suitability criteria. In 52 hearts, repeat E-function assessment was possible. Nineteen of 52 had initially subnormal E-function, which improved in over half (53%). H-function could be manipulated to meet functional suitability criteria for transplant even without E-function change. Neither initial thyroid status nor hormonal therapy affected LV function.

CONCLUSIONS: Echocardiography is possible in most potential heart donors. Normal E-function predicts hemodynamic suitability for transplantation but lacks specificity. More than 50% of hearts with subnormal E-function can attain hemodynamic transplantation criteria after donor management. Repeat echocardiography is feasible but has a limited role. Both initial echocardiography and PAC-guided management should be used routinely.

Author List

Venkateswaran RV, Townend JN, Wilson IC, Mascaro JG, Bonser RS, Steeds RP

Author

Jorge G. Mascaro MD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Catheterization, Swan-Ganz
Donor Selection
Double-Blind Method
Echocardiography
Feasibility Studies
Female
Graft Survival
Heart Transplantation
Hemodynamics
Humans
Male
Methylprednisolone
Middle Aged
Predictive Value of Tests
Prospective Studies
Stroke Volume
Systole
Thyroid Function Tests
Time Factors
Tissue Donors
Treatment Outcome
Triiodothyronine
Ventricular Function, Left