Stress Echocardiography as a Gatekeeper to Donation in Aged Marginal Donor Hearts: Anatomic and Pathologic Correlations of Abnormal Stress Echocardiography Results

• Published in: The Journal of heart and lung transplantation Vol. 28; no. 11; pp. 1141 - 1149
• Main Authors: Leone, Ornella, MD, Gherardi, Sonia, MD, Targa, Luigi, MD, Pasanisi, Emilio, MD, Mikus, Piero, MD, Tanganelli, Piero, MD, Maccherini, Massimo, MD, Arpesella, Giorgio, MD, Picano, Eugenio, Bombardini, Tonino, MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.11.2009; Elsevier
• Subjects: Aged; Biological and medical sciences; Brain Death; Cardiology. Vascular system; Cardiovascular system; Dipyridamole - therapeutic use; Dobutamine; Echocardiography, Stress - methods; Female; Heart - anatomy & histology; Heart Valves - pathology; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Myocardium - pathology; Organ Size; Patient Selection; Pressure; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Tissue Donors - statistics & numerical data; Ultrasonic investigative techniques; Sonography; Heart; Suboptimal donor; Correlation; Echocardiography; Circulatory system; Anatomy; Cardiology; Phlebology; Stress; Result
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2009.05.029

Background Owing to the shortage of donor hearts, the criteria for acceptance have been considerably expanded. Pharmacologic stress echocardiography is highly accurate in identifying prognostically significant coronary artery disease, but brain death and catecholamine storm in potential heart donors may substantially alter the cardiovascular response to stress. This study assessed correlates of an abnormal resting/stress echocardiography results in potential donors. Methods From April 2005 to December 2007, 18 marginal candidate donors (9 men) aged 58 ± 5 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 min) or dobutamine (up to 40 μg/kg/min) stress echo. Non-eligible hearts (with abnormal rest or stress echo findings) were excluded and underwent cardioautoptic verification. Results Resting echocardiography showed wall motion abnormalities in 5 patients (excluded from donation). Stress echocardiography was performed in the remaining 13 (dipyridamole in 11; dobutamine in 2). Results were normal in 7, of which 6 were uneventfully transplanted in marginal recipients. Results were abnormal in 6, and autoptic verification performed showed coronary artery disease in 5, and initial cardiomyopathy in 1. Conclusions Bedside pharmacologic stress echocardiography can safely be performed in candidate heart donors, is able to unmask occult coronary artery disease or cardiomyopathy, and shows potential to extend donor criteria in heart transplantation. Further experience with using marginal donors is needed before exact guidelines can be established.