Echocardiography in the potential heart donor

Area of Science:

• Cardiology
• Transplant Surgery
• Critical Care Medicine

Background:

• The correlation between echocardiographic left ventricular (LV) systolic function (E-function) and pulmonary artery catheter (PAC) hemodynamic function (H-function) in potential heart donors is not well-defined.
• Investigating the impact of optimization on abnormal E-function, the feasibility of repeat echocardiography, and the influence of thyroid status is crucial for donor selection.

Purpose of the Study:

• To determine if optimization can improve abnormal echocardiographic left ventricular (LV) systolic function (E-function) in potential heart donors.
• To assess the feasibility and usefulness of repeat transthoracic echocardiography (TTE).
• To investigate whether thyroid status and therapy affect E-function in potential heart donors.

Main Methods:

• Transthoracic echocardiography (TTE) for E-function assessment at baseline and 4 hours in potential donors undergoing PAC-guided optimization.
• Donors were part of a randomized controlled trial involving tri-iodothyronine +/- methylprednisolone (MP) therapy.
• Post-hoc analysis of images for LV wall thickness, ejection fraction, and Tei index.

Main Results:

• Both LV ejection fraction (LVEF) and LV-Tei correlated with cardiac index (CI; P<0.001).
• Normal LVEF predicted hemodynamic suitability for transplant (odds ratio 1.05, P=0.021) but lacked specificity.
• Over 50% of donors with initially subnormal E-function improved after management, and hemodynamic function could be optimized for transplant criteria independently of E-function changes. Thyroid status and therapy did not impact LV function.

Conclusions:

• Echocardiography is feasible in most potential heart donors and normal E-function predicts hemodynamic suitability, though with limited specificity.
• Donor management can improve E-function in over 50% of cases, enabling attainment of hemodynamic transplantation criteria.
• Routine use of initial echocardiography alongside PAC-guided management is recommended for optimal donor selection.