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Updated: Jun 17, 2026
Functional Assessment of the Donor Heart During Ex Situ Perfusion: Insights from Pressure-Volume Loops and Surface Echocardiography
Published on: October 11, 2022
Echocardiography in the potential heart donor
Rajamiyer V Venkateswaran1, Jonathan N Townend, Ian C Wilson
1Department of Cardiothoracic Surgery, Queen Elizabeth Hospital, University Hospital Birmingham NHS Trust, Edgbaston, Birmingham, UK.
Insights
Echocardiography can assess heart donor function, with normal results predicting transplant suitability. Many donors with initially poor function improve, and hemodynamic optimization is key for transplant success.
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.
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.
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