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Updated: Nov 9, 2025
Author Spotlight: Enhancing Graft Viability Assessment Through Quantitative Metrics and Innovative Reservoir Systems
Published on: August 2, 2024
Donor Left Ventricular Function Assessed by Echocardiographic Strain is a Novel Predictor of Primary Graft Failure
Hemamalini Palani1, Govini Balasubramani2
1Institute of Heart and Lung Transplantation, Gleneagles Global Health City, Chennai, India.
Insights
Assessing donor left ventricular global longitudinal strain (LV GLS) using echocardiography can predict primary graft failure (PGF) after heart transplantation (HT). Impaired donor LV GLS is an independent predictor of PGF, aiding in better patient outcomes.
Area of Science:
- Cardiology
- Transplantation Medicine
- Echocardiography
Background:
- Primary graft failure (PGF) is a significant complication following orthotopic heart transplantation (HT).
- Accurate prediction of PGF is crucial for improving patient outcomes and donor selection.
- Donor cardiac function assessment is vital in predicting post-transplant graft survival.
Purpose of the Study:
- To evaluate the utility of donor left ventricular global longitudinal strain (LV GLS) by echocardiography in predicting PGF after HT.
- To identify independent predictors of PGF in adult patients undergoing isolated HT.
Main Methods:
- Retrospective observational study of 100 adult patients undergoing isolated HT.
- Collected demographic, clinical, and echocardiographic data, including donor LV GLS derived from 2D speckle-tracking echocardiography.
- Analyzed donor variables and procedural factors for association with PGF using univariate and multivariate Cox regression analyses.
Main Results:
- PGF occurred in 40% of patients.
- Donor LV GLS, along with RADIAL score, emerged as significant independent predictors of PGF in multivariate analysis (p < 0.001).
- LV GLS at -11.5% demonstrated high predictive accuracy for PGF (AUC = 0.889, sensitivity 92.5%, specificity 65%).
Conclusions:
- Impaired donor LV GLS is an independent predictor of PGF after orthotopic heart transplantation.
- Echocardiographic assessment of donor LV GLS can enhance risk stratification for PGF.
- This finding supports the integration of LV GLS into donor evaluation protocols for HT.
Objectives:
This study sought to determine the utility of donor left ventricular function assessment by echocardiographic left ventricular global longitudinal strain (LV GLS) in predicting primary graft failure (PGF) after orthotopic heart transplantation (HT).
Design:
Retrospective, observational study.
Setting:
Tertiary referral hospital.
Participants:
Adult patients (>18 years) who underwent isolated HT.
Interventions:
Demographic, clinical, and echocardiographic data were collected on 100 patients who underwent HT between January 2010 and December 2019 at the authors' institution. The respective donor variables, as well as procedural factors, were reviewed and analyzed to assess their independent association with PGF. Standard donor echocardiographic measurements were supplemented by two-dimensional speckle-tracking echocardiography to obtain LV GLS. PGF was defined as per the International Society for Heart and Lung Transplantation 2014 consensus statement.
Measurements And Main Results:
PGF occurred in 40 of the 100 patients (40%). Initial univariate analysis found that RADIAL score, donor ejection fraction, and donor LV GLS were associated with PGF. However, in a multivariate Cox regression analysis, only RADIAL score and donor LV GLS remained significant predictors of PGF, with a p < 0.001. By receiver operating characteristic curve analysis, LV GLS at a cut-off value of -11.5% showed the greatest area under the curve (area under the curve = 0.889; 95% confidence interval, 0.826-0.952) and predicted PGF with 92.5% sensitivity and 65% specificity.
Conclusions:
Impaired donor LV GLS was proven to be an independent predictor of PGF after HT.
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