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Comparing Cardiac Mechanics and Myocardial Fibrosis in DBD and DCD Heart Transplant Recipients
Matthew K Burrage1, Caitlin Cheshire2, Cong Ying Hey2
1Transplant Unit, Royal Papworth Hospital, Cambridge, UK; Faculty of Medicine, University of Queensland, Brisbane, Australia.
Insights
Heart transplantation (HTx) using donation after circulatory death (DCD) hearts shows comparable cardiac mechanics and fibrosis to donation after brain death (DBD) HTx. This study found no significant differences in early cardiovascular magnetic resonance (CMR) imaging outcomes between DCD and DBD HTx recipients.
Area of Science:
- Cardiology
- Transplantation Medicine
- Medical Imaging
Background:
- Donation after circulatory death (DCD) heart transplantation (HTx) is increasing but associated with longer warm ischemic times.
- The impact of DCD HTx on cardiac mechanics and myocardial fibrosis remains underreported.
- This study investigates cardiac function and fibrosis in DCD vs. donation after brain death (DBD) HTx recipients.
Purpose of the Study:
- To compare cardiac mechanics and myocardial fibrosis between DCD and DBD heart transplant recipients.
- To evaluate the impact of DCD vs. DBD heart donation on early post-transplant cardiac health.
- To utilize cardiovascular magnetic resonance (CMR) imaging for objective assessment.
Main Methods:
- Cardiovascular magnetic resonance (CMR) imaging was used to assess cardiac mechanics (strain) and myocardial fibrosis (extracellular volume).
- 82 heart transplant recipients (42 DBD, 40 DCD) were included, with data analyzed at a median of 9 months post-transplant.
- Strain analysis included global longitudinal, global circumferential, and right ventricular free-wall longitudinal strain.
Main Results:
- Heart transplant recipients exhibited impaired myocardial strain and increased extracellular volume compared to healthy controls.
- No significant differences were observed in myocardial fibrosis (extracellular volume) between DCD and DBD HTx recipients.
- Cardiac mechanics, including all assessed strain parameters, showed no significant differences between DCD and DBD HTx groups.
Conclusions:
- Heart transplantation recipients generally show impaired cardiac mechanics and increased fibrosis.
- Early cardiovascular magnetic resonance (CMR) findings indicate comparable cardiac health between DCD and DBD heart transplants.
- These results support the use of DCD donors for heart transplantation, showing similar early outcomes to DBD donors.
Background:
Heart transplantation (HTx) after donation after circulatory death (DCD) is an expanding practice but is associated with increased warm ischemic time. The impact of DCD HTx on cardiac mechanics and myocardial fibrosis has not been reported. We aimed to compare cardiac mechanics and myocardial fibrosis using cardiovascular magnetic resonance (CMR) imaging in donation after brain death (DBD) and DCD HTx recipients and healthy controls.
Methods And Results:
Consecutive HTx recipients between March 2015 and March 2021 who underwent routine surveillance CMR imaging were included. Cardiac mechanics were assessed using CMR feature tracking to compute global longitudinal strain, global circumferential strain, and right ventricular free-wall longitudinal myocardial strain. Fibrosis was assessed using late gadolinium enhancement imaging and estimation of extracellular volume. There were 82 (DBD n = 42, DCD n = 40) HTx recipients (aged 53 years, interquartile range 41-59 years, 24% female) who underwent CMR imaging at median of 9 months (interquartile range 6-14 months) after transplantation. HTx recipients had increased extracellular volume (29.7 ± 3.6%) compared with normal ranges (25.9%, interquartile range 25.4-26.5). Myocardial strain was impaired after transplantation compared with controls (global longitudinal strain -12.6 ± 3.1% vs -17.2 ± 1.8%, P < .0001; global circumferential strain -16.9 ± 3.1% vs -19.2 ± 2.0%, P = .002; right ventricular free-wall longitudinal strain -15.7 ± 4.5% vs -21.6 ± 4.7%, P < .0001). There were no differences in fibrosis burden (extracellular volume 30.6 ± 4.4% vs 29.2 ± 3.2%; P = .39) or cardiac mechanics (global longitudinal strain -13.1 ± 3.0% vs -12.1 ± 3.1%, P = .14; global circumferential strain -17.3 ± 2.9% vs -16.6 ± 3.1%, P = .27; right ventricular free-wall longitudinal strain -15.9 ± 4.9% vs -15.5 ± 4.1%, P = .71) between DCD and DBD HTx.
Conclusions:
HTx recipients have impaired cardiac mechanics compared with controls, with increased myocardial fibrosis. There were no differences in early CMR imaging characteristics between DBD and DCD heart transplants, providing further evidence that DCD and DBD HTx outcomes are comparable.
