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In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
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Predicted Heart Mass: A Tale of 2 Ventricles

Eduard Ródenas-Alesina1, Farid Foroutan2, Chun-Po Fan2

  • 1Ted Rogers Centre for Heart Research (E.R.-A., I.B., N.A., H.J.R., Y.M.), Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada.

Circulation. Heart Failure
|August 21, 2023
PubMed

Insights

Assessing donor and recipient predicted heart mass (PHM) separately for the left and right ventricles improves 1-year graft failure risk prediction after heart transplantation. This refined matching strategy enhances donor-recipient compatibility and donor organ utilization.

Area of Science:

  • Cardiology
  • Transplantation Medicine
  • Biostatistics

Background:

  • Total predicted heart mass (PHM) is standard for donor-recipient size matching in heart transplantation.
  • Separate measurement of right ventricular (RV) and left ventricular (LV) PHM may enhance risk prediction for 1-year graft failure.

Purpose of the Study:

  • To evaluate if separate LV and RV PHM assessment improves risk prediction of 1-year graft failure compared to total PHM.
  • To assess the reclassification of risk using combined LV and RV PHM versus total PHM.

Main Methods:

  • Analysis of adult heart transplant recipients from the UNOS database (2000-2018).
  • Modeling of LV and RV PHM using restricted cubic splines.
  • Adjusted Cox regression to determine association with 1-year graft failure.
  • Net reclassification index (NRI) to assess risk reclassification.

Main Results:

  • A U-shaped association was observed between total PHM and 1-year graft failure risk.
  • Increased graft failure risk was noted for LV undersizing (>5%) and RV oversizing (>20%).
  • Separate LV/RV PHM assessment yielded an NRI of 8.5% for improved risk reclassification.

Conclusions:

  • Donor-recipient PHM matching risk is influenced by LV undersizing and RV oversizing.
  • Separate assessment of LV and RV PHM refines donor-recipient matching for heart transplantation.
  • This approach may minimize 1-year graft failure and increase donor organ utilization.
Abstract

Keywords:
donor-recipient matchinggraft failureheart transplantmortalitypredicted heart mass

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