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Adequacy of Size Matching With Predicted Heart Mass Ratio in Diverse Types of Cardiomyopathies

Roh Yanagida1, Ahad Firoz2, Mohammed Kashem1

  • 1Division of Cardiovascular Surgery, Department of Surgery, Temple University Hospital, Philadelphia, PA.

The American Journal of Cardiology
|September 18, 2023
PubMed

Insights

Predicted heart mass ratio (PHMr) size matching for donor hearts is not uniform across all cardiomyopathies. Undersized hearts decreased survival in dilated and valvular disease, but not hypertrophic, restrictive, or congenital heart disease.

Area of Science:

  • Cardiology
  • Transplantation Medicine
  • Medical Statistics

Background:

  • Predicted heart mass ratio (PHMr) is a proposed metric for donor heart size selection.
  • The uniform applicability of PHMr across different cardiomyopathy etiologies remains unconfirmed.

Purpose of the Study:

  • To investigate whether size matching criteria based on PHMr impacts survival outcomes uniformly across diverse cardiomyopathy types in heart transplant recipients.
  • To identify specific cardiomyopathy groups where PHMr-based size matching is less critical for survival.

Main Methods:

  • Analysis of the United Network for Organ Sharing registry database (1987-2021) including 53,573 heart transplant recipients.
  • Categorization of recipients into six cardiomyopathy groups: dilated, coronary artery disease, hypertrophic, restrictive, valvular, and adult congenital heart disease.
  • Stratification of patients by PHMr into five size categories (severely undersized to severely oversized) to assess survival and cause of death.

Main Results:

  • Recipients with dilated and valvular cardiomyopathy receiving undersized hearts (PHMr <0.86) exhibited decreased survival compared to size-matched controls.
  • Survival outcomes for patients with hypertrophic, restrictive cardiomyopathy, or adult congenital heart disease were not significantly affected by size matching based on PHMr.
  • Hazard ratios indicated significant survival decrements for undersized hearts in dilated (1.17, p=0.001) and valvular (1.79, p=0.032) cardiomyopathies.

Conclusions:

  • The effectiveness of PHMr for donor heart size matching is not uniform across all cardiomyopathy etiologies.
  • Current size matching criteria may be overly restrictive for certain conditions.
  • Findings suggest increased donor heart acceptance rates are possible for patients with hypertrophic, restrictive cardiomyopathy, and congenital heart disease where size matching is less critical for survival.

Keywords:
cardiomyopathyheart transplantationsize matching

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