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Updated: Jul 9, 2026
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Myocardial Microcirculation Combined With Lactate Measurements Predicts Ventricular Contractility in a Canine DCD
Lars Saemann1, Robert Ferencz1, Kálmán Benke1,2
1Department of Cardiac Surgery, University Hospital Halle, University of Halle, Halle, Germany.
Insights
Lactate alone is insufficient for assessing donor heart viability after circulatory death. Combining microcirculation monitoring with lactate levels improves prediction accuracy for transplant suitability in donation after circulatory death hearts.
Area of Science:
- Cardiovascular Surgery
- Organ Transplantation
- Physiology
Background:
- Lactate levels alone are criticized for assessing donor heart viability after circulatory death (DCD).
- Novel prediction parameters based on myocardial microcirculation were developed in prior porcine studies.
- This study verifies these parameters in canine DCD hearts undergoing orthotopic heart transplantation (HTx).
Purpose of the Study:
- To validate novel myocardial microcirculation parameters for predicting donor heart transplantability.
- To develop a prediction model combining microcirculation and lactate levels.
- To assess the model's accuracy in predicting post-transplant left-ventricular end-systolic pressure-volume relationship (LV-ESPVR).
Main Methods:
- Seven DCD canine hearts were maintained using ex vivo blood perfusion (EVBP).
- Myocardial microcirculation was monitored using laser Doppler perfusion (LDP) during EVBP.
- A prediction model was developed using LDP shifts and venous lactate, correlating with post-transplant LV-ESPVR.
Main Results:
- A linear model combining LDP shift and venous lactate demonstrated high predictive power for LV-ESPVR (r=0.950, r²=0.902).
- The developed prediction model achieved 100% sensitivity and 83.3% specificity.
- This model accurately predicts if at least 80% of donor LV-ESPVR is reached post-transplantation.
Conclusions:
- Left-ventricular end-systolic pressure-volume relationship (LV-ESPVR) after DCD heart transplantation is predictable.
- Combining microcirculatory parameters (First-to-Last interval shift) with end-EVBP venous lactate offers a robust prediction model.
- This approach enhances the assessment of donor heart viability for transplantation.
Background:
Strictly trusting lactate to classify a donation after circulatory death (DCD) heart as transplantable or not during ex vivo blood perfusion (EVBP) has been criticized. Here, we verified novel prediction parameters based on myocardial microcirculation, which we had developed in previous porcine Langendorff experiments, in canine orthotopic heart transplantation (HTx) with DCD.
Methods:
The hearts (n = 7) were maintained by EVBP. We measured lactate, monitored the myocardial microcirculation in the left-ventricular (LV) anterior wall during EVBP, using a laser Doppler perfusion (LDP) needle probe, and developed a prediction model based on LDP shifts and venous lactate during EVBP. The hearts were transplanted, and the LV-end-systolic pressure volume relationship (ESPVR) was determined. Considering that reaching at least 80% of the donor-LV-ESPVR is acceptable to maintain circulation in the recipient, we also calculated sensitivity and Specificity of the model to predict that 80% of the donor-LV-ESPVR will be reached after HTx.
Results:
The combination of the LDP shift and venous lactate in a linear model showed the highest r (0.950) and r2 (0.902) for LV-ESPVR and thus served best for a prediction model. The respective, exemplary formula to predict that at least 80% of the donor-LV-ESPVR will be reached after HTx showed a sensitivity of 100% and a specificity of 83.3%.
Conclusions:
We conclude that the LV-ESPVR after orthotopic HTx with DCD seems to be predictable by combining the microcirculatory parameter First-to-Last interval shift during, and the Lac ven at the end of EVBP in a linear model.
