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Impact of Donor Left Ventricular Geometric Remodeling and Hypertrophy on Heart Acceptance and Recipient Survival

Christian O'Donnell1, Juka S Kim2, Akansha Tarun1

  • 1Division of Cardiothoracic Anesthesiology, Stanford University School of Medicine, Stanford, California, USA.

JACC. Heart Failure
|May 20, 2026
PubMed

Insights

Classifying donor hearts by geometric remodeling, not just wall thickness, may increase acceptance rates without impacting patient survival. This study analyzed donor heart remodeling patterns and their effect on transplant outcomes.

Area of Science:

  • Cardiology
  • Transplant Surgery
  • Medical Imaging

Background:

  • Current donor heart screening relies solely on left ventricular (LV) wall thickness, overlooking diverse geometric remodeling patterns.
  • These patterns, crucial in other cardiovascular conditions, haven't been assessed in donor heart evaluation.

Purpose of the Study:

  • To determine the prevalence of LV geometric remodeling patterns in brain-dead donor hearts.
  • To evaluate the clinical impact of these patterns on donor heart acceptance and recipient survival.

Main Methods:

  • Utilized echocardiograms from 3,647 brain-dead donors (February 2015-May 2020) in the Donor Heart Study (DHS).
  • Classified LV geometric remodeling using American Society of Echocardiography (ASE) guidelines.
  • Compared remodeling patterns and LV wall thickness (>1.3 cm) with transplant acceptance and 3-year recipient mortality via multivariable modeling.

Main Results:

  • Concentric remodeling was the most frequent pattern (58.5%).
  • Increased LV wall thickness often indicated concentric remodeling (52.1%), not solely concentric hypertrophy (43.8%).
  • Neither LV wall thickness, concentric remodeling, nor concentric hypertrophy significantly correlated with 3-year recipient survival.

Conclusions:

  • Classifying donor hearts by LV geometric remodeling patterns could potentially decrease rejections due to perceived "hypertrophy."
  • This refined assessment may expand the donor pool without negatively affecting patient outcomes.
Abstract

Keywords:
echocardiographygeometric remodelingheart transplantationhypertrophyleft ventricular mass

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