BACKGROUND: Owing to the shortage of donor hearts, the criteria for acceptance have been considerably expanded. Pharmacologic stress echocardiography is highly accurate in identifying prognostically significant coronary artery disease, but brain death and catecholamine storm in potential heart donors may substantially alter the cardiovascular response to stress. This study assessed correlates of an abnormal resting/stress echocardiography results in potential donors. METHODS: From April 2005 to December 2007, 18 marginal candidate donors (9 men) aged 58 +/- 5 years were initially enrolled. After legal declaration of brain death, all marginal donors underwent bedside echocardiography, with baseline and (when resting echocardiography was normal) dipyridamole (0.84 mg/kg in 6 min) or dobutamine (up to 40 microg/kg/min) stress echo. Non-eligible hearts (with abnormal rest or stress echo findings) were excluded and underwent cardioautoptic verification. RESULTS: Resting echocardiography showed wall motion abnormalities in 5 patients (excluded from donation). Stress echocardiography was performed in the remaining 13 (dipyridamole in 11; dobutamine in 2). Results were normal in 7, of which 6 were uneventfully transplanted in marginal recipients. Results were abnormal in 6, and autoptic verification performed showed coronary artery disease in 5, and initial cardiomyopathy in 1. CONCLUSIONS: Bedside pharmacologic stress echocardiography can safely be performed in candidate heart donors, is able to unmask occult coronary artery disease or cardiomyopathy, and shows potential to extend donor criteria in heart transplantation. Further experience with using marginal donors is needed before exact guidelines can be established.
BACKGROUND: Owing to the shortage of donor hearts, the criteria for acceptance have been considerably expanded. Pharmacologic stress echocardiography is highly accurate in identifying prognostically significant coronary artery disease, but brain death and catecholamine storm in potential heart donors may substantially alter the cardiovascular response to stress. This study assessed correlates of an abnormal resting/stress echocardiography results in potential donors. METHODS: From April 2005 to December 2007, 18 marginal candidate donors (9 men) aged 58 +/- 5 years were initially enrolled. After legal declaration of brain death, all marginal donors underwent bedside echocardiography, with baseline and (when resting echocardiography was normal) dipyridamole (0.84 mg/kg in 6 min) or dobutamine (up to 40 microg/kg/min) stress echo. Non-eligible hearts (with abnormal rest or stress echo findings) were excluded and underwent cardioautoptic verification. RESULTS: Resting echocardiography showed wall motion abnormalities in 5 patients (excluded from donation). Stress echocardiography was performed in the remaining 13 (dipyridamole in 11; dobutamine in 2). Results were normal in 7, of which 6 were uneventfully transplanted in marginal recipients. Results were abnormal in 6, and autoptic verification performed showed coronary artery disease in 5, and initial cardiomyopathy in 1. CONCLUSIONS: Bedside pharmacologic stress echocardiography can safely be performed in candidate heart donors, is able to unmask occult coronary artery disease or cardiomyopathy, and shows potential to extend donor criteria in heart transplantation. Further experience with using marginal donors is needed before exact guidelines can be established.
Authors: Eugenio Picano; Quirino Ciampi; Lauro Cortigiani; Adelaide M Arruda-Olson; Clarissa Borguezan-Daros; José Luis de Castro E Silva Pretto; Rosangela Cocchia; Eduardo Bossone; Elisa Merli; Garvan C Kane; Albert Varga; Gergely Agoston; Maria Chiara Scali; Doralisa Morrone; Iana Simova; Martina Samardjieva; Alla Boshchenko; Tamara Ryabova; Alexander Vrublevsky; Attila Palinkas; Eszter D Palinkas; Robert Sepp; Marco A R Torres; Hector R Villarraga; Tamara Kovačević Preradović; Rodolfo Citro; Miguel Amor; Hugo Mosto; Michael Salamè; Paul Leeson; Cristina Mangia; Nicola Gaibazzi; Domenico Tuttolomondo; Costantina Prota; Jesus Peteiro; Caroline M Van De Heyning; Antonello D'Andrea; Fausto Rigo; Aleksandra Nikolic; Miodrag Ostojic; Jorge Lowenstein; Rosina Arbucci; Diego M Lowenstein Haber; Pablo M Merlo; Karina Wierzbowska-Drabik; Jaroslaw D Kasprzak; Maciej Haberka; Ana Cristina Camarozano; Nithima Ratanasit; Fabio Mori; Maria Grazia D'Alfonso; Luigi Tassetti; Alessandra Milazzo; Iacopo Olivotto; Alberto Marchi; Hugo Rodriguez-Zanella; Angela Zagatina; Ratnasari Padang; Milica Dekleva; Ana Djordievic-Dikic; Nikola Boskovic; Milorad Tesic; Vojislav Giga; Branko Beleslin; Giovanni Di Salvo; Valentina Lorenzoni; Matteo Cameli; Giulia Elena Mandoli; Tonino Bombardini; Pio Caso; Jelena Celutkiene; Andrea Barbieri; Giovanni Benfari; Ylenia Bartolacelli; Alessandro Malagoli; Francesca Bursi; Francesca Mantovani; Bruno Villari; Antonello Russo; Michele De Nes; Clara Carpeggiani; Ines Monte; Federica Re; Carlos Cotrim; Giuseppe Bilardo; Ariel K Saad; Arnas Karuzas; Dovydas Matuliauskas; Paolo Colonna; Francesco Antonini-Canterin; Mauro Pepi; Patricia A Pellikka Journal: J Clin Med Date: 2021-08-17 Impact factor: 4.964