Document Detail


Echocardiography in the potential heart donor.
MedLine Citation:
PMID:  20075789     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The relationship between echocardiographic left ventricular(LV) systolic function (E-function) and pulmonary artery catheter(PAC) assessment of hemodynamic function (H-function) in potential heart donors is ill defined. We investigated this and determined (a) whether optimization could improve abnormal E-function, (b) feasibility and usefulness of repeat transthoracic echocardiography (TTE), and (c) whether thyroid status and therapy affected E-function. MATERIALS AND METHODS: Transthoracic E-function imaging was performed at baseline and 4 hr in potential donors (enrolled in a randomized controlled trial of tri-iodothyronine+/-methylprednisolone [MP] therapy) undergoing PAC-guided algorithmic optimization. Images were analyzed post hoc for LV wall thickness, ejection fraction, and Tei index. RESULTS: The study comprised 66 donors. Both LV ejection fraction (LVEF) and LV-Tei correlated with cardiac index (CI; P<0.001), and LV Tei was most frequently measurable and repeatable(P=0.01). Normal LVEF independently predicted end-assessment H-functional suitability (odds ratio 1.05, 95% confidence interval 1.007-1.088 [P=0.021]) but had poor specificity. Initial subnormal E-function was identified in 29 of 66 of hearts, of which 58% (17/29) achieved H-function suitability criteria. In 52 hearts, repeat E-function assessment was possible. Nineteen of 52 had initially subnormal E-function, which improved in over half (53%). H-function could be manipulated to meet functional suitability criteria for transplant even without E-function change. Neither initial thyroid status nor hormonal therapy affected LV function. CONCLUSIONS: Echocardiography is possible in most potential heart donors. Normal E-function predicts hemodynamic suitability for transplantation but lacks specificity. More than 50% of hearts with subnormal E-function can attain hemodynamic transplantation criteria after donor management. Repeat echocardiography is feasible but has a limited role. Both initial echocardiography and PAC-guided management should be used routinely.
Authors:
Rajamiyer V Venkateswaran; Jonathan N Townend; Ian C Wilson; Jorge G Mascaro; Robert S Bonser; Richard P Steeds
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Transplantation     Volume:  89     ISSN:  1534-6080     ISO Abbreviation:  Transplantation     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-04-13     Completed Date:  2010-04-29     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0132144     Medline TA:  Transplantation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  894-901     Citation Subset:  IM    
Affiliation:
Department of Cardiothoracic Surgery, Queen Elizabeth Hospital, University Hospital Birmingham NHS Trust, Edgbaston, Birmingham, UK.
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MeSH Terms
Descriptor/Qualifier:
Adult
Catheterization, Swan-Ganz
Donor Selection / methods*
Double-Blind Method
Echocardiography*
Feasibility Studies
Female
Graft Survival
Heart Transplantation*
Hemodynamics* / drug effects
Humans
Male
Methylprednisolone / administration & dosage
Middle Aged
Predictive Value of Tests
Prospective Studies
Stroke Volume
Systole
Thyroid Function Tests
Time Factors
Tissue Donors / supply & distribution*
Treatment Outcome
Triiodothyronine / administration & dosage
Ventricular Function, Left* / drug effects
Grant Support
ID/Acronym/Agency:
//British Heart Foundation
Chemical
Reg. No./Substance:
6893-02-3/Triiodothyronine; 83-43-2/Methylprednisolone
Comments/Corrections
Comment In:
Transplantation. 2010 Apr 15;89(7):809-10   [PMID:  20098356 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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