Document Detail


Is stress cardiomyopathy the underlying cause of ventricular dysfunction associated with brain death?
MedLine Citation:
PMID:  20627624     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Most deaths in the first 30 days after cardiac transplantation are due to failure of the donor heart, often with the clinical picture of right ventricular failure. Indeed, there is a significant reduction in contractility of the human donor heart and loss of contractile reserve before and soon after transplantation. This myocardial insult appears in association with brain death in the donor and follows a "catecholamine storm" associated with a rapidly rising intracranial pressure. Microscopy of the myocardium in organ donors shows a picture typical of catecholamine-induced injury and similar to changes found in endomyocardial specimens of stress cardiomyopathy (catecholamine-induced cardiomyopathy, or Takotsubo cardiomyopathy). There are 3 common features between stress cardiomyopathy and the heart of a brain-dead donor: exposure of the heart to unusually high catecholamine levels, ventricular dysfunction, and prompt recovery. Stress cardiomyopathy is a temporary myocardial dysfunction that has been described after sub-arachnoid hemorrhage, traumatic head injury, pheochromocytoma, acute emotional distress, exogenous administration of catecholamines, and non-related surgery. Given the common features of this catecholamine-mediated myocardial insult, we ask if brain-dead donor heart dysfunction is an extreme variant of stress cardiomyopathy? And, if so is it, like stress cardiomyopathy, reversible? Can we therefore expect recovery of the dysfunctional donor heart over time, thereby permitting increased use of hearts offered for transplantation?
Authors:
Marius Berman; Ayyaz Ali; Euan Ashley; Darren Freed; Kieran Clarke; Steven Tsui; Jayan Parameshwar; Stephen Large
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Publication Detail:
Type:  Journal Article     Date:  2010-06-08
Journal Detail:
Title:  The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation     Volume:  29     ISSN:  1557-3117     ISO Abbreviation:  J. Heart Lung Transplant.     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-08-23     Completed Date:  2010-12-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9102703     Medline TA:  J Heart Lung Transplant     Country:  United States    
Other Details:
Languages:  eng     Pagination:  957-65     Citation Subset:  IM    
Copyright Information:
Copyright 2010 International Society for Heart and Lung Transplantation. All rights reserved.
Affiliation:
Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, UK.
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MeSH Terms
Descriptor/Qualifier:
Brain Death*
Catecholamines / metabolism,  toxicity
Electrocardiography
Heart Failure / pathology
Heart Transplantation / mortality*
Heart Ventricles / pathology
Humans
Myocardial Stunning / chemically induced
Organ Size
Stroke Volume
Takotsubo Cardiomyopathy / chemically induced,  complications*,  pathology
Tissue Donors
Ventricular Dysfunction / etiology*
Ventricular Dysfunction, Left / complications
Ventricular Dysfunction, Right / complications
Chemical
Reg. No./Substance:
0/Catecholamines

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


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