Evaluation of left and right heart function by echocardiography in potential heart donors: a cohort study
CCCF ePoster library. Serri K. Nov 1, 2016; 150950; 70
Karim Serri
Karim Serri
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Topic: Retrospective or Prospective Cohort Study

Evaluation of left and right heart function by echocardiography in potential heart donors: a cohort study


Frenette, Anne Julie; Veillette, Charles; Williamson David, Serri, Karim; Charbonney, Emmanuel



Abstract:

Introduction: Myocardial dysfunction, classically defined as abnormal left ventricular ejection fraction (LVEF), is a well-described phenomenon among brain dead organ donors. Cardiac dysfunction often precludes retrieval and transplantation of hearts to waiting list patients. Moreover, RV dysfunction post transplant is frequent and may be related to RV failure in the donor. Studies evaluating cardiac dysfunction have reported rates ranging from 26 to 42%, but often lack precision and include unclear populations, making comparison between studies and population difficult. Also, definition of cardiac dysfunction varies among studies that use different LVEF cut offs and sometimes include regional wall motion abnormalities in the definition. In addition, dysfunction of the right ventricle (RV) is less well described, often not reported, even though it may also have an impact on the recipient’s outcome.  Over the past years, efforts have been made to improve management of donors in order to increase the quality and number of individual organs, including the heart. The impact of the evolution of practices on the incidence of cardiac dysfunction is unknown.
Objectives: The primary objective was to report the incidence of abnormal LVEF among a cohort of potential heart donors. The secondary objective was to characterize right ventricular function.
Methods: We retrospectively analyzed the echocardiographic results of all consecutive potential heart donors admitted to a tertiary referral centre with expertise in organ donation from 2009 to 2016. Precision on incidence was calculated on the number of potential heart donors with available echocardiography results with a confidence interval of 95%. A cardiologist with a specialty in echocardiography adjudicated all echocardiographic results.
Results: Medical charts of all potential organ donors between January 2009 and July 2016 were reviewed (n= 509). Among these patients, 184 potential heart donors were identified. At least one echocardiography report was available for 144 patients.  Patients had a median age of 45 years and 67% of them were men. Previous to brain death, 67% of included patients suffered from traumatic brain injury and 27% had non-traumatic intracranial bleed. Other causes of death included ischemic stroke and brain anoxia. When using a definition of myocardial dysfunction of LVEF lower than 50%, the incidence was 25.7 (95%CI 18.6% to 32.8%). Right ventricular systolic function was not calculated for all patients. However out of the 72 patients with available data, 24 had abnormal RV function (33.3%).
Conclusion: Incidence of left heart dysfunction remains high among potential heart donors although it varies according to definition.  The frequency of RV dysfunction, although scarcely reported in the literature, may be even higher. Future studies should aim at prospectively evaluating the incidence of RV dysfunction and its impact on transplantation outcomes and at studying new strategies that could optimize both left and right heart function in donors.
 


References:

Borbely et al. Neurocrit Care 2015 23:66-71
Krishnamoorthy et al. Ped Crit Care Med 2015;16e107-e112
Dujardin et al. J Heart & Lung Transplant 2001;20:350-357
Hartmuth et al. Ann Thor Surg 1999;68: 1605-11
 



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