Echocardiographic Characteristics Associated with Left Ventricular Recovery in Donor Hearts

Abstract

Purpose There is a significant unmet patient need for heart transplantation that is in part driven by low donor heart utilization, with left ventricular (LV) systolic dysfunction the most common reason for non-allocation. Previous studies have shown a significant proportion of donors will have transient LV dysfunction, and these allocated hearts have no difference in post-transplant outcomes. We reviewed our OPO's protocol-driven management at a centralized diagnostic and recovery center to identify echocardiographic features associated with donor LV recovery. Methods A retrospective study of all potential donors managed at a single OPO between 2015-2017 with reduced initial LV ejection fraction (LVEF) ≤ 40%. Donors were divided into (1) LV recovery and (2) no recovery based on if subsequent echocardiogram revealed LVEF ≥ 50%. All donor echocardiograms were read by a single reader, including global longitudinal strain (GLS) analysis, to identify echocardiographic measures associated with recovery. Results 54 donors were included in this analysis, of which 29 (54%) had LV recovery, while 25 (54%) donors did not have LV recovery. Donors with LV recovery had a higher initial LVEF and trended towards having increased fractional shortening (FS) and LVOT VTI; they also had greater overall LVEF improvement. Donors with LV recovery had greater average LV GLS, right ventricle (RV) global and free wall longitudinal strain. However, when normalized for initial LVEF, strain was not independently associated with LV recovery. Conclusion In our experience managing potential donors at a centralized OPO, we found multiple echocardiographic measures were associated with LV recovery, including initial LVEF and both LV and RV GLS. However, strain did not seem to offer additional information, as it was not associated with recovery when normalized for initial LVEF. Additional work will further our ability to predict donors who will recover ventricular function and thus expand the cardiac donor pool.