Temporal changes in left ventricular systolic function in heart donors: results of serial echocardiography

Echocardiographic detection of dysfunctions in donor hearts

Heart transplantation activity is steadily declining worldwide, despite initiatives to increase the donor pool. The yield of transplantable hearts remains low, leading to wastage of over two-thirds of donor organs. Accurate assessment and intervention is required to increase the number of transplantable hearts. The retrieval rate could be increased if techniques become available to differentiate between transplantable and nontransplantable hearts. Echocardiography is an ideally suited noninvasive investigation that may guide donor optimization. However, there are technical difficulties in acquiring high-quality views, and changes in ventricular function following catecholamine storm in brainstem death often lead to misinterpretation of standard 2D images. Current advances in technology, including the routine use of left ventricular contrast, 3D imaging and tissue doppler studies, may improve the accuracy, and thereby the utilization, of echocardiography in donor heart assessment.

Prospective analysis of prevalence, distribution, and rate of recovery of left ventricular systolic dysfunction in patients with subarachnoid hemorrhage

OBJECT

Subarachnoid hemorrhage (SAH) has been associated with cardiac injury and left ventricular (LV) dysfunction. The incidence and natural history of neurocardiogenic injury after SAH remains poorly understood. The objective of this study was to describe the incidence, time course, recovery rate, and segmental patterns of LV dysfunction after SAH.

METHODS

Echocardiography was performed three times over a 7-day period in 173 patients with SAH. The incidence of global (ejection fraction [EF] < 50%) and segmental (any regional wall-motion abnormality [RWMA]) LV dysfunction was measured. The time course of LV dysfunction was determined by comparing the prevalence of LVEF less than 50% and RWMA at 0 to 2, 3 to 5, and 6 to 8 days after SAH. The recovery rate was defined as the proportion of patients with partial or complete normalization of function. The distribution of RWMAs among 16 LV segments was also determined. An LVEF less than 50% was found in 15% of patients, and 13% had an RWMA with a normal LVEF. There was a trend toward increased dysfunction at 0 to 2 days after SAH, compared with 3 to 8 days after SAH. Recovery of LV function was observed in 66% of patients. The most frequently abnormal LV segments were the basal and middle ventricular portions of the anteroseptal and anterior walls. The apex was rarely affected.

CONCLUSIONS

Left ventricular systolic dysfunction occurs frequently after SAH and usually improves over time. The observed segmental patterns of LV dysfunction often do not correlate with coronary artery distributions.