- 作者：Ornella Leone ; Sonia Gherardi ; Luigi Targa ; Emilio Pasanisi ; Piero Mikus ; Piero Tanganelli ; Massimo Maccherini ; Giorgio Arpesella ; Eugenio Picano ; Tonino Bombardini
- 刊名：The Journal of Heart and Lung Transplantation
- 出版年：2009
- 出版时间：November 2009
- 年：2009
- 卷：28
- 期：11
- 页码：1141-1149
- 全文大小：1589 K
Background
Owing to the shortage of donor hearts, the criteria for acceptance have been considerably expanded. Pharmacologic stress echocardiography is highly accurate in identifying prognostically significant coronary artery disease, but brain death and catecholamine storm in potential heart donors may substantially alter the cardiovascular response to stress. This study assessed correlates of an abnormal resting/stress echocardiography results in potential donors.Methods
From April 2005 to December 2007, 18 marginal candidate donors (9 men) aged 58 ± 5 years were initially enrolled. After legal declaration of brain death, all marginal donors underwent bedside echocardiography, with baseline and (when resting echocardiography was normal) dipyridamole (0.84 mg/kg in 6 min) or dobutamine (up to 40 μg/kg/min) stress echo. Non-eligible hearts (with abnormal rest or stress echo findings) were excluded and underwent cardioautoptic verification.
Results
Resting echocardiography showed wall motion abnormalities in 5 patients (excluded from donation). Stress echocardiography was performed in the remaining 13 (dipyridamole in 11; dobutamine in 2). Results were normal in 7, of which 6 were uneventfully transplanted in marginal recipients. Results were abnormal in 6, and autoptic verification performed showed coronary artery disease in 5, and initial cardiomyopathy in 1.
Conclusions
Bedside pharmacologic stress echocardiography can safely be performed in candidate heart donors, is able to unmask occult coronary artery disease or cardiomyopathy, and shows potential to extend donor criteria in heart transplantation. Further experience with using marginal donors is needed before exact guidelines can be established.