Article

Electrocardiographic Characteristics of Potential Organ Donors and Associations With Cardiac Allograft Use

Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305-5406, USA.
Circulation Heart Failure (Impact Factor: 5.95). 05/2012; 5(4):475-83. DOI: 10.1161/CIRCHEARTFAILURE.112.968388
Source: PubMed

ABSTRACT Current regulations require that all cardiac allograft offers for transplantation must include an interpreted 12-lead electrocardiogram (ECG). However, little is known about the expected ECG findings in potential organ donors or the clinical significance of any identified abnormalities in terms of cardiac allograft function and suitability for transplantation.
A single experienced reviewer interpreted the first ECG obtained after brain stem herniation in 980 potential organ donors managed by the California Transplant Donor Network from 2002 to 2007. ECG abnormalities were summarized, and associations between specific ECG findings and cardiac allograft use for transplantation were studied. ECG abnormalities were present in 51% of all cases reviewed. The most common abnormalities included voltage criteria for left ventricular hypertrophy, prolongation of the corrected QT interval, and repolarization changes (ST/T wave abnormalities). Fifty-seven percent of potential cardiac allografts in this cohort were accepted for transplantation. Left ventricular hypertrophy on ECG was a strong predictor of allograft nonuse. No significant associations were seen among corrected QT interval prolongation, repolarization changes, and allograft use for transplantation after adjusting for donor clinical variables and echocardiographic findings.
We have performed the first comprehensive study of ECG findings in potential donors for cardiac transplantation. Many of the common ECG abnormalities seen in organ donors may result from the heightened state of sympathetic activation that occurs after brain stem herniation and are not associated with allograft use for transplantation.

0 Followers
 · 
102 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: La mort encéphalique (ME) est susceptible d’entraîner une dysfonction cardiocirculatoire, par l’intermédiaire de différents mécanismes résultant de l’ischémie cérébrale: orage catécholaminergique, dysfonction neurohormonale et inflammation systémique. Cette dysfonction cardiovasculaire est potentiellement exacerbée par les antécédents du potentiel donneur décédé en mort encéphalique (DDME) et le contexte clinique dans lequel survient la ME. La détection et la prise en charge d’une défaillance hémodynamique survenant dans ce contexte sont cruciales dans le but de préserver la viabilité des greffons potentiels, mais aussi de tenter d’en améliorer la qualité et d’en augmenter le nombre. Cette prise en charge hémodynamique nécessite de connaître la physiopathologie de la ME et d’utiliser un monitorage. Elle repose sur l’administration d’agents inotropes en cas de dysfonction myocardique, la correction d’une hypovolémie et l’administration d’amines vasopressives. En l’état actuel, une opothérapie substitutive (hormones thyroïdiennes, glucocorticoïdes) ne peut être recommandée. Les principales mesures associées indispensables sont: la correction des désordres électrolytiques et métaboliques, la lutte contre l’hypothermie et le traitement d’un diabète insipide. Une réanimation « agressive » du potentiel DDME doit être poursuivie jusqu’au clampage aortique au bloc opératoire. Le sujet en ME, potentiel donneur d’organe(s), doit être considéré comme un « patient » de réanimation à part entière. Abstract During brain death (BD) process, several mechanisms may induce cardio-circulatory failure. These mechanisms are secondary to brain ischemia and involve a catecholamine storm, a systemic inflammatory state and a hormonal dysfunction. Donor past history and associated medical context may worsen the hemodynamic failure. Objectives of early recognition and treatment of cardiocirculatory failure in potentials BD donors are: to preserve the viability of the potential grafts, to improve organ’s function and to increase the number of recovered organs. Hemodynamic resuscitation is principally based on the use of inotropic agents in case of myocardial dysfunction, the correction of hypovolemia and the use of vasopressors (norepinephrine) adapted using a cardiovascular monitorage. Systematic hormone therapy is still debated. Associated supportive treatment includes correction of metabolic and electrolytic disorders, avoidance of hypothermia and management of diabetes insipidus. Aggressive management must be conducted until aortic clamping during organ recovery in operating room. Potential BD donor must be managed like any other intensive care unit patient.
    Réanimation 03/2015; 24(2). DOI:10.1007/s13546-015-1055-5
  • Source
    Journal of electrocardiology 11/2013; 46(6):618. DOI:10.1016/j.jelectrocard.2013.09.015 · 1.36 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Cardiac transplantation is the best treatment available for patients with end-stage cardiomyopathy. Shortage of donor hearts is the main factor limiting the use of this treatment. Many donor hearts are rejected for transplantation because of left ventricular (LV) systolic dysfunction and/or wall motion abnormalities. While some donors have true cardiomyopathy, a significant proportion has reversible LV dysfunction due to neurogenic stunned myocardium. This condition is triggered by excess of catecholamines, which is typical for brain-dead donors. If given time to recover, LV function may improve, and the heart will be suitable for transplantation. Moreover, limiting of exogenous catecholamines may facilitate the recovery. In this review, we summarize the data on LV dysfunction/wall motion abnormalities in heart donors and propose the strategy to increase the utilization of donor hearts.
    Heart Failure Reviews 05/2014; DOI:10.1007/s10741-014-9434-y · 3.99 Impact Factor