Author + information
- Shivank Madan, MD, MHA,
- Daniel Sims, MD,
- Omar Saeed, MD,
- Snehal R. Patel, MD and
- Ulrich P. Jorde, MD∗ ()
- ↵∗Division of Cardiology, Montefiore Medical Center, Medical Arts Pavilion-7A, 3400 Bainbridge Avenue, Bronx, New York 10467
We thank Dr. Madias and Dr. El-Battrawy et al. for their thoughtful comments on our recently published study (1), which showed that donor hearts with left ventricular systolic dysfunction (LVSD) that are successfully resuscitated can be transplanted without increasing recipient mortality, cardiac allograft vasculopathy, or primary graft failure. Considering that up to 25% of donor hearts may be rejected for LVSD, our study highlights the importance of donor management and the potential for increasing donor organ utilization rates for such hearts.
In our study, of the 472 donor hearts with LVSD on the initial transthoracic echocardiogram (TTE), 123 (26%) had significant regional wall motion abnormalities (RWMA), and the remaining 349 (74%) had diffuse hypokinesis without significant RWMA. Of the 123 donor hearts with significant RWMA, 11 had typical Takotsubo syndrome (TTS)–like pattern with apical to midventricular hypokinesis, 30 had base to midventricular hypokinesis with relative sparing of the apex or “reverse TTS” pattern, and 8 had midventricular hypokinesis on the initial TTE. The remaining 74 of 123 donor hearts with RWMA did not have TTS-like features.
Furthermore, although there may be a certain degree of overlap in the pathophysiology of TTS cardiomyopathy and LVSD seen in the hearts of brain dead organ donors (2), the TTS cardiomyopathy typically occurs in postmenopausal elderly females, is usually preceded by an emotional or physical trigger, and commonly involves apical ballooning (3). In contrast, our study found that of donor hearts with LVSD that eventually improved and were transplanted, 27% belonged to female donors, and the majority had either diffuse hypokinesis or heterogeneous RWMA on TTE. Although there may be an inherent selection bias in our cohort, TTS and donor LVSD in the presence of brain death are perhaps variations in a spectrum of diseases with an underlying brain–heart connection.
In response to the comments by Dr. El-Battrawy and colleagues about different types of TTS being associated with different patient outcomes, our present study only evaluated the outcomes of donor hearts with improved LVSD after transplantation, and thus should not be compared to the existing published data about outcomes in patients with TTS.
Please note: The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- 2018 American College of Cardiology Foundation