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Cardiac Transplantation Using Hearts With Transient Dysfunction: Role of Takotsubo-Like Phenotype.
- Source :
- Annals of Thoracic Surgery; Jul2020, Vol. 110 Issue 1, p76-84, 9p
- Publication Year :
- 2020
-
Abstract
- The impact of different types of regional wall motion abnormalities (RWMAs), including the Takotsubo syndrome–like (TTS-like) phenotype, on posttransplant outcomes when using donor hearts with transient left ventricular systolic dysfunction (LVSD) is unknown. We evaluated the prevalence, clinical characteristics, and prognostic association of different RWMAs including TTS-like hypokinesis and posttransplant outcomes when using donor hearts with transient LVSD. From all adult (≥18 years) heart transplants in United Network of Organ Sharing between January 2007 and September 2015, we identified 472 donor hearts with improving or transient LVSD, defined as left ventricular ejection fraction ≤ 40% on initial transthoracic echocardiogram (TTE) that improved to ≥50% on follow-up TTE during donor evaluation. These improved LVSD donors were then subdivided into 3 groups based on RWMAs on the initial TTE, TTS-like (49, 10.38%), non-TTS RWMAs (74, 15.68%), and diffuse global hypokinesis (349, 73.94%), and compared for baseline characteristics and posttransplant outcomes with follow up until June 2018. Donors with TTS-like LVSD were older and more likely to be female. The type of RWMA on initial TTE (including TTS-like) of transient LVSD donor hearts was not associated with 1-year or 5-year posttransplant mortality. Posttransplant functional status scores of recipients (at 1 year) and donor left ventricular ejection fraction (at median follow-up of 3.6 years) improved in all 3 subgroups. Rates of stroke or pacemaker predischarge were also similar. In the largest analysis of transplanted donor hearts with transient LVSD, 1 in 4 had RWMAs on the initial TTE, but this was not associated with adverse posttransplant outcomes. Donor hearts with initial LVSD should be pursued irrespective of TTS-like hypokinesis or other RWMAs. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 00034975
- Volume :
- 110
- Issue :
- 1
- Database :
- Supplemental Index
- Journal :
- Annals of Thoracic Surgery
- Publication Type :
- Academic Journal
- Accession number :
- 143799136
- Full Text :
- https://doi.org/10.1016/j.athoracsur.2019.09.101