Abstract
Background
Heart transplantation (HTx) after donation after circulatory death (DCD) is an expanding
practice but is associated with increased warm ischemic time. The impact of DCD HTx
on cardiac mechanics and myocardial fibrosis has not been reported. We aimed to compare
cardiac mechanics and myocardial fibrosis using cardiovascular magnetic resonance
(CMR) imaging in donation after brain death (DBD) and DCD HTx recipients and healthy
controls.
Methods and Results
Consecutive HTx recipients between March 2015 and March 2021 who underwent routine
surveillance CMR imaging were included. Cardiac mechanics were assessed using CMR
feature tracking to compute global longitudinal strain, global circumferential strain,
and right ventricular free-wall longitudinal myocardial strain. Fibrosis was assessed
using late gadolinium enhancement imaging and estimation of extracellular volume.
There were 82 (DBD n = 42, DCD n = 40) HTx recipients (aged 53 years, interquartile range 41–59 years, 24% female)
who underwent CMR imaging at median of 9 months (interquartile range 6–14 months)
after transplantation. HTx recipients had increased extracellular volume (29.7 ± 3.6%)
compared with normal ranges (25.9%, interquartile range 25.4–26.5). Myocardial strain
was impaired after transplantation compared with controls (global longitudinal strain
–12.6 ± 3.1% vs –17.2 ± 1.8%, P < .0001; global circumferential strain –16.9 ± 3.1% vs –19.2 ± 2.0%, P = .002; right ventricular free-wall longitudinal strain –15.7 ± 4.5% vs –21.6 ± 4.7%,
P < .0001). There were no differences in fibrosis burden (extracellular volume 30.6
± 4.4% vs 29.2 ± 3.2%; P = .39) or cardiac mechanics (global longitudinal strain –13.1 ± 3.0% vs –12.1 ± 3.1%,
P = .14; global circumferential strain –17.3 ± 2.9% vs –16.6 ± 3.1%, P = .27; right ventricular free-wall longitudinal strain –15.9 ± 4.9% vs –15.5 ± 4.1%,
P = .71) between DCD and DBD HTx.
Conclusions
HTx recipients have impaired cardiac mechanics compared with controls, with increased
myocardial fibrosis. There were no differences in early CMR imaging characteristics
between DBD and DCD heart transplants, providing further evidence that DCD and DBD
HTx outcomes are comparable.
Key Words
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References
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Article info
Publication history
Published online: December 12, 2022
Accepted:
November 28,
2022
Received in revised form:
November 11,
2022
Received:
October 1,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
Crown Copyright © 2022 Published by Elsevier Inc. All rights reserved.
