Donor cardiac troponin-I: a biochemical surrogate of heart function☆☆☆

Abstract

The donor cTnI level represents a biochemical surrogate of functional donor heart assessment. High cTnI is associated with worse donor heart function and may act as a prompt for detailed assessment and optimisation.

Temporal Changes in Left Ventricular Systolic Function and Use of Echocardiography in Adult Heart Donors

“…This finding correlates with the hypothesized pathophysiology of brain death-induced cardiac dysfunction, in which increased catecholamine release results in a stunned myocardium that can be potentially reversed with intensive donor management and a prolonged recovery phase [24,25]. Further studies are required in order to determine an optimal time from brain death to EF evaluation to allow for greater utilization of cardiac dysfunctional hearts.…”

N-terminal pro-brain-type natriuretic peptide: a biochemical surrogate of cardiac function in the potential heart donor☆☆☆

“…Several studies have identified a shorter time from coning to be associated with worse ventricular function and greater troponin release [18]. The down-sloping correlation between NT-proBNP levels and time from coning in this study supports the postulate that cardiac dysfunction following BSD may be a time-dependent recoverable phenomenon or alternatively a simple marker of time from brain injury.…”

“…These will provide both an indication of cardiac function and the likelihood that a heart will become suitable for transplantation following a period of donor optimisation. Candidate biomarkers include NT-proBNP or BNP [10], troponins [10,17,18], procalcitonin [19,20] and the cytokines, tumour necrosis factor-a and interleukin-6 [20,21]. Whether individual biomarkers of cardiac stress, injury or inflammation provide superior discrimination is not yet known.…”

Assessment of the Potential Heart Donor

“…As traumatic brain death is declining, the fraction of brain death from intracranial hemorrhage is increasing, along with an increase in the mean age of the eligible donor pool, increasing from 23 years in 1983 to 30 years in 2005 to 2007. Although the mean age remains only 30 years, the proportion of donors older than 50 years now makes up 12% of the donor population, and this underscores the importance of careful donor assessment (2)(3)(4). Although older donor hearts can be safely transplanted, increasing donor age worsens post-transplantation prognosis at 1 and 5 years (2) and is associated with an increasing prevalence of donor coronary artery disease.…”

“…However, ventricular dysfunction may be transient (8,9), and arbitrary thresholds of LV function may exclude hearts that could be resuscitated to transplantable status. This exclusion is compounded by the fact that in practice, pulmonary artery catheter assessment, although defining the hemodynamic status of the donor heart and facilitating management of ventricular filling and afterload (3,10), is usually reserved for the heart donor already provisionally accepted for transplantation and attended by a retrieving team. However, the achievement of defined hemodynamic performance criteria of mean arterial pressure Ͼ60 mm Hg, central venous and pulmonary capillary wedge pressures Ͻ12 mm Hg with cardiac indices Ն2.4 l·min Ϫ1 m Ϫ2 and normal vascular resistance is associated with very satisfactory outcomes and appears to be the cornerstone of the final assessment of donor pre-retrieval (8,11).…”