Echocardiographic surrogate of left ventricular stroke work in a model of brain stem death donors

Kei Sato; Louise See Hoe; Jonathan Chan; Nchafatso G Obonyo; Karin Wildi; Silver Heinsar; Sebastiano M Colombo; Carmen Ainola; Gabriella Abbate; Noriko Sato; Margaret R Passmore; Mahe Bouquet; Emily S Wilson; Kieran Hyslop; Samantha Livingstone; Andrew Haymet; Jae-Seung Jung; Kris Skeggs; Chiara Palmieri; Nicole White; David Platts; Jacky Y Suen; David C McGiffin; Gianluigi Li Bassi; John F Fraser

doi:10.1111/eci.14259

Echocardiographic surrogate of left ventricular stroke work in a model of brain stem death donors

Eur J Clin Invest. 2024 Oct;54(10):e14259. doi: 10.1111/eci.14259. Epub 2024 Jun 6.

Authors

Kei Sato^{1

2}, Louise See Hoe^{1

2

3}, Jonathan Chan^{4

5}, Nchafatso G Obonyo^{1

2

6

7}, Karin Wildi^{1

2

8}, Silver Heinsar^{1

2

9}, Sebastiano M Colombo^{1

2

10}, Carmen Ainola^{1

2}, Gabriella Abbate^{1

2}, Noriko Sato^{1

2}, Margaret R Passmore^{1

2}, Mahe Bouquet^{1

2}, Emily S Wilson^{1

2}, Kieran Hyslop^{1

2}, Samantha Livingstone^{1

2}, Andrew Haymet^{1

2}, Jae-Seung Jung^{1

2

11}, Kris Skeggs^{1

12}, Chiara Palmieri¹³, Nicole White^{1

14}, David Platts^{1

2}, Jacky Y Suen^{1

2

3}, David C McGiffin^{1

15

16}, Gianluigi Li Bassi^{1

2

17

18}, John F Fraser^{1

2}

Affiliations

¹ Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia.
² Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.
³ School of Pharmacy and Medical Sciences, Griffith University, Southport, Queensland, Australia.
⁴ Division of Cardiology, The Prince Charles Hospital, Brisbane, Queensland, Australia.
⁵ School of Medicine, Griffith University, Gold Coast, Queensland, Australia.
⁶ Wellcome Trust Centre for Global Health Research, Imperial College London, London, UK.
⁷ Initiative to Develop African Research Leaders (IDeAL)/KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.
⁸ Cardiovascular Research Institute Basel, Basel, Switzerland.
⁹ Department of Intensive Care, North Estonia Medical Centre, Tallinn, Estonia.
¹⁰ Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy.
¹¹ Department of Thoracic and Cardiovascular Surgery, College of Medicine, Korea University, Seoul, Republic of Korea.
¹² Princess Alexandra Hospital, Brisbane, Queensland, Australia.
¹³ Faculty of Science, School of Veterinary Science, University of Queensland, Gatton, Queensland, Australia.
¹⁴ Faculty of Health, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia.
¹⁵ Cardiothoracic Surgery and Transplantation, The Alfred Hospital, Melbourne, Victoria, Australia.
¹⁶ The Department of Surgery, Monash University, Melbourne, Victoria, Australia.
¹⁷ Intensive Care Units, St Andrew's War Memorial Hospital, The Wesley Hospital, Uniting Care Hospitals, Brisbane, Queensland, Australia.
¹⁸ Medical Faculty, Queensland University of Technology, Brisbane, Queensland, Australia.

Abstract

Background: The commonest echocardiographic measurement, left ventricular ejection fraction, can not necessarily predict mortality of recipients following heart transplantation potentially due to afterload dependency. Afterload-independent left ventricular stroke work index (LVSWI) is alternatively recommended by the current guideline; however, pulmonary artery catheters are rarely inserted in organ donors in most jurisdictions. We propose a novel non-invasive echocardiographic parameter, Pressure-Strain Product (PSP), as a potential surrogate of catheter-based LVSWI. This study aimed to investigate if PSP could correlate with catheter-based LVSWI in an ovine model of brain stem death (BSD) donors. The association between PSP and myocardial mitochondrial function in the post-transplant hearts was also evaluated.

Methods: Thirty-one female sheep (weight 47 ± 5 kg) were divided into two groups; BSD (n = 15), and sham neurologic injury (n = 16). Echocardiographic parameters including global circumferential strain (GCS) and global radial strain (GRS) and pulmonary artery catheter-based LVSWI were simultaneously measured at 8-timepoints during 24-h observation. PSP was calculated as a product of GCS or GRS, and mean arterial pressure for PSP_circ or PSP_rad, respectively. Myocardial mitochondrial function was evaluated following 6-h observation after heart transplantation.

Results: In BSD donor hearts, PSP_circ (n = 96, rho = .547, p < .001) showed the best correlation with LVSWI among other echocardiographic parameters. PSP_circ returned AUC of .825 to distinguish higher values of cardiomyocyte mitochondrial function (cut-off point; mean value of complex 1,2 O₂ Flux) in post-transplant hearts, which was greater than other echocardiographic parameters.

Conclusions: PSP_circ could be used as a surrogate of catheter-based LVSWI reflecting mitochondrial function.

Keywords: brain stem death; heart transplantation; left ventricular stroke work; speckle‐tracking echocardiography.

MeSH terms

Animals
Brain Death* / diagnostic imaging
Brain Death* / physiopathology
Echocardiography*
Female
Heart Transplantation*
Mitochondria, Heart / metabolism
Sheep
Stroke Volume* / physiology
Tissue Donors
Ventricular Function, Left / physiology

Abstract

MeSH terms

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