Impact of Donor Left Ventricular Geometric Remodeling and Hypertrophy on Heart Acceptance and Recipient Survival

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BACKGROUND: Current guidelines recommend screening donor hearts for hypertrophy using solely left ventricular (LV) wall thickness measurements, but this does not capture the type of LV geometric remodeling. Remodeling patterns have been shown to be predictive of clinical outcomes in many cardiovascular diseases but have not been evaluated in donor heart assessment. OBJECTIVES: The purpose of this study was to describe the prevalence and clinical impact of geometric remodeling patterns in brain-dead donor heart acceptance and recipient survival. METHODS: The DHS (Donor Heart Study) collected echocardiograms from brain-dead donors across the United States from February 2015 to May 2020. Donor hearts were classified by LV geometric remodeling patterns using ASE (American Society of Echocardiography) guidelines and were compared with LV wall thickness measurements of >1.3 cm for the association with transplant acceptance and 3-year recipient mortality, using multivariable modeling. RESULTS: Concentric remodeling (58.5%) was the most common geometric remodeling pattern in 3,647 brain dead donors. Donor hearts with increased LV wall thickness (>1.3 cm) were more likely reclassified as concentric remodeling (52.1%) than concentric hypertrophy (43.8%). Donors with nonacceptance surveys (n = 1,874) commonly (20.3%) had LV hypertrophy listed as a reason for rejection, but most of those hearts had normal geometry (10.8%) or concentric remodeling (60.0%). Neither increased LV wall thickness (adjusted HR [aHR]: 0.94; 95% CI: 0.73-1.21), concentric remodeling (aHR: 1.13; 95% CI: 0.86-1.47), nor concentric hypertrophy (aHR: 0.64; 95% CI: 0.35-1.15) correlated with 3-year recipient survival. CONCLUSIONS: Classifying donor hearts using LV geometric remodeling patterns may reduce the number turned down for "hypertrophy" without compromising recipient survival.

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