HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Rajamiyer V. Venkateswaran Joyce Thekkudan Ian C. Wilson Jorge Mascaro Richard Thompson Robert Stuart Bonser Permission Requests Google Scholar Articles by Venkateswaran, R. V. Articles by Bonser, R. S. PubMed Articles by Venkateswaran, R. V. Articles by Bonser, R. S. Related Collections Transplantation - heart

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

^a Department of Heart and Lung Transplantation, University Hospital Birmingham NHS Trust, Birmingham, UK
^b Department of Cardiology, University Hospital Birmingham NHS Trust, Birmingham, UK
^c University of Birmingham, Birmingham, UK

Received 20 September 2008; received in revised form 14 February 2009; accepted 20 February 2009.

^_* Corresponding author. Address: Department of Cardiothoracic Surgery, University Hospital Birmingham NHS Foundation Trust, Edgbaston, Birmingham B15 2TH, UK. Tel.: +44 121 627 2543; fax: +44 121 627 2542. (Email: robert.bonser{at}uhb.nhs.uk).

Objective: Cardiac troponin-I (cTnI) levels in the potential heart transplant donor may be a marker of heart dysfunction and predictive of recipient outcome. We studied the prevalence of cTnI elevation, its association with heart function and usability and its relationship with the time duration from coning. Methods: In a prospective study, cTnI measurement, Swan–Ganz catheterisation and transthoracic echocardiography were performed at initial assessment in 79 potential heart donors (mean age 43 ± 13.1 years). All donors were then managed according to a strict algorithm to optimise cardiac function, some receiving hormonal therapy as part of a randomised trial. Donor heart suitability for transplantation was assessed after 7 h of management. The association of cTnI with initial functional indices was assessed and outcome compared for donors categorised according to cTnI level 1 µg l^–1 or >1 µg l^–1. Results: Serum cTnI levels negatively correlated with initial cardiac index (CI) (p = 0.003), right (p < 0.001) and left ventricular ejection fraction (p = 0.001) and positively with LV Tei index (p = 0.003). Serum cTnI was >1 µg l^–1 in 29/79 donors. Higher CVP (10 ± 5.1 vs 7.9 ± 2.9; p = 0.026) and PAWP (12 ± 5.4 vs 8.1 ± 3.1; p = 0.002), lower cardiac index (2.7 ± 1.1 vs 3.6 ± 0.9; p = 0.001) and fractional shortening (p < 0.01) and worse wall motion score index (p < 0.01) were observed in the cTnI >1 µg l^–1 group. CTnI and functional markers correlated with the time duration from coning. Conclusion: 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.

Key Words: Cardiac troponin-I • Heart transplantation • Donor management