Heart transplant systolic and diastolic function is impaired by prolonged pretransplant graft ischaemic time and high donor age: an echocardiographic study

OBJECTIVES Due to the need for suitable donors for heart transplantation (HTx), older grafts and grafts with prolonged graft ischaemic time (GIT) are accepted. The impact of GIT and donor age on post-transplant cardiac function has not been examined with either newer echocardiographic techniques (tissue Doppler imaging, TDI) or cardiopulmonary exercise testing (CPET). Thus, we studied the influence of GIT and donor age on post-transplant cardiac function and exercise capacity. METHODS Fifty-two stable recipients underwent echocardiography with colour TDI and CPET at a median of 4 years after HTx. Left ventricular (LV) systolic (s′) and early diastolic (e′) mitral annular velocities, right ventricular (RV) s′, RVe′ as well as LV ejection fraction (EF) and VO2peak were analysed. RESULTS HTx recipients with GIT ≥ median value (200 min) had significantly lower septal LVs′ (15%, P = 0.005), LVEF (9%, P = 0.015), RVs′ (21%, P = 0.007), septal LVe′ (22%, P = 0.001) and RVe′ velocities (23%, P = 0.011), and slightly lower VO2peak (P = 0.098). Recipients with grafts from donor ≥median age (37 years) had significantly lower LVe′ velocities (septal LVe′ P = 0.047 and lateral LVe′ P = 0.010), but not LV systolic or RV parameters. CONCLUSIONS Prolonged GIT impairs both systolic and diastolic function at the interventricular septum and RV free wall, while increasing donor age impairs LV diastolic function. The duration of graft ischaemia and donor age should be taken into account when evaluating for cardiac dysfunction in HTx recipients.