A NEW study has found that echocardiographically measured donor left ventricular mass (LVM) is more accurate for heart size matching in transplants, reducing the risk of adverse one-year outcomes compared to traditional methods.
Heart transplantation relies on precise donor-recipient size matching to ensure successful outcomes. The predicted heart mass (PHM) ratio is often used for this purpose but may not perform well in cases of donor or recipient obesity. This study explored whether echocardiographically measured LVM, compared to the PHM ratio, offers improved predictive accuracy for the risk of death or retransplantation within one year of surgery.
Researchers conducted the Donor Heart Study, a prospective, multicenter cohort study that analysed echocardiograms from 2,015 brain-dead donors. The donor’s measured LVM was compared to the recipient’s predicted LVM to calculate the measured LVM ratio. Undersized matches (<0.80) were associated with a 47% higher risk of the composite outcome (adjusted hazard ratio [aHR]: 1.47; 95% CI: 1.01-2.15), while oversized matches (>1.20) had a 58% increased risk (aHR: 1.58; 95% CI: 1.05-2.37). Nonlinear modelling revealed a U-shaped relationship between the measured LVM ratio and the risk of poor outcomes. In contrast, PHM and predicted LVM ratios were not associated with outcomes, indicating that the measured LVM ratio offers superior predictive power, particularly in obese recipients.
This study suggests that echocardiographic measurement of donor LVM should be integrated into clinical practice to enhance donor-recipient matching and improve post-transplant outcomes. The findings are particularly relevant for obese recipients, where traditional methods may fail to predict risk accurately. Future research should focus on refining these measures and exploring their application across diverse patient populations. Enhanced tools for heart size matching could transform transplantation protocols, offering more personalised approaches and better patient survival rates.
Katrina Thornber, EMJ
Reference
O’Donnel C et al. The association of echocardiographically measured donor left ventricular mass and 1-year outcomes after heart transplantation. J Am Coll Cardiol HF. 2025;13(1):118-30.
