BACKGROUND Donor-recipient heart size matching is crucial in heart transplantation; however, the often-used predicted heart mass (PHM) ratio may be inaccurate in the setting of obesity. OBJECTIVES In this study, the authors sought to investigate the association between echocardiographically measured donor left ventricular mass (LVM) for heart size matching and the risk of the primary 1-year composite outcome of death or retransplantation. METHODS The Donor Heart Study was a prospective, multicenter, observational cohort study that collected echocardiograms from brain-dead donors. The measured LVM ratio (donor measured LVM/recipient predicted LVM) was defined as the exposure variable, and the association with the primary outcome was analyzed with Cox proportional hazard modeling. Secondary analyses evaluated the association of the PHM and predicted LVM (donor predicted LVM/recipient predicted LVM) ratios with the primary outcome. RESULTS In 2,015 heart transplants, the measured LVM ratio demonstrated that undersized matches (<0.80) had a 47% higher risk (adjusted HR [aHR]: 1.47; 95% CI: 1.01-2.15) and oversized (>1.20) matches had a 58% increased risk (aHR: 1.58; 95% CI: 1.05-2.37) of the 1-year composite outcome compared with ideally matched transplants. However, the PHM and predicted LVM ratios were not associated with the primary outcome. Nonlinear modeling demonstrated a U-shaped relationship between the measured LVM ratio and composite outcome. The measured LVM ratio had superior predictive power for poor post-transplantation outcomes in obese recipients. CONCLUSIONS Measuring donor LVM with the use of echocardiography may provide a more accurate method for donor-recipient heart size matching that could improve heart transplant outcomes, especially in obese recipients.

中文翻译：

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超声心动图测量供体左心室质量与心脏移植后 1 年结局的关联。


背景 供体-受体心脏大小匹配在心脏移植中至关重要;然而，在肥胖的情况下，常用的预测心脏质量 （PHM） 比率可能不准确。目的 在这项研究中，作者试图调查超声心动图测量的供体左心室质量 （LVM） 与心脏大小匹配与主要 1 年复合结局风险（死亡或再移植）之间的关联。方法 供体心脏研究是一项前瞻性、多中心、观察性队列研究，收集脑死亡供体的超声心动图。测量的 LVM 比率 （供体测量的 LVM/受体预测的 LVM） 被定义为暴露变量，并使用 Cox 比例风险模型分析与主要结果的关联。二次分析评估了 PHM 和预测的 LVM （供体预测的 LVM/受体预测的 LVM） 比率与主要结局的关联。结果在 2,015 例心脏移植中，测得的 LVM 比率表明，与理想匹配的移植相比，大小过小的匹配 （<0.80） 的风险高出 47% （调整后的 HR [aHR]： 1.47;95% CI： 1.01-2.15） 和过大 （>1.20） 匹配的 1 年复合结果的风险增加 58% （aHR： 1.58;95% CI： 1.05-2.37）。然而，PHM 和预测的 LVM 比率与主要结局无关。非线性模型表明，测得的 LVM 比率与复合结果之间存在 U 形关系。测得的 LVM 比率对肥胖受者移植后不良结局具有卓越的预测能力。 结论 使用超声心动图测量供体 LVM 可能为供体-受体心脏大小匹配提供更准确的方法，从而可以改善心脏移植结果，尤其是在肥胖受者中。