There are an estimated 50,000 patients awaiting heart transplantation, with an average of only 5,000 transplants taking place each year. As a result, OPOs are under significant pressure to increase the amount of donor hearts available. This makes the assessment of potential donors key to helping more heart transplant patients live longer. Telecardiology can assist in the screening of donor hearts by providing remote cardiologist consultation. Board-Certified cardiologists provide interpretations of echocardiograms, CT angiograms (CTAs), ECGs and vascular ultrasound studies at the most critical moments in heart procurement to improve heart patient outcomes.
Increasing Heart Donors
With a shortage of donor hearts, accessing testing is key to increasing heart procurement. This includes considerations in donor heart procurement from brain-dead organ donors. Telecardiology can help healthcare centers avoid discrepancies in the donor assessment process to properly identify and secure viable hearts from donors. By improving donor and donor heart assessment, higher utilization rates of available donor hearts and decreased post-transplant recipient mortality is achievable.
Telecardiology also helps improve brain-dead and overall donor management. Telecardiologists assist in the evaluation and selection of donors, offering the review of medical history, electrocardiography, cardiac imaging, biomarkers and hemodynamic and arrhythmia assessment by remote cardiologist consultation. Recognition of the characterization of potential heart donors with traumatic brain death can greatly increase donor heart availability once assessment establishes the absence of cardiac injury, including:
- Myocardial contusion
- Heart valve injury
- Free wall interatrial or interventricular septum rupture
- Injury to large vessels
Donor Factors Affecting Early Outcomes
There are a variety of donor factors that increase risk in the early stages following transplantation. While factors such as female donors associated with increased one-year mortality do not require further study, other factors such as narrowing of the coronary arteries in donors over 40 can be examined with the assistance of telecardiologists. Left ventricular hypertrophy in the donor heart also sees poorer outcomes than hearts without thickening, and testing and consultation can also rule out this issue. Consultations to determine if other risk factors, such as elevated troponin I and T in the donor’s blood levels, rule out heart donors can also be discussed, as higher levels can lead to heart muscle damage increasing the risk of early heart failure.
Telecardiology includes computed tomography angiography or CT angiography utilizing a combination of CT technology and contrast material to gather 3D images of the heart and blood vessels. This test is critical in diagnosing blood vessel function to determine whether artery walls contain plaque.
CT studies via telecardiology utilize state-of-the-art x-ray equipment to take numerous cross-sectional images of a specific area of the heart, while CTA exams help detect common roadblocks to donor viability, including aneurysms, narrowing blood vessels, and blood clots. Physicians and surgeons can consult during the process, reviewing images for coronary angiography cardiac (CT). This allows ICU teams to work alongside cardiologists via teleconferencing to establish viability based on the following:
- Reading structural information, including ventricular volumes and ejection fraction.
- Chamber function via electron beam CT with high temporal resolution.
- Ejection fraction and other relevant structural data via multidetector CT with improved spatial and decreased temporal resolution.
New protocols are also being researched, including low-dose radiation using a 64-slice cardiac CT technology to determine LV ejection fraction. However, the effectiveness of this procedure can be inhibited by a large amount of contrast dye used and the lower heart rates required.
Echocardiography exams utilizing sound waves to capture videos of the heart also help in the diagnosis of heart disease, studying heart motion, heart wall thickness, and heart valve function. Other measurements in donor assessment include ejection fraction (EF) as well as the potential stenosis or regurgitation of heart valves. Via telecardiology, contrast echocardiography provides an improved assessment of the endocardium in patients with ambiguous ejection fraction.
Patients with good acoustic windows and normal ventricle size can also be examined to determine LV volumes and LVEF, but testing can be misleading in patients with enlarged ventricles or where image quality is poor. Telecardiology can improve image quality to take more precise and accurate measurements to help identify more acceptable heart donors. Also, higher quality testing and equipment also improve testing capabilities. For example, 3DE is more accurate and precise in measuring EF and LV volumes than 2DE when imaging is of high quality.
Increasing demand for cardiac consultants can be alleviated using teleconferencing. Consulting cardiologists can be present via telehealth to help manage a higher volume of donor patients during the assessment and screening stage. ICUs can use teleconferencing technology at critical moments when donor assessment is underway, expediting the process while improving protocols with cardiologist input and management. Cardiologists can also be present during high-risk surgical procedures for donor patients providing instant input to determine whether the heart is suitable for donation. Heart patients around the world can benefit from this approach.
Telecardiology at Specialist Direct
Telecardiology is an integral part of the services provided by Specialist Direct. Our specialists accurately read and interpret telecardiology studies for better results. Contact us for a consultation or information on our services today.