Figure 4

Form for stress echo report. The dipyridamole (0.84 mg/kg in 6 min ) "fast" pharmacological stress echo test is performed following the European Association of Echocardiography protocol. The Wall Motion Score Index is calculated in each potential donor at baseline and peak stress, from 1 = normal to 4 = dyskinetic, in a 17-segment model of the left ventricle. A test result is considered positive when the wall motion score increases by one grade or more at peak stress, with at least one normal segment becoming hypokinetic, akinetic or dyskinetic; it had been agreed a priori to consider mild hypokinesia. Regional wall motion abnormalities (WMSI > 1.0) exclude the heart from eligibility for donorship, and the phrase "inducible ischemia " automatically appears in the web stress echo report. Once the web form with rest and peak stress LV volume (EDV and ESV) values and pressures is filled out, contractile reserve is automatically calculated by the web system as the SP/ESV (Systolic Pressure/End-Systolic Volume) index increase (from baseline to peak stress). The contractile reserve is automatically reported normal up-sloping when peak exercise SP/ESV index is higher than baseline; abnormal negative, when peak exercise systolic pressure/end systolic volume index is lower than baseline. Donor hearts with abnormal negative contractile reserve are also excluded from donorship even if no signs of inducible ischemia are reported. Prematurely halted submaximal stress are considered non-diagnostic and exclude the heart from donorship.