What tests will I need to have before I am considered for heart transplantation?

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A heart transplant is extraordinarily demanding on many levels. Because there are so many more candidates for transplants than there are available hearts, the transplant list must be carefully screened. A multidisciplinary team of heart doctors, surgeons, nurses, social workers, and bioethicists evaluates your medical history, diagnostic test results, social history, and psychosocial assessment. This is referred to as a formal pretransplant evaluation.

Extensive pretransplant testing is performed to assess whether any other treatment options exist for you, to determine if you are sick enough to require a transplant, and to ensure that you are physically capable of having a transplant. A careful search is conducted for any potential contraindications to a heart transplant, such as undiagnosed cancer or other serious medical problem. A description of many of the tests that are necessary follows:

• Blood tests

❍ A series of blood tests are used to evaluate your liver function, kidney function, blood and tissue type, and any previous exposure to various infections. You will be tested for HIV, regardless of your risk factors.

• BNP laboratory test

❍ This is a heart failure blood test. It measures the level of a hormone in your blood called B-type natriuretic peptide (BNP). Your heart’s pumping chambers (ventricles) produce extra BNP when they can’t pump enough blood to meet your body’s needs. The BNP level in the blood increases when heart failure symptoms worsen and decreases when the heart failure condition improves or is stable. Normally, only a low amount of BNP is found in your blood; a higher BNP level correlates with more severe heart failure.

• Chest x-ray

❍ A chest x-ray is a picture of the lungs and the position of the heart in the chest. This test determines the presence of lung disease, detects fluid in your lungs, and detects any potential silent lung cancer. A CT of the chest may be necessary to provide more detailed pictures.

• Electrocardiogram (ECG)

❍ The electrocardiogram shows the pattern of electrical impulses in your heart. Small pads (electrode leads) connected with wires are placed over different parts of your body. These leads noninvasively detect the rhythm and pattern of the electrical waves of your heart and convert it into lines on a sheet of paper for your doctor to interpret.

• Echocardiogram (Echo)

❍ An echocardiogram is a noninvasive form of cardiac imaging (an ultrasound of the heart) that uses sound waves to examine the size, shape, and motion of all cardiac structures. The important structures that are seen include the four heart valves, the pumping function of the right and left ventricles (lower chambers), and the pericardial sac (the lining of the heart). This test is used to determine your ejection fraction (EF), which is a measurement of the percentage of blood that your heart ejects with each beat.

• MUGA

❍ A MUGA is a noninvasive nuclear medicine picture test. Your vein is injected with a nonradioactive compound, and a special camera is placed over your chest while you are lying down, to measure the ability of your heart to pump blood. This test is specifically used to measure your ejection fraction.

• Exercise tolerance (treadmill) test

❍ This noninvasive procedure monitors you and your heart’s response to strenuous exercise. It is also known as a “stress test.” You are connected to wires and electrode leads, just like when you have an electrocardiogram (ECG). Your monitored walking on the treadmill functions as a “stress” to the heart and can measure your exercise tolerance and capacity.

• Pulmonary function test (PFT)

❍ A pulmonary function test is a series of breathing tests that are performed on your lungs to measure their capacity and their ability to carry oxygen. This is done to detect any lung disease and to determine your ability to wean from the breathing ventilator after your transplant surgery.

• Noninvasive carotid artery Doppler studies

❍ This is an ultrasound of the carotid (neck) arteries that looks for blockages in the arteries that supply blood to the brain, which is more common in patients who have atherosclerosis. If the carotid arteries have severe narrowing, this must be corrected before your transplant surgery. • Abdominal ultrasound ❍ An ultrasound of your belly is a painless test performed to rule out any gallbladder disease/stones and to assess for an abnormally enlarged abdominal aorta (aneurysm).

• Bone scan (DEXA scan)

❍ A bone scan is used specifically to assess the risk of fracture by detecting osteoporosis, which is a thinning of the bones that can occur with aging. The scan takes approximately 10 minutes. Lowenergy x-rays are passed through the bones to measure the mineral (calcium) content of the bones. Not all patients require this test.

• Skin tests

❍ A skin test is performed to check for exposure to tuberculosis. A small needle is used on your arm to inject a serum in three different places. Your arm is then checked within 48 hours to look for a skin reaction. If the test reveals that you have been exposed to tuberculosis, you will be treated with certain medications while waiting for your heart transplant.

• Urine tests

❍ A routine urinalysis is sent to look for any type of urine infection. If needed, a 24-hour urine collection is done to further assess your kidney function.

• Mammogram/Pap smear

❍ A gynecologic exam is performed on all women who have not had recent testing. It is important to undergo a comprehensive cancer screening as a part of your transplant evaluation.

• Prostate test

❍ A simple prostate specific antigen (PSA) laboratory test is performed in men to exclude any silent prostate cancer. If necessary, a supplemental prostate exam may be required.

• Stool sample to detect blood

❍ A simple stool sample test (a “stool guaiac card”) is an easy way to check the stool for any hidden blood in the intestinal tract. Blood in the stool can possibly indicate a hidden colon cancer. If necessary, a colonoscopy may be required to more carefully exclude any potential colon cancer.

• Left heart catheterization and coronary angiogram

❍ This is described in more detail in Question 74. A left heart catheterization allows your doctor to actually see how the blood flows through your heart and coronary arteries. When dye is injected into your coronary arteries to take an x-ray movie picture, it is called a coronary angiogram. This is the best way to evaluate the coronary arteries for any potential blockage problems. It is usually done through a small catheter (fine hollow tube) inserted into an artery on the side of your groin (the femoral artery).

• Right heart catheterization

❍ This is described in more detail in Question 74. This invasive test is performed to measure the pressures inside the right side of your heart and to check for the presence of pulmonary hypertension (elevated pressure in the lungs). It is usually done through the right jugular vein on the side of the neck.

• Cardiopulmonary stress test (VO2).

❍ This is described in more detail in Question 76. This is a special type of exercise test that measures your combined heart and lung function and ability to use oxygen. You walk on a treadmill while attached to a special breathing monitor/apparatus.

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