CARDIOVASCULAR

Full list of author information is available at the end of the articleIntroduction Heart transplantation is an established procedure in end-stage heart failure patients, albeit limited by severe and incremental donor organ shortage. In Europe every year a pool of ≈ 4500 unused hearts (500 in Italy) with permission granted for heart donation is estimated, from which additional transplants could be generated, with more confidence in their post-transplantation perform-ance (Council of Europe, Donation and Transplantation, 2011) [1,2]. A stress echo-driven selection of donors has proven successful in three settings: 1) older donors with normal left ventricular (LV) resting function and negative stress echo [3,4]; 2) reversible resting left ventricular dys-function acutely improving over minutes during stress [5]; 3) regional and global LV dysfunction slowly improving (over hours) during intensive hormonal treatment (HT) [6-11]. In all three conditions, encouraging results and short-term progress have been reported in preliminary proof of principle studies, but data on medium-term out-come have been conspicuously lacking to date. Aim of this study is to assess the medium-term outcome of recipients of marginal donor hearts selected via new echocardio-graphic techniques over standard criteria