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Comparison of left ventricular reverse remodeling induced by cardiac contractility modulation and cardiac

Qing Zhang1, Yat-Sun Chan, Yu-Jia Liang

  • 1Li Ka Shing Institute of Health Sciences, Institute of Vascular Medicine and Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.

International Journal of Cardiology
|February 15, 2012
PubMed

Insights

Cardiac contractility modulation (CCM) offers similar left ventricular reverse remodeling as cardiac resynchronization therapy (CRT) in heart failure patients with narrow QRS. However, CRT shows greater benefits in patients with very wide QRS durations.

Area of Science:

  • Cardiology
  • Medical Devices
  • Heart Failure Management

Background:

  • Cardiac contractility modulation (CCM) is an emerging therapy for advanced systolic heart failure.
  • CCM is indicated for patients with normal QRS duration, unsuitable for cardiac resynchronization therapy (CRT).
  • Both CCM and CRT have shown left ventricular (LV) reverse remodeling, but direct comparisons are limited.

Purpose of the Study:

  • To compare the extent of LV reverse remodeling between CCM and CRT in heart failure patients.
  • To evaluate the efficacy of CCM versus CRT across different QRS durations.

Main Methods:

  • Observational study of three heart failure groups (LV ejection fraction <35% despite optimal medical therapy).
  • Group 1: CCM (n=33, QRS <120 ms).
  • Group 2: CRT (n=43, QRS 120-150 ms).
  • Group 3: CRT (n=56, QRS >150 ms).
  • LV end-systolic volume (LVESV) measured at baseline and 3 months.

Main Results:

  • Significant LV reverse remodeling observed in all groups.
  • Similar LVESV reduction in CCM (Group 1) and CRT with mildly prolonged QRS (Group 2) (-11.3% vs. -13.6%, p=0.833).
  • Greater LVESV reduction with CRT in patients with very wide QRS (Group 3) (-25.0%, p<0.01 vs. Groups 1 & 2).
  • Responder rates (≥15% LVESV reduction) were comparable for CCM and CRT in narrow/mildly prolonged QRS (39% vs. 42%), but significantly higher for CRT in very wide QRS (68%, p=0.009).

Conclusions:

  • CCM demonstrates comparable LV reverse remodeling to CRT in heart failure patients with normal QRS duration.
  • CRT shows superior LV reverse remodeling compared to CCM in patients with very wide QRS durations.
  • Device selection should consider QRS duration for optimal heart failure management.
Abstract

Keywords:
Cardiac contractility modulationCardiac resynchronization therapyReverse remodeling

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