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Evaluation of Cardiac Contractility Modulation Therapy in 2D Human Stem Cell-Derived Cardiomyocytes
Published on: December 16, 2022
Improvement of long-term survival by cardiac contractility modulation in heart failure patients: A case-control study
Ming Liu1, Fang Fang1, Xiu Xia Luo1
1Division of Cardiology and HEART Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong; Institute of Vascular Medicine, The Chinese University of Hong Kong, Hong Kong; LCW Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong.
Insights
Cardiac contractility modulation (CCM) significantly improves long-term survival in heart failure patients, especially those with ejection fraction (EF) ≥ 25-40%. This therapy also reduced heart failure hospitalizations in this subgroup.
Area of Science:
- Cardiology
- Heart Failure Management
- Medical Devices
Background:
- Cardiac contractility modulation (CCM) is an established therapy for improving heart failure (HF) symptoms and cardiac function.
- Limited data exists regarding the long-term survival benefits of CCM.
Purpose of the Study:
- To investigate the impact of CCM on long-term survival in patients with heart failure.
- To analyze the effect of CCM on mortality and hospitalization rates stratified by ejection fraction (EF).
Main Methods:
- A cohort of 41 HF patients receiving CCM was compared with 41 control HF patients over approximately 6 years.
- Primary endpoint was all-cause mortality, with secondary endpoints including HF hospitalization, cardiovascular death, and composite outcomes.
- Patient groups were matched for age, gender, EF, and HF etiology.
Main Results:
- All-cause mortality was significantly lower in the CCM group (39%) compared to the control group (71%) (p=0.001).
- Survival benefits were more pronounced in patients with EF ≥ 25-40% (36% vs. 80% mortality, p<0.001).
- CCM also reduced cardiovascular death and composite outcomes, and decreased HF hospitalizations in the EF ≥ 25-40% subgroup.
Conclusions:
- CCM significantly enhances long-term survival in heart failure patients.
- The survival benefit of CCM is particularly notable in patients with ejection fraction between 25-40%.
- CCM may also reduce heart failure hospitalizations in patients with less severely reduced ejection fraction.
Introduction:
Cardiac contractility modulation (CCM) has been shown to be effective in improving symptoms and cardiac function in heart failure (HF). However, there is limited data on the role of CCM on long-term survival, which was explored in the present study.
Methodology:
Forty-one consecutive HF patients with left ventricular ejection fraction (EF) <40% received CCM and were followed for approximately 6 years. They were compared with another 41 HF patients who were enrolled into the HF registry in the same period, and had similar age, gender, EF and etiology of HF. The primary end-point was all cause-mortality. This was stratified by EF. Secondary end-points included HF hospitalization, cardiovascular death, and the composite outcome of death or heart failure hospitalization.
Results:
The CCM and control groups were well balanced for demographic data, medications and baseline left ventricular EF (27 ± 6 vs 27 ± 7%, p=NS). The mean follow-up duration was 75 ± 19 months in the CCM group and 69 ± 17 months in the control group. All-cause mortality was lower in the CCM group than the control group (39% vs. 71%, respectively; Log-rank χ(2)=11.23, p=0.001). Of note, the improvement of all-cause mortality is more dramatic in patients with EF ≥ 25-40% (36% vs. 80%, Log-rank χ(2)=15.8, p<0.001) than those with EF<25% (50% vs. 56%, p=NS), CCM vs. control respectively. Similar results were shown for the benefit of CCM in the secondary endpoints of cardiovascular death, and the composite outcome of death or heart failure hospitalization. The occurrence of HF hospitalization showed no significant difference between CCM and control groups in the whole cohort (41% vs. 49%, p=NS), but was significantly lower with CCM in subjects with EF ≥ 25-40% at baseline (36% vs. 64%, Log-rank χ(2)=7.79, p=0.005).
Conclusion:
CCM resulted in significant improvement of long-term survival, in particular in those with EF ≥ 25-40%. A reduction in heart failure hospitalizations was also seen in this group of patients with less severely reduced EF.
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