Long-term survival with Cardiac Contractility Modulation in patients with NYHA II or III symptoms and normal QRS
Axel Kloppe1, Thomas Lawo1, Dejan Mijic2
1Dept of Cardiology and Angiology, Klinikum Bergmannsheil, Ruhr University Bochum, Germany.
Insights
Cardiac Contractility Modulation (CCM) therapy for heart failure patients demonstrated reduced long-term mortality compared to predictions. This innovative treatment shows promise for improving survival in heart failure management.
Area of Science:
- Cardiology
- Biomedical Engineering
Background:
- Cardiac Contractility Modulation (CCM) is an electrical stimulation therapy for heart failure.
- CCM enhances myocardial function and patient quality of life.
- Long-term survival impact of CCM has not been extensively studied.
Purpose of the Study:
- To evaluate the long-term survival rates of heart failure patients treated with CCM.
- To compare observed mortality with predicted survival using the Seattle Heart Failure Model (SHFM).
Main Methods:
- Retrospective analysis of 68 heart failure patients (NYHA II-III, QRS ≤130ms) implanted with CCM devices.
- Survival data collected over a mean follow-up of 4.5 years.
- Kaplan-Meier analysis compared observed mortality with SHFM predictions.
Main Results:
- Lower 1-, 2-, and 5-year mortality rates were observed in the CCM cohort compared to SHFM predictions.
- At 5 years, CCM group mortality was 14.2% versus 27.7% predicted (p=0.007).
- Mean patient age was 61 years, 88% male, with a mean LVEF of 26%.
Conclusions:
- CCM therapy is associated with reduced long-term mortality in selected heart failure patients.
- Findings suggest CCM may improve survival outcomes in heart failure.
- Prospective studies are recommended to confirm these survival benefits.
Aims:
Cardiac Contractility Modulation (CCM) is a treatment for heart failure based on electrical signals applied during the absolute refractory period. CCM improves myocardial molecular and biochemical characteristics of heart failure and improves exercise tolerance and quality of life. However, the long term impact on survival has not been described.
Methods And Results:
Survival was determined retrospectively from a cohort of 68 consecutive heart failure cases with NYHA II or III symptoms and QRS duration ≤130ms, implanted with a CCM device between May 2002 and July 2013 in either Bochum or Ludenscheid, Germany. Results were compared with predicted survival (Seattle Heart Failure Model; SHFM) pre-implant for each patient. Mean follow-up was 4.5years (range 0.25-10.3years). Baseline characteristics were as follows: mean age 61years, 88% male, 68% with ischemic heart disease, 78% with an ICD, mean NYHA class 2.9±0.3, LVEF 26%±6% (range 15-40%) and mean QRS duration 106±11ms. Mortality rates (Kaplan-Meier analysis) at 1-, 2- and 5-years were lower with CCM than predicted by SHFM for the cohort (0% with CCM vs. 6.1% per SHFM, 3.5% vs. 11.8%, and 14.2% vs. 27.7%, respectively, p=0.007).
Conclusions:
Long-term mortality rates in heart failure patients with NYHA (II-III) and QRS≤130ms are lower when treated by CCM than predicted for the cohort. These findings warrant substantiation in a prospective study.
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