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Published on: February 13, 2021
Cardiac contractility modulation in left ventricular systolic dysfunction: one-year experience in a pilot study and
Mario Matta1, Chiara Devecchi2, Federica DE Vecchi2
1Division of Cardiology, Sant'Andrea Hospital, Vercelli, Italy - m.matta26@gmail.com.
Insights
Cardiac contractility modulation (CCM) improved heart failure symptoms and exercise tolerance in patients with chronic heart failure (CHF). This therapy also reduced hospitalizations, offering a net clinical benefit for many patients.
Area of Science:
- Cardiology
- Medical Devices
- Heart Failure Management
Background:
- Cardiac contractility modulation (CCM) is an option for symptomatic chronic heart failure (CHF) patients with reduced ejection fraction (LVEF) ineligible for cardiac resynchronization.
- Mid-term follow-up data for CCM are limited, necessitating further investigation.
Purpose of the Study:
- To assess the impact of CCM on quality of life, symptoms, and exercise tolerance in CHF patients.
- To evaluate CCM's effect on left ventricular function in patients with moderate-to-severe systolic dysfunction.
Main Methods:
- Ten patients with CHF (LVEF <45%, NYHA class >II) received CCM implantation.
- Evaluations included ECG, echocardiogram, clinical assessment, 6-minute walking test, and MLWHFQ at baseline and 3, 6, 12 months.
Main Results:
- After 15 months, LVEF showed non-significant improvement (29.4% to 32.2%).
- Significant improvements were observed in 6-minute walking test distance (179m to 304m), NYHA class (3.0 to 1.6), and MLWHFQ score (59.6 to 34.2).
- Hospitalizations decreased, and 6 out of 9 patients experienced net clinical benefit.
Conclusions:
- CCM can enhance quality of life, alleviate symptoms, and improve exercise capacity in CHF patients.
- CCM therapy may reduce hospitalizations when added to optimal medical and electrical management.
- A prospective registry will further define patient subsets benefiting most and assess long-term outcomes.
Background:
Cardiac contractility modulation (CCM) is a treatment option for patients suffering symptomatic chronic heart failure (CHF) with reduced left ventricular ejection fraction (LVEF) who are not eligible for cardiac resynchronization. Data on mid-term follow-up are limited to small observational studies. The aim of this study was to assess the impact of CCM on quality of life, symptoms, exercise tolerance and left ventricular function in patients with CHF and moderate-to-severe left ventricular systolic dysfunction.
Methods:
Patients suffering CHF with LVEF <45% and NYHA class >II despite optimal medical therapy, underwent CCM implantation. Enrolled patients underwent baseline and 3, 6 and 12-months evaluation with ECG, echocardiogram, clinical assessment, 6-minute walking test and Minnesota Living with Heart Failure Questionnaire (MLWHFQ).
Results:
Ten patients underwent CCM implantation. All patients were actively treated with the optimal pharmacological therapy as tolerated and had at least one hospitalization for worsening heart failure during the previous year. After a mean follow-up of 15 months, 9 patients were alive, while one patient died for worsening heart failure precipitated by pneumonia. Among the remaining 9 patients, LVEF improved non-significantly from 29.4±8% to 32.2±10% (P=0.092), 6-minute walking test distance improved from 179±73 m to 304±99 m (P<0.001), NYHA class reduced from 3.0±0.4 to 1.6±0.5 (P=0.003) and MLWHFQ score improved from 59.6±49 to 34.2±32 (P=0.037). Only 2 patients have been hospitalized during the 12 months. Overall, a net clinical benefit was detected in 6 out of 9 patients.
Conclusions:
CCM could be effective in improving quality of life, symptoms and exercise tolerance, and reduces hospitalizations in patients with symptomatic CHF on top of optimal medical and electrical therapy. A prospective registry has been designed to identify the subsets of patients gaining more benefit, and to assess the long-term effect of CCM on those clinical endpoints.
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