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Cardiac Contractility Modulation in Patients with Ischemic versus Non-ischemic Cardiomyopathy: Results from the

Christian Fastner1, Goekhan Yuecel1, Boris Rudic1

  • 1First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany.

International Journal of Cardiology
|July 30, 2021
PubMed

Insights

Cardiac contractility modulation (CCM) therapy shows particular benefit for non-ischemic cardiomyopathy (NICM) patients, improving systolic function. Ischemic cardiomyopathy (ICM) patients experienced lower-than-predicted mortality at 3 years.

Area of Science:

  • Cardiology
  • Medical Devices
  • Heart Failure Management

Background:

  • Cardiac contractility modulation (CCM) is an FDA-approved therapy for symptomatic systolic heart failure patients with normal QRS width, despite optimal medical treatment.
  • This study investigates the long-term efficacy of CCM in patients with ischemic cardiomyopathy (ICM) compared to non-ischemic cardiomyopathy (NICM).

Purpose of the Study:

  • To compare the long-term therapeutic effects of CCM in patients with ICM versus NICM.
  • To evaluate functional parameters and mortality rates between ICM and NICM patients undergoing CCM therapy.

Main Methods:

  • A retrospective analysis of 174 patients with chronic heart failure who received CCM device implantation between 2002 and 2019.
  • Comparison of changes in NYHA class, KDIGO CKD stage, left ventricular ejection fraction (LVEF), tricuspid annular plane systolic excursion (TAPSE), and NT-proBNP levels.
  • Analysis of observed mortality rates at 1 and 3 years against predicted rates using the MAGGIC heart failure risk score.

Main Results:

  • NICM patients showed significantly higher LVEF after 3 years (35 ± 9% vs. 30 ± 9%; p=0.0211) and higher TAPSE after 5 years (21 ± 5% vs. 18 ± 5%; p=0.0437) compared to ICM patients.
  • No significant differences were observed in other effectiveness parameters between the groups.
  • Overall mortality was 35%, with ICM patients exhibiting lower-than-predicted 3-year mortality (35% vs. 43%; p=0.0395).

Conclusions:

  • Patients with non-ischemic cardiomyopathy (NICM) appear to derive particular benefit from CCM therapy regarding the improvement of biventricular systolic function.
  • CCM therapy demonstrates potential long-term benefits for specific heart failure patient populations.
Abstract

Keywords:
Cardiac remodelingDevice therapyHeart failureLeft ventricular ejection fractionSurvivalTricuspid annular plane systolic excursion

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