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Impact of baseline left ventricular ejection fraction on long-term outcomes in cardiac contractility modulation

Gökhan Yücel1,2, Christian Fastner1,2, Svetlana Hetjens3

  • 1First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.

Pacing and Clinical Electrophysiology : PACE
|March 9, 2022
PubMed

Insights

Cardiac contractility modulation (CCM) therapy may offer better long-term systolic recovery for heart failure patients with lower baseline left ventricular ejection fraction (LVEF ≤ 30%). Clinical improvements, however, were similar across LVEF groups.

Area of Science:

  • Cardiology
  • Medical Devices
  • Heart Failure Management

Background:

  • Cardiac contractility modulation (CCM) is used for symptomatic chronic heart failure (HF) patients with narrow QRS complex.
  • CCM can improve reduced left ventricular ejection fraction (LVEF), but the impact of pre-implantation LVEF on long-term outcomes requires further investigation.

Purpose of the Study:

  • To compare the long-term outcomes of CCM therapy in heart failure patients with lower (≤ 30%) versus higher (≥ 31%) pre-implantation LVEF.
  • To assess the influence of baseline LVEF on survival, echocardiographic parameters, and clinical status post-CCM implantation.

Main Methods:

  • Retrospective analysis of 172 heart failure patients who underwent CCM implantation between 2002-2019.
  • Patients were stratified into two groups based on baseline LVEF: Group 1 (≤ 30%) and Group 2 (≥ 31%).
  • Comparison of survival, LVEF, tricuspid annular plane systolic excursion (TAPSE), NYHA class, and Minnesota Living with Heart Failure Questionnaire (MLWHFQ) scores up to 5 years post-implantation.

Main Results:

  • Baseline LVEF did not impact patient survival.
  • Patients with lower baseline LVEF (≤ 30%) demonstrated significantly better recovery in echocardiographic parameters, including LVEF and TAPSE.
  • Both groups showed comparable improvements in clinical parameters like NYHA class and MLWHFQ scores.

Conclusions:

  • Pre-implantation LVEF ≤ 30% may be associated with better long-term biventricular systolic recovery potential with CCM therapy.
  • Clinical improvements in heart failure symptoms, assessed by NYHA class and MLWHFQ, can be achieved irrespective of baseline LVEF.
Abstract

Keywords:
cardiac contractility modulationheart failureleft ventricular ejection fraction

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