Device-therapy in chronic heart failure: Cardiac contractility modulation versus cardiac resynchronization therapy
Goekhan Yuecel1,2, Leo Gaasch1, Abbass Kodeih1
1Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Insights
Cardiac resynchronization therapy with defibrillator (CRT-Ds) and cardiac contractility modulation (CCMs) offer comparable functional improvements for heart failure patients. However, CCM patients experienced higher hospitalization rates, potentially due to more advanced heart failure at implantation.
Area of Science:
- Cardiology
- Medical Devices
- Heart Failure Management
Background:
- Cardiac implantable electrical devices (CRT-Ds, CCMs) are options for symptomatic heart failure (HF) with reduced left ventricular ejection fraction (LVEF) despite optimal medical treatment.
- A direct comparison between CRT-Ds and CCMs has not been previously established.
Purpose of the Study:
- To compare the efficacy and outcomes of CRT-Ds versus CCMs in patients with symptomatic heart failure and reduced LVEF.
- To evaluate changes in New York Heart Association (NYHA) classification, LVEF, tricuspid annular plane systolic excursion (TAPSE), and QRS-width after 12 months.
Main Methods:
- Retrospective analysis of patients receiving CRT-Ds (n=220) or CCMs with defibrillators (n=105) between 2012 and 2021.
- Comparison of baseline characteristics and 12-month follow-up data including NYHA, LVEF, TAPSE, and QRS-width.
- Analysis of heart failure hospitalization rates.
Main Results:
- CCM patients had lower baseline LVEF and worse NYHA classification compared to CRT-D patients.
- Both CRT-Ds and CCMs showed comparable improvements in NYHA, LVEF, and TAPSE at 12 months.
- HF hospitalizations were significantly higher in CCM patients (45.7%) compared to CRT-D patients (16.8%).
Conclusions:
- Both CRT-Ds and CCMs provide comparable functional status and ventricular reverse remodeling improvements in heart failure patients at 12 months.
- Higher HF hospitalization rates in CCM patients may be attributed to their more advanced HF at the time of implantation.
- Appropriate implantation of CCMs and CRT-Ds can lead to similar positive outcomes in selected heart failure patients.
Aims:
Cardiac implantable electrical devices such as cardiac resynchronization therapy with defibrillator (CRT-Ds) or cardiac contractility modulation (CCMs) are therapy options for patients with symptomatic heart failure (HF) and reduced left ventricular ejection fraction (LVEF) despite optimal medical treatment. As yet, a comparison between both devices has not been performed.
Methods And Results:
The Mannheim Cardiac Resynchronization Therapy Registry (MARACANA) and the Mannheim Cardiac Contractility Modulation Observational Study (MAINTAINED) included all patients who received CRTs or CCMs in our medical centre between 2012 and 2021. For the present analysis, we retrospectively compared patients provided with either CRT-Ds (n = 220) or CCMs with additional defibrillators (n = 105) regarding New York Heart Association classification (NYHA), LVEF, tricuspid annular plane systolic excursion (TAPSE), QRS-width and other HF modification aspects after 12 months. Before implantation, CCM patients presented with lower LVEF (23.6 ± 6.2 vs. 26.3 ± 6.5%) and worse NYHA (3.03 ± 0.47 vs. 2.81 ± 0.48, both P < 0.05), compared with CRT-D patients. Follow-up improvements in NYHA (2.43 ± 0.67 vs. 2.28 ± 0.72), LVEF (30.5 ± 10.7 vs. 35.2 ± 10.5%) and TAPSE (17.2 ± 5.2 vs. 17.1 ± 4.8 to 18.9 ± 3.4 vs. 17.3 ± 3.6 mm, each P < 0.05) were comparable. The intrinsic QRS-width was stable with CCM (109.1 ± 18 vs. 111.7 ± 19.7 ms, P > 0.05), while the paced QRS-width with CRT-D after 12 months was lower than intrinsic values at baseline (157.5 ± 16.5 vs. 139.2 ± 16 ms, P < 0.05). HF hospitalizations occurred more often for CCM than CRT-D patients (45.7 vs. 16.8%/patient years, odds ratio 4.2, P < 0.001).
Conclusions:
Chronic heart failure patients could experience comparable 12-month improvements in functional status and ventricular reverse remodelling, with appropriately implanted CCMs and CRT-Ds. Differences in HF hospitalization rates may be due to the more advanced HF of CCM patients at implantation.
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