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Pathophysiology of Cardiac Performance01:29

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Typical heart performance is influenced by heart rate, rhythm, myocardial contraction, and metabolism or blood flow. The cardiac muscle exhibits distinct electrophysiological features, including pacemaker activity and calcium channel control, which play a vital role in the heart's response to various drugs. The autonomic nervous system, comprising the sympathetic and parasympathetic branches, regulates heart rate. Sympathetic activation increases heart rate, while parasympathetic activation...
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Acute Hemodynamic Changes Induced by Cardiac Contractility Modulation Evaluated Using the NICaS® System: A Pilot

Andrea Madeo1, Silvana De Bonis2, Anna Lucia Cavaliere1

  • 1Cardiology Department, Ferrari Hospital, ASP Cosenza, 87012 Castrovillari, Italy.

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Summary

Cardiac contractility modulation (CCM) significantly improves stroke volume and reduces total peripheral resistance index in heart failure patients. The non-invasive NICaS system reliably tracks these hemodynamic changes, aiding treatment optimization.

Keywords:
NICaS®cardiac contractility modulationheart failurehemodynamicsnon-invasive monitoring

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Area of Science:

  • Cardiology
  • Biomedical Engineering
  • Medical Devices

Background:

  • Heart failure with reduced ejection fraction (HFrEF) is a major global health concern.
  • Cardiac contractility modulation (CCM) offers a therapeutic option for HFrEF patients ineligible for cardiac resynchronization therapy (CRT).
  • Accurate, non-invasive assessment of CCM's hemodynamic effects is crucial for patient management.

Purpose of the Study:

  • To evaluate the acute hemodynamic impact of CCM on stroke volume (SV) and total peripheral resistance index (TPRI).
  • To assess the utility of the non-invasive bioimpedance system NICaS® for monitoring these changes.

Main Methods:

  • Eight HFrEF patients received Optimizer Smart Mini CCM device implantation.
  • Stroke volume (SV) and total peripheral resistance index (TPRI) were measured using NICaS® at baseline and at 1 week, 1 month, and 3 months post-implantation.
  • Non-parametric statistical tests were employed for data analysis.

Main Results:

  • A significant increase in median SV was observed, from 40.02 mL at baseline to 69.83 mL at 3 months (p < 0.0001).
  • A significant decrease in median TPRI was recorded, from 2537 dn·s/cm⁵·m² at baseline to 1307 dn·s/cm⁵·m² at 3 months (p < 0.0001).
  • CCM therapy demonstrated significant improvements in SV and reductions in TPRI within three months.

Conclusions:

  • CCM therapy effectively enhances stroke volume and reduces total peripheral resistance index in HFrEF patients.
  • The NICaS® system provides a reliable, non-invasive method for monitoring acute hemodynamic changes induced by CCM.
  • NICaS® supports the clinical application of CCM therapy for heart failure management.