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Cardiac contractility modulation to enhance optimized medical therapy and improve cardiac remodeling in advanced

Lina Feng1,2, Lina Su2, Jingyi Ren1,2

  • 1Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China.

Frontiers in Cardiovascular Medicine
|June 23, 2025
PubMed

Insights

Cardiac contractility modulation (CCM) helps heart failure patients with reduced ejection fraction (HFrEF) who experience hypotension. This therapy enables better tolerance of guideline-directed medical therapy (GDMT), improving cardiac function and remodeling.

Area of Science:

  • Cardiology
  • Biomedical Engineering

Background:

  • Guideline-directed medical therapy (GDMT) is crucial for reducing morbidity and mortality in heart failure with reduced ejection fraction (HFrEF).
  • Hypotension frequently prevents patients with advanced HFrEF from tolerating optimal GDMT.
  • Cardiac contractility modulation (CCM) enhances myocardial contractility and reverses cardiac remodeling in HFrEF, but its role in facilitating GDMT is unclear.

Observation:

  • A 56-year-old male with dilated cardiomyopathy and NYHA class III HFrEF experienced recurrent hospitalizations due to hypotension (SBP ≤90 mmHg).
  • The patient could not tolerate full-dose GDMT, with medications significantly limited.
  • A CCM device was implanted, leading to gradual blood pressure improvement.

Findings:

  • Post-CCM implantation, the patient tolerated initiation and uptitration of all four major GDMT drug classes.
  • Over 12 months, significant improvements were observed in exercise capacity, quality of life, and cardiac remodeling.
  • Echocardiography showed increased LVEF from 15% to 48%, improved GLS from -3.3% to -16.2%, and normalized NT-proBNP levels.

Implications:

  • CCM may be a viable strategy to overcome GDMT intolerance caused by hypotension in HFrEF patients.
  • Facilitating GDMT optimization through CCM can lead to improved cardiac remodeling and patient prognosis.
  • This case highlights CCM's potential to bridge hemodynamic vulnerability and enable comprehensive HFrEF management.
Abstract

Keywords:
cardiac contractility modulationcardiac remodelingguideline-directed medical therapyheart failure with reduced ejection fractionhypotension

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