Long-term results of combined cardiac contractility modulation and subcutaneous defibrillator therapy in patients with heart failure and reduced ejection fraction

Abstract Aims Cardiac contractility modulation therapy (CCMT) has been shown to reduce hospitalizations and to improve quality of life in heart failure patients with reduced ejection fraction (HFrEF) who remain symptomatic despite disease-modifying therapies. Strain imaging derived myocardial work (MW) is an emerging tool for evaluating left ventricular mechanics by incorporating systolic deformation and afterload burden in the analysis. To evaluate prospectively the impact of CCMT in HFrEF patients on MW derived parameters in relation to standard echocardiographic indices. Methods and results We recruited 12 HFrEF patients with indications to CCMT according to current clinical practice. A comprehensive echo-Doppler evaluation, including speckle tracking derived assessment of global longitudinal strain (GLS), was performed before and after three months from the CCM device implantation. Parameters of MW such as global work index (GWI), global constructive work (GCW) global wasted work (GWW), and global work efficiency (GWE) were calculated according to standardized procedures. Median values (interquartile range) were compared for all those parameters from baseline and 3-month follow-up with Wilcoxon Rank Sum test for continuous variables. At three months from CCM implant an improvement of LVEF [from 32% (27–34) to 36% (29–39), P < 0.05], GLS [from 7.4% (6.2–11.2) to 9.9% (7.5–9.4), P < 0.05], GWI [from 461 mmHg (372–613) to 589 mmHg (413–696), P < 0.05], GCW [from 800 mmHg (620–930) to 970 mmHg (644–1009), P = 0.236], and GWE [from 73% (65–78) to 85% (78–87), P < 0.05] was observed, with a consistent reduction of GWW [from 161 mmHg (148–227) to 125 mmHg (101–188), P < 0.05]. We also found a positive correlation between the magnitude of LVEF improvement and the baseline values of GCW (r = 0.727, P = 0.011). Conclusions At 3 months, CCMT significantly improves standard and advanced left ventricular systolic function indices. This improvement is due to the increase of constructive work and a reduction of wasted work. In addition, the increase of left ventricular ejection fraction can be predicted by the global constructive work levels at baseline.

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Two-year follow-up of patients with heart failure with reduced ejection fraction receiving cardiac contractility modulation

Russian Journal of Cardiology ◽

10.15829/1560-4071-2020-3853 ◽

2020 ◽

Vol 25 (7) ◽

pp. 3853

Author(s):

M. A. Vander ◽

E. A. Lyasnikova ◽

L. A. Belyakova ◽

M. A. Trukshina ◽

V. L. Galenco ◽

...

Keyword(s):

Heart Failure ◽

Independent Predictor ◽

Nyha Class ◽

Cardiac Contractility ◽

Composite Endpoint ◽

Class Ii ◽

Cardiac Contractility Modulation ◽

Reduced Ejection Fraction ◽

Patients With Heart Failure

Aim. To assess the 2-year prognosis of patients with heart failure with reduced ejection fraction (HFrEF) receiving cardiac contractility modulation (CCM).Material and methods. This single-center observational study included 55 patients (46 men, mean age 53±11 years) with NYHA class II-III HFrEF receiving optimal medical therapy, with sinus rhythm, QRS <130 ms or QRS<150 ms with nonspecific intraventricular conduction delay. NYHA class II and III were established in 76% and 24% of patients, respectively. All patients were implanted with CCM devices between October 2016 and September 2017. Follow-up visits were carried out every 3 months during the 1st year and every 6 months during the 2nd year of observation. The primary composite endpoint was mortality and heart transplantation. Secondary composite endpoints included death, heart transplantation, paroxysmal ventricular tachycardia/ ventricular fibrillation, hospitalizations due decompensated HFResults. The one-year and two-year survival rate was 95% and 80%, respectively. Primary endpoint was observed in 20% of patients. NYHA class III and higher levels of N-terminal pro-brain natriuretic peptide (NTproBNP) were associated with unfavorable prognosis (p=0,014 and p=0,026, respectively). NTproBNP was an independent predictor of survival (p=0,018). CCM contributed to a significant decrease in hospitalizations due to decompensated HF (p<0,0001). The secondary endpoint was observed in 18 (33%) of patients during the 1st year. The predictor for the secondary composite endpoint was NTproBNP (p=0,047).Conclusion. CCM is associated with a significant decrease in hospitalization rate due to decompensated HF. The 2-year survival rate of patients with NYHA class II-III HF receiving CCM was 80%. The NTproBNP level was an independent predictor of survival in patients receiving CMM for 2 years. Further longer-term studies of the CCM efficacy are required.

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Cardiac contractility modulation for the treatment of heart failure with reduced ejection fraction

Heart Failure Reviews ◽

10.1007/s10741-020-10017-1 ◽

2020 ◽

Author(s):

Peysh A. Patel ◽

Ramesh Nadarajah ◽

Noman Ali ◽

John Gierula ◽

Klaus K. Witte

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Cardiac Contractility ◽

Cardiac Contractility Modulation ◽

Reduced Ejection Fraction

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Relation between therapy‐induced changes in natriuretic peptide levels and long‐term therapeutic effects on mortality in patients with heart failure and reduced ejection fraction

European Journal of Heart Failure ◽

10.1002/ejhf.1411 ◽

2019 ◽

Vol 21 (5) ◽

pp. 613-620 ◽

Cited By ~ 5

Author(s):

Benjamin S. Wessler ◽

Michael McCauley ◽

Kevin Morine ◽

Marvin A. Konstam ◽

James E. Udelson

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Natriuretic Peptide ◽

Therapeutic Effects ◽

Reduced Ejection Fraction ◽

Patients With Heart Failure ◽

Induced Changes

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Reverse remodelling of the heart after atrial fibrillation ablation in patients with heart failure with reduced ejection fraction

Kardiologiia ◽

10.18087/cardio.2671 ◽

2019 ◽

Vol 59 (8S) ◽

pp. 37-43

Author(s):

N. Z. Gasimova ◽

E. N. Mikhaylov ◽

V. S. Orshanskaya ◽

A. V. Kamenev ◽

R. B. Tatarsky ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Left Ventricle ◽

Ejection Fraction ◽

Reverse Remodeling ◽

Left Heart ◽

Reduced Ejection Fraction ◽

Patients With Heart Failure

Aim. To evaluate the effect of atrial fibrillation (AF) catheter ablation (CA) on long-term freedom from AF and left heart reverse remodeling in patients with heart failure with reduced ejection fraction (HFrEF).Methods. There were 47 patients (mean age 53.3 ± 10 years, 39 males) enrolled into single-center observational study, with left ventricular ejection fraction (LVEF) <40 %. Patients underwent CA for AF refractory to antiarrhythmic drugs. Baseline clinical data and diagnostic tests results were obtained during personal visits and / or via secure telemedical services. Personal contact with evaluation of recurrence of AF and echocardiographic values was performed with 30 (64 %) patients.Results. Paroxysmal AF was present in 12 (40 %) patients, persistent – in 18 (60 %). During mean follow-up of 3 years (0.5–6 years) redo ablation was performed in 9 patients (30 %) with average number of 1.3 procedures per patient. At 6 months 24 (80 %) patients were free from AF, at last follow-up – 16 (53 %). The mean time to first recurrence following CA was 15.6±13.3 months. Follow-up echocardiography revealed significant LVEF improvement (р<0,0001), reduction of left atrium size (р<0,0001), left ventricle end-diastolic volume (р<0,002) and left ventricle endsystolic volume (p<0,0001) and mitral regurgitation (р=0,001).Conclusion. AF CA in patients with HFrEF is associated with improvement in systolic function and left heart reverse remodeling. Durable long-term antiarrhythmic effect often requires repeated procedures.

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