Cardiac contractility modulation for the treatment of heart failure with 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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Cardiac contractility modulation improves long‐term survival and hospitalizations in heart failure with reduced ejection fraction

European Journal of Heart Failure ◽

10.1002/ejhf.1374 ◽

2019 ◽

Vol 21 (9) ◽

pp. 1103-1113 ◽

Cited By ~ 17

Author(s):

Stefan D. Anker ◽

Martin Borggrefe ◽

Hans Neuser ◽

Marc‐Alexander Ohlow ◽

Susanne Röger ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Cardiac Contractility ◽

Term Survival ◽

Cardiac Contractility Modulation ◽

Long Term Survival ◽

Reduced Ejection Fraction

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Cardiac contractility modulation: mechanisms of action in heart failure with reduced ejection fraction and beyond

European Journal of Heart Failure ◽

10.1002/ejhf.1349 ◽

2018 ◽

Vol 21 (1) ◽

pp. 14-22 ◽

Cited By ~ 14

Author(s):

Carsten Tschöpe ◽

Behrouz Kherad ◽

Oliver Klein ◽

Axel Lipp ◽

Florian Blaschke ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Cardiac Contractility ◽

Mechanisms Of Action ◽

Cardiac Contractility Modulation ◽

Reduced Ejection Fraction

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Cardiac contractility modulation: first experience in heart failure patients with reduced ejection fraction and permanent atrial fibrillation

EP Europace ◽

10.1093/europace/euu050 ◽

2014 ◽

Vol 16 (8) ◽

pp. 1205-1209 ◽

Cited By ~ 15

Author(s):

S. Roger ◽

R. Schneider ◽

B. Rudic ◽

V. Liebe ◽

K. Stach ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Ejection Fraction ◽

Cardiac Contractility ◽

Cardiac Contractility Modulation ◽

Reduced Ejection Fraction ◽

Heart Failure Patients ◽

Permanent Atrial Fibrillation

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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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The assessment of left ventricular myocardial work in patients with chronic heart failure receiving cardiac contractility modulation therapy

European Heart Journal ◽

10.1093/eurheartj/ehab724.0135 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

S Dobrovolskaya ◽

M Saidova ◽

A Safiullina ◽

T Uskach ◽

A Belevskaya ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Ejection Fraction ◽

Nyha Class ◽

Cardiac Contractility ◽

Left Ventricular ◽

Cardiac Contractility Modulation ◽

Device Implantation ◽

Echocardiographic Parameters ◽

Global Work

Abstract Introduction A new non-invasive technology for the assessment of left ventricular myocardial work (LVMW) is based on speckle-tracking echocardiography and considers LV pressure. Changes in LVMW are described in patients with different cardiovascular diseases. In patients with chronic heart failure (CHF), LVMW is associated with long-term prognosis and favorable response to cardiac resynchronization therapy. Purpose To study echocardiographic parameters, including LVMW, in patients with CHF receiving cardiac contractility modulation therapy. Methods The study included 40 patients (31 men and 7 women) aged 60.5 [55.0; 66.0] years with heart failure with reduced ejection fraction (NYHA class II or III) in combination with atrial fibrillation. Before implantation of cardiac contractility modulation (CCM) device and 2, 6 and 12 months after, the patients underwent transthoracic echocardiography with an assessment of the main structural and functional parameters. Also, initially and after 12 months of CCM therapy, an assessment of global longitudinal strain (GLS) and LVMW was performed (global work index (GWI), global constructive work (GCW), global wasted work, global work efficiency (GWE)). Results Initially, the patients included in the study had enlarged left heart chambers and decreased left ventricular ejection fraction (LVEF). CCM therapy was accompanied by significant increase in LVEF from 30.0 [26.5; 37.0]% before device implantation up to 34.4 [27.0; 40.0]% (p=0.016) after 2 months and up to 38.0 [30.5; 42.0]% (p<0.01) after 6 months of treatment. One year after device implantation, a significant increase in LVEF was maintained as compared with initial data (39 [31; 45]%, p<0.01). We also analyzed the dynamics of echocardiographic parameters depending on etiology of CHF (ischemic and non-ischemic). As in general group of patients regardless of CHF etiology there was a significant increase in LVEF, that reached maximum values after 12 months of therapy (36 [30; 42]% in group with ischemic etiology, p<0.01 and 37 [30; 45]% in group with non-ischemic etiology, p<0.01). The assessment of GLS before and 12 months after device implantation revealed no significant dynamics (−7 [−9; −4]% and −8 [−9; −5]%, p=0.93). However, we observed significant changes in LVMW: an increase in GWI from 429 [332; 744] to 635 [401; 815] mm Hg% (p=0.01) and GWE (from 73 [68; 79] to 74 [70; 87] %, p=0.02) due to an increase in GCW (from 791 [530; 1031] to 836 [708; 1109] mm Hg%, p=0.03). Conclusions A significant increase in LVEF, GWI and GWE in patients with CHF (NYHA class II or III) receiving CCM therapy indicates an improvement in LV systolic function and the effectiveness of CCM therapy. The modern echocardiographic technologies open great opportunities for detailed assessment of the effectiveness of treatment of patients with CHF, including the use of CCM devices. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Health of Russian Federation

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New Generation Cardiac Contractility Modulation Device—Filling the Gap in Heart Failure Treatment

Journal of Clinical Medicine ◽

10.3390/jcm8050588 ◽

2019 ◽

Vol 8 (5) ◽

pp. 588 ◽

Cited By ~ 4

Author(s):

Diana Tint ◽

Roxana Florea ◽

Sorin Micu

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Cardiac Contractility ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Device Therapy ◽

Ventricular Ejection Fraction ◽

Cardiac Contractility Modulation ◽

New Device ◽

Wide Range

(1) Background: Heart failure (HF) is a major cause of morbidity and mortality throughout the world. Despite substantial progress in its prevention and treatment, mortality rates remain high. Device therapy for HF mainly includes cardiac resynchronization therapy (CRT) and the use of an implantable cardioverter-defibrillator (ICD). Recently, however, a new device therapy—cardiac contractility modulation (CCM)—became available. (2) Aim: The purpose of this study is to present a first case-series of patients with different clinical patterns of HF with a reduced ejection fraction (HFrEF), supported with the newest generation of CCM devices. (3) Methods and results: Five patients with a left ventricular ejection fraction (LVEF) ≤ 35% and a New York Heart Association (NYHA) class ≥ III were supported with CCM OPTIMIZER® SMART IPGCCMX10 at our clinic. The patients had a median age of 67 ± 8.03 years (47–80) and were all males—four with ischemic etiology dilated cardiomyopathy. In two cases, CCM was added on top of CRT (non-responders), and, in one patient, CCM was delivered during persistent atrial fibrillation (AF). After 6 months of follow-up, the LVEF increased from 25.4 ± 6.8% to 27 ± 9%, and the six-minute walk distance increased from 310 ± 65.1 m to 466 ± 23.6 m. One patient died 47 days after device implantation. (4) Conclusion: CCM therapy provided with the new model OPTIMIZER® SMART IPG CCMX10 is safe, feasible, and applicable to a wide range of patients with HF.

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Cardiac Contractility Modulation Therapy for Heart Failure – First Romanian Experience

Romanian Journal of Cardiology ◽

10.47803/rjc.2021.31.3.609 ◽

2021 ◽

Vol 31 (3) ◽

pp. 609-614

Author(s):

Diana TINT ◽

◽

Sorin MICU ◽

Keyword(s):

Heart Failure ◽

Nyha Class ◽

Cardiac Contractility ◽

Case Series ◽

Cardiac Resynchronization ◽

Cardiac Contractility Modulation ◽

Reduced Ejection Fraction ◽

Cardiac Contractile ◽

Patients With Heart Failure

Aim: The purpose of this study is to present the first Romanian case-series of patients with heart failure with reduced ejection fraction (HFrEF), supported with the newest generation of cardiac contractility modulation (CCM) device. Methods and results: 16 patients (15 men), aged 66.6±7.49 years, were supported with OPTIMIZER® smart IPG CCMX10 device and followed-up for an average duration of 385.75±326.32 days. The etiology of HF was ischemic in 13 patients (81%), 8 patients (50%) had atrial fibrillation, mean creatinine clearance value was 55.8±13.87 ml/min, and 5 patients (31,2%) had diabetes mellitus. All patients were supported with an implanted cardio verter-defibrillator (ICD), while 5 patients (31.2%) had cardiac resynchronization therapy (CRT) on top. The pharma cological treatment has been optimized in all patients. Six months after implantation, the LVEF has increased from 25.93%±6.21 to 35.5%±4.31 (p=0.00002), NYHA class improved from 3.18±0.4 to 1.83±0.38 (p<0.0001), and exercise tolerance evaluated with 6 minute walking test (6MWT) increased (from 321.87±70.63m to 521.41±86.43m; p<0,00001). Three patients (18,7%) died during the follow-up period after 48, 108 and 545 days (one non-cardiac death). Conclusions: Cardiac contractile therapy is a feasible, safe, and useful therapy for patients with HFrEF whose symptomatology is not improved with optimal standard therapy.

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Cardiac contractility modulation therapy in elderly patients with chronic heart failure: results of the 12-month follow-up

Jounal of arrhythmology ◽

10.35336/va-2021-2-5-10 ◽

2021 ◽

Vol 28 (2) ◽

pp. 5-10

Author(s):

I. A. Chugunov ◽

K. V. Davtyan ◽

A. H. Topchyan ◽

N. A. Mironova ◽

E. M. Gupalo

Keyword(s):

Heart Failure ◽

Elderly Patients ◽

Nyha Class ◽

Cardiac Contractility ◽

Signs And Symptoms ◽

Left Ventricular ◽

Additional Treatment ◽

Cardiac Contractility Modulation ◽

Reduced Ejection Fraction

Aim. This study aimed to evaluate the efficacy and safety of cardiac contractility modulation (CCM) therapy in elderly patients with heart failure with reduced ejection fraction (HFrEF).Methods. Sixteen patients older than 65 years old (median age 70 years) undergoing CCM Optimizer (Impulse Dynamics) device implantation due to HFrEF (NYHA class II - 9 (56%), III - 4 (25%), IV - 3 (19%)) were enrolled in this two-center observational study. Before implantation 6-minute walk test (6MWT), transthoracic echocardiography (TTE) was performed on all patients, and NTproBNP levels were assessed. The follow-up duration was 12 months with 2, 6, 12-month follow-up visits. Control 6MWT, TTE and NTproBNP tests were performed at 6-month and 12-month follow-up visits.Results. Two patients died during follow-up due to HF decompensation. The remaining patients showed a significant improvement in 6MWT (350 m vs 402.5 m, p=0,01). We also noted a tendency towards the left ventricular EF improvement (33% vs 40%, p=0,2) and lower values of NTproBNP levels (1112 pg/ml vs 527 pg/ml, p=0,19).Conclusion. CCM therapy is a safe and efficient additional treatment option to manage elderly patients with HFrEF for reducing signs and symptoms of HF.

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