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

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.

scholarly journals Cardiac Contractility Modulation Therapy for Heart Failure – First Romanian Experience 

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.

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

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.

P3523Cardiac contractility modulation provides improved ventilatory efficiency and reduces oscillatory breathing pattern

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D Schoene ◽  
A Aweimer ◽  
L Boesche ◽  
P Patsalis ◽  
J Zeidler ◽  
...  
Keyword(s):  
Heart Failure ◽  
Breathing Pattern ◽  
Cardiac Contractility ◽  
Cardiopulmonary Exercise Testing ◽  
Control Group ◽  
Cardiac Contractility Modulation ◽  
Ventilatory Efficiency ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure

Abstract Introduction Cardiac Contractility Modulation (CCM) is a treatment for patients with heart failure with reduced ejection fraction (HFrEF) providing improved myocardial molecular and biochemical characteristics and thus improved exercise tolerance and quality of life by application of electrical signals during the absolute refractory period. Cardiopulmonary exercise testing is an integrative method to assess exercise tolerance in heart failure patients providing insights in circulatory, respiratory and metabolic reactions during exercise. The VE/VCO2-Slope (minute ventilation/carbon dioxide production) and an oscillatory breathing pattern have widely been demonstrated to have strong prognostic value for patients with chronic heart failure. Methods Between February 2017 and January 2019 15 patients (mean age 64.4±7.9 years, NYHA 2.93±0.58) with standard indication for CCM-therapy have been enrolled in a single center in Germany. Prior to implantation of the Optimizer Smart System, symptom-limited cardiopulmonary exercise testing was performed using a bicycle ramp protocol (25W+10W/min). The Follow-up was conducted 6 weeks post implantation. The control group consisted of 45 patients (mean age 64.8±7.9 years, NYHA 2.2±0.72) with stable systolic heart failure and reduced ejection fraction. Statistical Analysis was performed by paired and unpaired t tests. Results 6 weeks after CCM-implantation the VE/VCO2-Slope showed a significant decrease (39.6±11.1 vs. 36.6±8.9, p<0.05) showing changes in ventilatory efficiency whereas the control-group showed stable measurements with even an increasing tendency (33.6±7.4 vs. 34.2±7.4, p=0.43). The absolute change of the VE/VCO2-Slope between the CCM-group and control-group highlights the improvement after the intervention (−2.99±5.07 vs. 0.63±4.79, p<0.05). The number of patients presenting an oscillatory breathing pattern markedly decreased with CCM-therapy (11 of 15 vs. 6 of 15, p<0.05), whereas even one additional patient of the control group showed an oscillatory breathing pattern at follow up (15 of 45 vs. 16 of 45). In contrast, subjects showed no significant changes in watt-measurements (72.67 W ± 19.2 W vs. 76.57 W ± 18.5 W) or maximal oxygen uptake (1034 ml/min ± 247 ml/min vs. 1104 ml/min ± 256 ml/min) compared to baseline. Similarly, the control-group showed stable measurements for external load (79.9 W ± 16.4 W vs. 77.1 W ± 17.5 W) and peak oxygen uptake (1097 ml/min ± 225 ml/min vs. 1116 ml/min ± 330 ml/min). Conclusion Cardiac Contractility Modulation provides improved ventilatory efficiency measures by VE/VCO2-slope and reduces oscillatory breathing pattern during exercise at follow up. As the low ventilatory efficiency observed in patients with heart failure constitutes an important predictor of cardiovascular mortality these results provide an interesting insight of therapeutic effects of Cardiac Contractility Modulation apart from VO2-measurements.

scholarly journals Effect of dapagliflozin in patients with heart failure on reducing cardiovascular mortality in federal project on the prevention of cardiovascular diseases

2020 ◽  
Vol 25 (10) ◽  
pp. 4142
Author(s):  
M. V. Zhuravleva ◽  
S. N. Tereshchenko ◽  
I. V. Zhirov ◽  
S. V. Villevalde ◽  
T. V. Marin ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Diseases ◽  
Cardiovascular Mortality ◽  
Nyha Class ◽  
Target Population ◽  
Class Ii ◽  
Reduced Ejection Fraction ◽  
Kaplan Meier ◽  
Study Results ◽  
Patients With Heart Failure

Aim. To assess the effect of dapagliflozin in patients with heart failure with reduced ejection fraction (HFrEF) on reducing cardiovascular mortality as the main goal of a federal project on the prevention of cardiovascular diseases.Material and methods. All adult Russian patients with a documented NYHA class II-IV HFrEF (EF £40%) were considered the target population. The characteristics of the patients corresponded to those of the Russian Hospital Heart Failure Registry (RUS-HFR). The study looked at an increase in the dapagliflozin use in addition to standard therapy by 10% of patients annually in 2021-2023 and calculated the number of deaths that could be prevented. Cardiovascular mortality curve was created by extrapolation of the DAPA-HF study results using the Kaplan-Meier method. Further, the contribution of prevented deaths with dapagliflozin to the achievement of regional and federal targets for reducing cardiovascular mortality was calculated for 1, 2, and 3 years. Results. In case of 10% annual increase in dapagliflozin use in patients with NYHA class II-IV HFrEF, this will allow:—   to prevent an additional 1,736 cardiovascular deaths in the first year, achieving the target of federal project on the prevention of cardiovascular diseases in 2021 by 5,9%;—   to prevent an additional 3,784 cardiovascular deaths in the second year, achieving the target of federal project on the prevention of cardiovascular diseases in 2022 by 12,9%;—   to prevent an additional 5,485 cardiovascular deaths in the third year, achieving the target of federal project on the prevention of cardiovascular diseases in 2023 by 18,7%.Conclusion. The use of dapagliflozin in patients with HFrEF will reduce mortality from cardiovascular diseases.

P3553Right ventricular echocardiographic composite parameters in predicting major adverse cardiac events in patients with heart failure with reduced ejection fraction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M S Stefanovic ◽  
I S Srdanovic ◽  
A M Milovancev ◽  
S B Bjelic ◽  
A V Vulin ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Right Ventricle ◽  
Predictive Value ◽  
Independent Predictor ◽  
Systolic Pressure ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
Relationship Of

Abstract Background Echocardiography assessment of right ventricle still play an indispensable role in diagnosis, decision-making for further therapy and risk assessment of patients with heart failure with reduced ejection fraction (HFrEF). Aims Our objective was to compare the predictive value of five composite echo parameters of right ventricle (RV) in decompensated patients with HFrEF. Methods and results A total of 191 NYHA III-IV patients admitted for decompensation of advanced HFrEF (EF=25.53±6,87%) were prospectively enrolled. During the follow-up period mean period of 340±84 days, 111 (58.1%) patients met the primary composite endpoint (MACE) of cardiac death, rehospitalization due to repeated decompensation, malignant rhythm disorders, heart attack or stroke. The average time of MACE occurrence was 110.5±98.7 days. Among group of patients with MACE, during the follow-up, there were 34 (30.6%) cardiac related deaths. Re-hospitalization due to cardiovascular causes had 77 patients (69.4%). The study was performed at our hospital between June 2016 and January 2018. Patients were assessed for the following combined echo parameters: (i) relationship of right and left ventricle basal diameter (RVb/LVb x0,1); (ii) relationship of tricuspid annular plane systolic excursion and right ventricle systolic pressure (TAPSE/RVSP mm/mmHg); (iii) relationship of tricuspid annular systolic velocity and right ventricle systolic pressure (TAs'x100/ RVSP cm/s/mmHg); (iv) product of tricuspid annular systolic velocity and pulmonic valve acceleration time (TAs'x PVAcT (cm/s2 x 1000)); (v) product of systolic and diastolic velocity of tricuspid annulus (TAs xTAe). The last three parameters were result of this study and were not mentioned in earlier researches. In this study, univariat analysis of combined RV echo parameters, TAPSE/RVSP, TAs'x100 /RVSP as well as TAs'xPVAcT have been shown to be highly significant predictors of MACE, p=0.001. The TAs'xTAe' product has been also distinguished as a significant predictor of MACE, p=0.04, as well as the ratio RVb/LVb x 0.1, p=0.007. Multivariate analysis of these five combined RV echo parameters shows that significant independent predictor of MACE turned out to be TAs'x100/RVSP (p<0.001, HR = 0.668 (0.531–0.840)). Obtained by reconstruction of the ROC curve (Area = 0.70 (95% CI 0.59–0.75); p<0.001, we have got cut off value of TAs'x100/RVSP = 1.92 (cm/s/mmHg). Kaplan-Meier curves were constructed by comparing the time to the occurrence of MACE. Patients with TAs'x100/RVSP ≤1.92 (cm/s/mmHg) have a significantly worse prognosis (Log Rank p<0.001). Conclusion New variable TAs'x100/RVSP, derived from this research, proved to be the most powerful combined RV echo parameter, independent predictor of one year MACE, with a better predictive value compared to the already described combined parameters in the literature.

Prevalence and prognostic impact of somatic mutations in patients with heart failure and reduced ejection fraction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D.J Vazquez Andres ◽  
A Hernandez Vicente ◽  
M Diez Diez ◽  
M Gomez Molina ◽  
A Quintas ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Somatic Mutations ◽  
Myocardial Dysfunction ◽  
Study Endpoint ◽  
Prognostic Impact ◽  
Reduced Ejection Fraction ◽  
Increased Risk ◽  
Patients With Heart Failure

Abstract Introduction Somatic mutations in hematopoietic cells are associated with age and have been associated with higher mortality in apparently healthy adults, especially due to atherosclerotic disease. In animal models, somatic mutations are associated with atherosclerosis progression and myocardial dysfunction, especially when gene TET2 is affected. Preliminary clinical data, referred to ischemic heart failure (HF), have associate the presence of these acquired mutations with impaired prognosis. Purpose To study the prevalence of somatic mutations in patients with heart failure with reduced ejection fraction (HFrEF) and their impact on long-term prognosis. Methods We studied a cohort of elderly patients (more than 60 years old) hospitalized with HFrEF (LVEF&lt;45%). The presence of somatic mutations was assessed using next generation sequencing (Illumina HiSeq 2500), with a mutated allelic fraction of at least 2% and a panel of 55 genes related with clonal hematopoiesis. Patients were followed-up for a median of three years. The study endpoint was a composite of death or readmission for worsening HF. Kaplan-Meier analysis (log-rank test) and Cox proportional hazards regression models were performed adjusting for age, sex and LVEF. Results A total of 62 patients (46 males (74.2%), age 74±7.5 years) with HFrEF (LVEF 29.7±7.8%) were enrolled in the study. The ischemic etiology was present in 54% of patients. Somatic mutations in Dnmt3a or Tet2 were present in 11 patients (17.7%). No differences existed in baseline characteristics except for a higher prevalence of atrial fibrillation in patients with somatic mutations (70% vs. 40%, p=0.007). During the follow-up period, 40 patients (64.5%) died and 38 (61.3%) had HF re-admission. The KM survival analysis for the combined event is shown in Figure 1. Compared with patients without somatic mutations and after adjusting for covariates, there was an increased risk of adverse outcomes when the somatic mutations were present (HR 3.6, 95% CI [1.6, 7.8], p=0.0014). This results remains considering death as a competing risk (Gray's test p=0.0097) and adjusting for covariates (HR = 2.21 95% CI [0.98, 5], p=0.0556). Conclusions Somatic mutation are present in patients with HFrEF and determine a higher risk of adverse events in the follow-up. Further studies are needed to assess the clinical implications of these findings. Figure 1 Funding Acknowledgement Type of funding source: None

Abstract 12849: Changes in N-terminal Pro Brain Natriuretic Peptide Levels Predicts Mortality and Heart Failure Hospitalization in Patients With Heart Failure and Preserved Ejection Fraction

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Gianluigi Savarese ◽  
Camilla Hage ◽  
Ulf Dahlström ◽  
Pasquale Perrone-Filardi ◽  
Lars H Lund
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Total Mortality ◽  
Preserved Ejection Fraction ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
The Impact

Introduction: Changes in N-terminal pro brain natriuretic peptide (NT-proBNP) have been demonstrated to correlate with outcomes in patients with heart failure (HF) and reduced ejection fraction (EF). However the prognostic value of a change in NT-proBNP in patients with heart failure and preserved ejection fraction (HFPEF) is unknown. Hypothesis: To assess the impact of changes in NT-proBNP on all-cause mortality, HF hospitalization and their composite in an unselected population of patients with HFPEF. Methods: 643 outpatients (age 72+12 years; 41% females) with HFPEF (ejection fraction ≥40%) enrolled in the Swedish Heart Failure Registry between 2005 and 2012 and reporting NT-proBNP levels assessment at initial registration and at follow-up were prospectively studied. Patients were divided into 2 groups according the median value of NT-proBNP absolute change that was 0 pg/ml. Median follow-up from first measurement was 2.25 years (IQR: 1.43 to 3.81). Adjusted Cox’s regression models were performed using total mortality, HF hospitalization (with censoring at death) and their composite as outcomes. Results: After adjustments for 19 baseline variables including baseline NT-proBNP, as compared with an increase in NT-proBNP levels at 6 months (NT-proBNP change>0 pg/ml), a reduction in NT-proBNP levels (NT-proBNP change<0 pg/ml) was associated with a 45.2% reduction in risk of all-cause death (HR: 0.548; 95% CI: 0.378 to 0.796; p:0.002), a 50.1% reduction in risk of HF hospitalization (HR: 0.49; 95% CI: 0.362 to 0.689; p<0.001) and a 42.6% reduction in risk of the composite outcome (HR: 0.574; 95% CI: 0.435 to 0.758; p<0.001)(Figure). Conclusions: Reductions in NT-proBNP levels over time are independently associated with an improved prognosis in HFPEF patients. Changes in NT-proBNP could represent a surrogate outcome in phase 2 HFPEF trials.

scholarly journals Changes of myocardial fibrosis markers with the use of beta-blockers and mineralocorticoid receptor antagonists in patients with heart failure with mid-range ejection fraction of ischemic origin

2021 ◽  
Vol 20 (7) ◽  
pp. 3068
Author(s):  
O. A. Osipova ◽  
E. V. Gosteva ◽  
T. P. Golivets ◽  
O. N. Belousova ◽  
O. A. Zemlyansky ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Myocardial Fibrosis ◽  
Mineralocorticoid Receptor ◽  
Nyha Class ◽  
Class Ii ◽  
Class I ◽  
Enzyme Linked Immunosorbent Assay ◽  
Mineralocorticoid Receptor Antagonist ◽  
Patients With Heart Failure

Aim. To compare the effect of 12-month pharmacotherapy with a betablocker (BB) (bisoprolol and nebivolol) and a combination of BB with a mineralocorticoid receptor antagonist (bisoprolol+eplerenone, nebivolol+eplerenone) on following fibrosis markers: matrix metalloproteinases 1 and 9 (MMP-1, MMP-9) and tissue inhibitor of MMP-1 (TIMP-1) in patients with heart failure with mid-range ejection fraction (HFmrEF) of ischemic origin.Material and methods. The study included 135 patients, including 40 (29,6%) women and 95 (70,4%) men aged 45-60 years (mean age, 53,1±5,7 years). Patients were randomized into subgroups based on pharmacotherapy with BB (bisoprolol or nebivolol) and their combination with eplerenone. The enzyme-linked immunosorbent assay was used to determine the level of MMP-1, MMP-9, TIMP-1 (ng/ml) using the commercial test system “MMP-1 ELISA”, “MMP-9 ELISA”, “Human TIMP-1 ELISA” (“Bender Medsystems “, Austria).Results. In patients with HFmrEF of ischemic origin, there were following downward changes in serum level of myocardial fibrosis markers, depending on the therapy: bisoprolol  — MMP-1 decreased by 35% (p<0,01), MMP-9  — by 56,3% (p<0,001), TIMP-1  — by 17,9% (p<0,01); nebivolol  — MMP-1 decreased by 45% (p<0,001), MMP-9  — by 57,1% (p<0,001), TIMP-1  — by 30,1% (p<0,01); combination of bisoprolol with eplerenone  — MMP-1 decreased by 43% (p<0,001), MMP-9  — by 51,2% (p<0,001), TIMP-1  — by 25,1% (p<0,01); combination of nebivolol with eplerenone  — MMP-1 decreased by 53% (p<0,001), MMP-9 — by 64,3% (p<0,001), TIMP-1 — by 39% (p<0,01). In patients with NYHA class I HFmrEF after 12-month therapy, the decrease in MMP-1 level was 39,9% (p<0,01), MMP-9  — 57,5% (p<0,001). In class II, the decrease in MMP-1 level was 47% (p<0,001), MMP-9 — 49,7% (p<0,001). A significant decrease in TIMP-1 level was revealed in patients with class I by 29% (p<0,01), in patients with class II by 27,1% (p<0,01) compared with the initial data.Conclusion. A significant decrease in the levels of myocardial fibrosis markers (MMP-1, MMP-9, TIMP-1) was demonstrated in patients with HFmrEF of ischemic origin receiving long-term pharmacotherapy. The most pronounced effect was determined in patients with NYHA class I HF.

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