Christian Fastner1, Goekhan Yuecel1, Boris Rudic1, Gereon Schmiel1, Matthias Toepel1, Daniel Burkhoff2, Volker Liebe1, Mathieu Kruska1, Svetlana Hetjens3, Martin Borggrefe1, Ibrahim Akin1, Juergen Kuschyk4. 1. First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany. 2. Cardiovascular Research Foundation, New York, NY, USA. 3. Department of Medical Statistics and Biomathematics, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany. 4. First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany. Electronic address: juergen.kuschyk@umm.de.
Abstract
BACKGROUND: Cardiac contractility modulation (CCM) is an FDA-approved device-based therapy for patients with systolic heart failure and normal QRS complex who are symptomatic despite optimal drug therapy. The purpose of this study was to compare the long-term therapeutic effects of CCM in patients with ischemic (ICM) compared to non-ischemic cardiomyopathy (NICM Changes in NYHA class, left ventricular ejection fraction (LVEF), tricuspid annular plane systolic excursion (TAPSE), NT-proBNP and KDIGO CKD stage, were compared as functional parameters. Moreover, observed mortality rates at one and three years were compared to those predicted by the MAGGIC heart failure risk score and compared between groups. RESULTS: One hundred and seventy-four consecutive patients with chronic heart failure were included in this retrospective analysis of patients implanted with a CCM device between 2002 and 2019. LVEF improved after three years of CCM treatment (35 ± 9 vs. 30 ± 9%; p = 0.0211) and after five years, TAPSE of NICM patients was significantly higher than that of ICM patients (21 ± 5 vs. 18 ± 5%; p = 0.0437). There were no differences in other effectiveness parameters. Over the entire follow-up period, 35% of all patients died (p = 0.81); only in ICM patients, mortality was lower than predicted at 3 years (35 vs. 43%, p = 0.0395). CONCLUSIONS: Regarding improvement of biventricular systolic function, patients with NICM appear to benefit particularly from CCM.
BACKGROUND: Cardiac contractility modulation (CCM) is an FDA-approved device-based therapy for patients with systolic heart failure and normal QRS complex who are symptomatic despite optimal drug therapy. The purpose of this study was to compare the long-term therapeutic effects of CCM in patients with ischemic (ICM) compared to non-ischemic cardiomyopathy (NICM Changes in NYHA class, left ventricular ejection fraction (LVEF), tricuspid annular plane systolic excursion (TAPSE), NT-proBNP and KDIGO CKD stage, were compared as functional parameters. Moreover, observed mortality rates at one and three years were compared to those predicted by the MAGGIC heart failure risk score and compared between groups. RESULTS: One hundred and seventy-four consecutive patients with chronic heart failure were included in this retrospective analysis of patients implanted with a CCM device between 2002 and 2019. LVEF improved after three years of CCM treatment (35 ± 9 vs. 30 ± 9%; p = 0.0211) and after five years, TAPSE of NICMpatients was significantly higher than that of ICM patients (21 ± 5 vs. 18 ± 5%; p = 0.0437). There were no differences in other effectiveness parameters. Over the entire follow-up period, 35% of all patients died (p = 0.81); only in ICM patients, mortality was lower than predicted at 3 years (35 vs. 43%, p = 0.0395). CONCLUSIONS: Regarding improvement of biventricular systolic function, patients with NICM appear to benefit particularly from CCM.