Cardiac contractility modulation improves long-term survival and hospitalizations in heart failure with reduced ejection fraction.

Autor: Anker SD; Division of Cardiology and Metabolism; Department of Cardiology (CVK; and Berlin-Brandenburg Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany.; Department of Cardiology and Pneumology and The German Center for Cardiovascular Research (DZHK), University Medicine Göttingen (UMG), Göttingen, Germany., Borggrefe M; First Department of Medicine, University Medical Centre Mannheim (UMM), Mannheim, Germany.; Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany.; DZHK (German Centre for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany., Neuser H; HELIOS Vogtland-Klinikum Plauen, Klinik für Innere Medizin II/Kardiologie, Pneumologie und Angiologie, Plauen, Germany., Ohlow MA; Zentralklinik Bad Berka GmbH, Bad Berka, Germany., Röger S; First Department of Medicine, University Medical Centre Mannheim (UMM), Mannheim, Germany.; Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany.; DZHK (German Centre for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany., Goette A; St. Vincenz Krankenhaus Paderborn, Paderborn, Germany.; Working Group of Molecular Electrophysiology, University Hospital Magdeburg, Magdeburg, Germany., Remppis BA; Herz- und Gefäßzentrum Bad Bevensen, Bad Bevensen, Germany., Kuck KH; Asklepios Klinik St. Georg, Hamburg, Germany., Najarian KB; Independent Statistical Consultant, Boston, MA, USA., Gutterman DD; Medical College of Wisconsin, Milwaukee, WI, USA., Rousso B; Scientific Consultant, Hod Hasharon, Israel., Burkhoff D; Cardiovascular Research Foundation, New York, NY, USA., Hasenfuss G; Department of Cardiology and Pneumology and The German Center for Cardiovascular Research (DZHK), University Medicine Göttingen (UMG), Göttingen, Germany.
Jazyk: angličtina
Zdroj: European journal of heart failure [Eur J Heart Fail] 2019 Sep; Vol. 21 (9), pp. 1103-1113. Date of Electronic Publication: 2019 Jan 16.
DOI: 10.1002/ejhf.1374
Abstrakt: Aims: Cardiac contractility modulation (CCM) improves symptoms and exercise tolerance and reduces heart failure (HF) hospitalizations over 6-month follow-up in patients with New York Heart Association (NYHA) class III or IV symptoms, QRS < 130 ms and 25% ≤ left ventricular ejection fraction (LVEF) ≤ 45% (FIX-HF-5C study). The current prospective registry study (CCM-REG) aimed to assess the longer-term impact of CCM on hospitalizations and mortality in real-world experience in this same population.
Methods and Results: A total of 140 patients with 25% ≤ LVEF ≤ 45% receiving CCM therapy (CCM-REG 25-45 ) for clinical indications were included. Cardiovascular and HF hospitalizations, Minnesota Living with Heart Failure Questionnaire (MLHFQ) and NYHA class were assessed over 2 years. Mortality was tracked through 3 years and compared with predictions by the Seattle Heart Failure Model (SHFM). A separate analysis was performed on patients with 35% ≤ LVEF ≤ 45% (CCM-REG 35-45 ) and 25% ≤ LVEF < 35% (CCM-REG 25-34 ). Hospitalizations decreased by 75% (from 1.2/patient-year the year before, to 0.35/patient-year during the 2 years following CCM, P < 0.0001) in CCM-REG 25-45 and by a similar amount in CCM-REG 35-45 (P < 0.0001) and CCM-REG 25-34 . MLHFQ and NYHA class improved in all three cohorts , with progressive improvements over time (P < 0.002). Three-year survival in CCM-REG 25-45 (82.8%) and CCM-REG 24-34 (79.4%) were similar to those predicted by SHFM (76.7%, P = 0.16; 78.0%, P = 0.81, respectively) and was better than predicted in CCM-REG 35-45 (88.0% vs. 74.7%, P = 0.046).
Conclusion: In real-world experience, CCM produces results similar to those of previous studies in subjects with 25% ≤ LVEF ≤ 45% and QRS < 130 ms; cardiovascular and HF hospitalizations are reduced and MLHFQ and NYHA class are improved. Overall mortality was comparable to that predicted by the SHFM but was lower than predicted in patients with 35% ≤ LVEF ≤ 45%.
(© 2019 The Authors. European Journal of Heart Failure © 2019 European Society of Cardiology.)
Databáze: MEDLINE
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