Cardiac contractility modulation treatment in patients with symptomatic heart failure despite optimal medical therapy and cardiac resynchronization therapy (CRT)

Cardiac contractility modulation treatment in patients with symptomatic heart failure despite optimal medical therapy and cardiac resynchronization therapy (CRT)

A significant proportion of patients receiving CRT are non-responders. We evaluated the efficacy of Cardiac Contractility Modulation in subjects with reduced LVEF who, despite cardiac resynchronization therapy (CRT), continued to experience clinically significant symptoms. This was a multi-center, o...

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Veröffentlicht in:International journal of cardiology 2019-02, Vol.277, p.173-177
Hauptverfasser: Kuschyk, Jürgen, Nägele, Herbert, Heinz-Kuck, Karl, Butter, Christian, Lawo, Thomas, Wietholt, Dietmar, Roeger, Susanne, Gutterman, David, Burkhoff, Daniel, Rousso, Benny, Borggrefe, Martin
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Cardiac contractility modulation
CRT
Exercise capacity
Heart failure
Non-responder
Quality of life
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container_start_page 173
container_title International journal of cardiology
container_volume 277
creator Kuschyk, Jürgen
Nägele, Herbert
Heinz-Kuck, Karl
Butter, Christian
Lawo, Thomas
Wietholt, Dietmar
Roeger, Susanne
Gutterman, David
Burkhoff, Daniel
Rousso, Benny
Borggrefe, Martin
description A significant proportion of patients receiving CRT are non-responders. We evaluated the efficacy of Cardiac Contractility Modulation in subjects with reduced LVEF who, despite cardiac resynchronization therapy (CRT), continued to experience clinically significant symptoms. This was a multi-center, open label, treatment-only, feasibility study of 17 CRT non-responders who received CCM therapy. Changes in NYHA class, ejection fraction (EF), Minnesota Living with Heart Failure Questionnaire (MLWHFQ) score, and exercise tolerance (6 minute walk test; 6MWT and peak VO2) were analyzed over 6 months. Mortality and hospitalization rates were determined. Patients (82% male) were 69.4 ± 9.6 years of age with baseline EF = 22.8 ± 6.5%. Among primary endpoints, peak VO2 increased 1.1 ± 1.6 ml/kg/min (p = 0.03) and MLWHFQ improved (−16 ± 16 points; p 
doi_str_mv 10.1016/j.ijcard.2018.10.086
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We evaluated the efficacy of Cardiac Contractility Modulation in subjects with reduced LVEF who, despite cardiac resynchronization therapy (CRT), continued to experience clinically significant symptoms. This was a multi-center, open label, treatment-only, feasibility study of 17 CRT non-responders who received CCM therapy. Changes in NYHA class, ejection fraction (EF), Minnesota Living with Heart Failure Questionnaire (MLWHFQ) score, and exercise tolerance (6 minute walk test; 6MWT and peak VO2) were analyzed over 6 months. Mortality and hospitalization rates were determined. Patients (82% male) were 69.4 ± 9.6 years of age with baseline EF = 22.8 ± 6.5%. Among primary endpoints, peak VO2 increased 1.1 ± 1.6 ml/kg/min (p = 0.03) and MLWHFQ improved (−16 ± 16 points; p &lt; 0.01). Mean NYHA class improved (−0.33 ± 0.49; p = 0.02), 6MWT increased (52 ± 60 m; p &lt; 0.01), while EF trended up (2.9 ± 5.8%; p = 0.08) at 6 months. During the 6-month follow-up period, there were 18 hospitalizations in 9 subjects and 2 patients died. Patients with heart failure and reduced ejection fraction who remain moderately to severely symptomatic despite use of CRT, may benefit from CCM therapy with improvement in quality of life and exercise tolerance. A larger prospective study in this population is warranted. •Patients who fail CRT may show symptomatic improvement with addition of CCM therapy.•The benefit of CCM + CRT was seen in those with moderate to severe heart failure.•The improvement in symptoms and function are not associated with an excess adverse event rate.</description><identifier>ISSN: 0167-5273</identifier><identifier>EISSN: 1874-1754</identifier><identifier>DOI: 10.1016/j.ijcard.2018.10.086</identifier><identifier>PMID: 30409733</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>Cardiac contractility modulation ; CRT ; Exercise capacity ; Heart failure ; Non-responder ; Quality of life</subject><ispartof>International journal of cardiology, 2019-02, Vol.277, p.173-177</ispartof><rights>2018 Elsevier B.V.</rights><rights>Copyright © 2018 Elsevier B.V. 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We evaluated the efficacy of Cardiac Contractility Modulation in subjects with reduced LVEF who, despite cardiac resynchronization therapy (CRT), continued to experience clinically significant symptoms. This was a multi-center, open label, treatment-only, feasibility study of 17 CRT non-responders who received CCM therapy. Changes in NYHA class, ejection fraction (EF), Minnesota Living with Heart Failure Questionnaire (MLWHFQ) score, and exercise tolerance (6 minute walk test; 6MWT and peak VO2) were analyzed over 6 months. Mortality and hospitalization rates were determined. Patients (82% male) were 69.4 ± 9.6 years of age with baseline EF = 22.8 ± 6.5%. Among primary endpoints, peak VO2 increased 1.1 ± 1.6 ml/kg/min (p = 0.03) and MLWHFQ improved (−16 ± 16 points; p &lt; 0.01). Mean NYHA class improved (−0.33 ± 0.49; p = 0.02), 6MWT increased (52 ± 60 m; p &lt; 0.01), while EF trended up (2.9 ± 5.8%; p = 0.08) at 6 months. During the 6-month follow-up period, there were 18 hospitalizations in 9 subjects and 2 patients died. Patients with heart failure and reduced ejection fraction who remain moderately to severely symptomatic despite use of CRT, may benefit from CCM therapy with improvement in quality of life and exercise tolerance. A larger prospective study in this population is warranted. •Patients who fail CRT may show symptomatic improvement with addition of CCM therapy.•The benefit of CCM + CRT was seen in those with moderate to severe heart failure.•The improvement in symptoms and function are not associated with an excess adverse event rate.</description><subject>Cardiac contractility modulation</subject><subject>CRT</subject><subject>Exercise capacity</subject><subject>Heart failure</subject><subject>Non-responder</subject><subject>Quality of life</subject><issn>0167-5273</issn><issn>1874-1754</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><recordid>eNp9kV2r1DAQhoMonvXoPxDJ5fGiaz7aprkRZPELDghyvA7Z6YTN0jY1SZX6b_ynZtnqpVczvDwzLzMvIS8523PG2zfnvT-Djf1eMN4Vac-69hHZ8U7VFVdN_ZjsCqaqRih5Q56ldGaM1Vp3T8mNZDXTSsod-X0oK7wFCmHK0UL2g88rHUO_DDb7MNEc0eYRp0z9ROeilTbRnz6faFrHOYexaEBPaGOmzvphiUh7TLPPSMOc_WgHOmLvodR8wmjnldqpp7A5R0zrBKcYJv9rs9you8PXh9fPyRNnh4QvtnpLvn14_3D4VN1_-fj58O6-AtmKXDnFtG6AtczZmmEHjvGjaxmvW9k61E6DPrbdkTeNBCV4I0QvtQOGCi1XSt6Su-veOYbvC6ZsRp8Ah8FOGJZkBJdCKFULVtD6ikIMKUV0Zo7lzLgazswlHHM213DMJZyLWsIpY682h-VYHvJv6G8aBXh7BbDc-cNjNAnKu6E8LyJk0wf_f4c_DSqmZg</recordid><startdate>20190215</startdate><enddate>20190215</enddate><creator>Kuschyk, Jürgen</creator><creator>Nägele, Herbert</creator><creator>Heinz-Kuck, Karl</creator><creator>Butter, Christian</creator><creator>Lawo, Thomas</creator><creator>Wietholt, Dietmar</creator><creator>Roeger, Susanne</creator><creator>Gutterman, David</creator><creator>Burkhoff, Daniel</creator><creator>Rousso, Benny</creator><creator>Borggrefe, Martin</creator><general>Elsevier B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-6687-6924</orcidid><orcidid>https://orcid.org/0000-0003-1514-9097</orcidid><orcidid>https://orcid.org/0000-0002-7585-0224</orcidid></search><sort><creationdate>20190215</creationdate><title>Cardiac contractility modulation treatment in patients with symptomatic heart failure despite optimal medical therapy and cardiac resynchronization therapy (CRT)</title><author>Kuschyk, Jürgen ; Nägele, Herbert ; Heinz-Kuck, Karl ; Butter, Christian ; Lawo, Thomas ; Wietholt, Dietmar ; Roeger, Susanne ; Gutterman, David ; Burkhoff, Daniel ; Rousso, Benny ; Borggrefe, Martin</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c362t-f70995c060fa40e8cf01bf6014636fe9f9c9b68b1553c721522d39fc0e7ea1773</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Cardiac contractility modulation</topic><topic>CRT</topic><topic>Exercise capacity</topic><topic>Heart failure</topic><topic>Non-responder</topic><topic>Quality of life</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kuschyk, Jürgen</creatorcontrib><creatorcontrib>Nägele, Herbert</creatorcontrib><creatorcontrib>Heinz-Kuck, Karl</creatorcontrib><creatorcontrib>Butter, Christian</creatorcontrib><creatorcontrib>Lawo, Thomas</creatorcontrib><creatorcontrib>Wietholt, Dietmar</creatorcontrib><creatorcontrib>Roeger, Susanne</creatorcontrib><creatorcontrib>Gutterman, David</creatorcontrib><creatorcontrib>Burkhoff, Daniel</creatorcontrib><creatorcontrib>Rousso, Benny</creatorcontrib><creatorcontrib>Borggrefe, Martin</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>International journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kuschyk, Jürgen</au><au>Nägele, Herbert</au><au>Heinz-Kuck, Karl</au><au>Butter, Christian</au><au>Lawo, Thomas</au><au>Wietholt, Dietmar</au><au>Roeger, Susanne</au><au>Gutterman, David</au><au>Burkhoff, Daniel</au><au>Rousso, Benny</au><au>Borggrefe, Martin</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cardiac contractility modulation treatment in patients with symptomatic heart failure despite optimal medical therapy and cardiac resynchronization therapy (CRT)</atitle><jtitle>International journal of cardiology</jtitle><addtitle>Int J Cardiol</addtitle><date>2019-02-15</date><risdate>2019</risdate><volume>277</volume><spage>173</spage><epage>177</epage><pages>173-177</pages><issn>0167-5273</issn><eissn>1874-1754</eissn><abstract>A significant proportion of patients receiving CRT are non-responders. 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source Elsevier ScienceDirect Journals Complete
subjects Cardiac contractility modulation
CRT
Exercise capacity
Heart failure
Non-responder
Quality of life
title Cardiac contractility modulation treatment in patients with symptomatic heart failure despite optimal medical therapy and cardiac resynchronization therapy (CRT)
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