Efficacy and survival in patients with cardiac contractility modulation: Long-term single center experience in 81 patients

• Published in: International journal of cardiology Vol. 183; pp. 76 - 81
• Main Authors: Kuschyk, Jürgen, Roeger, Susanne, Schneider, Raphaela, Streitner, Florian, Stach, Ksenija, Rudic, Boris, Weiß, Christel, Schimpf, Rainer, Papavasilliu, Theano, Rousso, Benny, Burkhoff, Daniel, Borggrefe, Martin
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ireland Ltd 15.03.2015
• Subjects: Aged; Cardiac contractility modulation; Cardiac Resynchronization Therapy; Cardiovascular; Device therapy; Female; Heart failure; Heart Failure - blood; Heart Failure - mortality; Heart Failure - therapy; Humans; Male; Middle Aged; Natriuretic Peptide, Brain - blood; Peptide Fragments - blood; Retrospective Studies; Stroke Volume - physiology; Surveys and Questionnaires; Treatment Outcome; Ventricular Function, Left - physiology; Heart failure; Cardiac contractility modulation; Device therapy
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2014.12.178

Abstract Aims To analyze long-term efficacy and survival in patients with chronic heart failure treated with cardiac contractility modulation. Methods 81 patients implanted with a CCM device between 2004 and 2012 were included in this retrospective analysis. Changes in NYHA class, ejection fraction (EF), Minnesota Living with Heart Failure Questionnaire, NT-proBNP and peak VO2 were analyzed during a mean follow up of 34.2 ± 28 months (6–123 months). Observed mortality rate was compared with that predicted by the MAGGIC Score. Results Patients were 61 ± 12 years old with EF 23 ± 7%. Heart failure was due to ischemic (n = 48, 59.3%) or idiopathic dilated (n = 33, 40.7%) cardiomyopathy. EF increased from 23.1 ± 7.9 to 29.4 ± 8.6% (p < 0.05), mean NT-proBNP decreased from 4395 ± 3818 to 2762 ± 3490 ng/l (p < 0.05) and mean peak VO2 increased from 13.9 ± 3.3 to 14.6 ± 3.5 ml/kg/min (p = 0.1). The overall clinical responder rate (at least 1 class improvement of NYHA within 6 months or last follow-up) was 74.1%. 21 (25.9%) patients died during follow up, 11 (52.4%) due to cardiac conditions and 10 (47.6%) due to non-cardiac conditions. Mortality rates at 1 and 3 years were 5.2% and 29.5% compared to mortality rates estimated from the MAGGIC risk score of 18.4% (p < 0.001) and 40% (p = ns), respectively. Log-Rank analysis of all events through 3 years of follow-up, however, was significantly less than predicted (p = 0.022). Conclusions CCM therapy improved quality of life, exercise capacity, NYHA class, EF and NT-proBNP levels during long-term follow up. Mortality rates appeared to be lower than estimated from the MAGGIC score.