Clinical effects of long-term cardiac contractility modulation (CCM) in subjects with heart failure caused by left ventricular systolic dysfunction

• Published in: Clinical research in cardiology Vol. 106; no. 11; pp. 893 - 904
• Main Authors: Müller, D., Remppis, A., Schauerte, P., Schmidt-Schweda, S., Burkhoff, D., Rousso, B., Gutterman, D., Senges, J., Hindricks, G., Kuck, K.-H.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.11.2017; Springer Nature B.V
• Subjects: Aged; Beta blockers; Cardiac Pacing, Artificial; Cardiology; Cardiovascular diseases; Cause of Death - trends; Clinical trials; Comparative analysis; Confidence intervals; Exercise Tolerance; Female; Follow-Up Studies; Germany - epidemiology; Heart; Heart diseases; Heart failure; Heart Failure - etiology; Heart Failure - mortality; Heart Failure - physiopathology; Humans; Israel - epidemiology; Male; Medicine; Medicine & Public Health; Middle Aged; Modulation; Morbidity; Mortality; Muscle contraction; Myocardial Contraction - physiology; Original Paper; Patients; Prospective Studies; Quality of Life; Safety; Stroke Volume - physiology; Survival Rate - trends; Therapy; Time Factors; Treatment Outcome; United States - epidemiology; Vanadium oxides; Ventricle; Ventricular Dysfunction, Left - complications; Ventricular Dysfunction, Left - diagnosis; Ventricular Dysfunction, Left - physiopathology; Ventricular Function, Left - physiology; Heart failure; Human; NYHA; MLWHFQ; Clinical; Electrical stimulation; LVEF; Registry; CCM; Survival
• ISSN: 1861-0684; 1861-0692; 1861-0692
• DOI: 10.1007/s00392-017-1135-9

Introduction Heart failure is a major cause of morbidity and mortality throughout the world. Despite advances in therapy, nearly half of patients receiving guideline-directed medical therapy remain limited by symptoms. Cardiac contractility modulation (CCM) can improve symptoms in this population, but efficacy and safety in prospective studies has been limited to 12 months of follow-up. We report on the first 2 year multi-site evaluation of CCM in patients with heart failure. Methods One hundred and forty-three subjects with heart failure and reduced ejection fraction were followed via clinical registry for 24 months recording NYHA class, MLWHFQ score, 6 min walk distance, LVEF, and peak VO 2 at baseline and 6 month intervals as clinically indicated. Serious adverse events, and all cause as well as cardiovascular mortality were recorded. Data are presented stratified by LVEF (all subjects, LVEF <35%, LVEF ≥35%). Results One hundred and six subjects from 24 sites completed the 24 month follow-up. Baseline parameters were similar among LVEF groups. NYHA and MLWHFQ improved in all 3 groups at each time point. LVEF in the entire cohort improved 2.5, 2.9, 5.0, and 4.9% at 6, 12, 18, and 24 months, respectively. Insufficient numbers of subjects had follow-up data for 6 min walk or peak VO 2 assessment, precluding comparative analysis. Serious adverse events ( n  = 193) were observed in 91 subjects and similarly distributed between groups with LVEF <35% and LVEF ≥35%, and similar to other device trials for heart failure. Eighteen deaths (7 cardiovascularly related) over 2 years. Overall survival at 2 years was 86.4% (95% confidence intervals: 79.3, 91.2%). Conclusion Cardiac contractility modulation provides safe and effective long-term symptomatic and functional improvement in heart failure. These benefits were independent of baseline LVEF and were associated with a safety profile similar to published device trials.