Cardiac contractility modulation in HFrEF patients with QRS duration 120-149 ms: reduction in heart failure hospitalizations and improvement in functional outcome.
Christian Fastner, Niraj Varma, Ishu Rao, Peter Falk, Bjoern Andrew Remppis, Kevin Najarian, Daniel Burkhoff, Ibrahim Akin, Juergen Kuschyk
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引用次数: 0
Abstract
Background: A subset of heart failure (HF) patients qualifies for cardiac resynchronization therapy (CRT). However, a 30% CRT non-responder rate persists, with patients with narrower QRS durations (i.e., QRSd 120-149 ms) receiving less or inconsistent benefit. CCM may be an important alternative therapy option but has largely been evaluated only in HF patients with QRSd <120 ms.
Objectives: Primarily to evaluate the impact of cardiac contractility modulation (CCM) on HF-related hospitalizations and secondarily on left ventricular EF (LVEF) as well as quality of life in HF patients with QRSd 120-149 ms, compared to QRSd <120 ms.
Methods: CCM-REG enrolled 503 HF patients with a follow-up of up to 2 yrs. Hospitalization rates were available for 1 yr pre-implant. Safety was assessed by comparison of actual versus MAGGIC score- or SHFM-predicted mortality.
Results: Among 111/455 subjects with QRSd 120-149 ms (mean QRSd 130±8 ms, age 68±10 yrs, 20% female, LVEF 29±9%, 82% NYHA class III), CCM diminished HF-related hospitalization rate by 72% (pre- vs. post-implant 0.90 vs. 0.25 events/per patient-yr over 2 yrs; p<0.001). LVEF improved by 7±8% (p=0.01 vs. baseline), MLWHFQ score by 10±23 pts (p=0.01 vs. baseline), and NYHA class by 0.5±0.7 classes (<0.001 vs. baseline). The effect size was similar to that in the QRSd <120 ms patients. Mortality within first year was 19% in QRSd 120-149 ms patients, i.e., not significantly different from the MAGGIC score or SHFM prediction.
Conclusions: CCM significantly improved HF control in NYHA III HFrEF patients with moderately prolonged QRSd 120-149 ms. The effect was similar to patients with QRSd <120ms.
期刊介绍:
HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability.
HeartRhythm integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community.
The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards.