Cardiac contractility modulation in heart failure with reduced ejection fraction patients with QRS duration 120-149 ms: Reduction in heart failure hospitalizations and improvement in functional outcome.

IF 8.3 2区材料科学 Q1 MATERIALS SCIENCE, MULTIDISCIPLINARY

ACS Applied Materials & Interfaces Pub Date : 2024-09-19 DOI:10.1016/j.hrthm.2024.09.038

Christian Fastner, Niraj Varma, Ishu Rao, Peter Falk, Bjoern Andrew Remppis, Kevin Najarian, Daniel Burkhoff, Ibrahim Akin, Juergen Kuschyk

{"title":"Cardiac contractility modulation in heart failure with reduced ejection fraction patients with QRS duration 120-149 ms: Reduction in heart failure hospitalizations and improvement in functional outcome.","authors":"Christian Fastner, Niraj Varma, Ishu Rao, Peter Falk, Bjoern Andrew Remppis, Kevin Najarian, Daniel Burkhoff, Ibrahim Akin, Juergen Kuschyk","doi":"10.1016/j.hrthm.2024.09.038","DOIUrl":null,"url":null,"abstract":"Background: A subset of heart failure with reduced ejection fraction (HFrEF) patients qualifies for cardiac resynchronization therapy (CRT). However, a 30% CRT nonresponder rate persists, with patients having narrower QRS durations (ie, QRSd 120-149 ms) receiving less or inconsistent benefit. Cardiac contractility modulation (CCM) may be an important alternative therapy option but has largely been evaluated only in HFrEF patients with QRSd <120 ms.Objectives: The purpose of this study was to evaluate the impact of CCM on HF-related hospitalizations and on left ventricular ejection fraction (LVEF) as well as quality of life in HFrEF patients with QRSd 120-149 ms compared to QRSd <120 ms.Methods: The CCM-REG Registry enrolled a total of 503 HFrEF patients with follow-up up to 2 years. Hospitalization rates were available for 1 year preimplant. Safety was assessed by comparison of actual vs Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) risk score- or Seattle Heart Failure Model (SHFM)-predicted mortality.Results: Among 111 of 455 patients with QRSd 120-149 ms (mean QRSd 130 ± 9 ms; 20% female; age 68 ± 11 years; LVEF 29% ± 9%; 82% New York Heart Association [NYHA] class III), CCM diminished HF-related hospitalization rate by 72% (pre- vs postimplant 0.90 vs 0.25 events per patient-year over 2 years; P <.001). LVEF improved by 7% ± 9% (P = .014 vs baseline), Minnesota Living with Heart Failure Questionnaire score by 10 ± 23 points (P = .010 vs baseline), and NYHA class by 0.5 ± 0.7 classes (<0.001 vs baseline). The effect sizes were similar to those in QRSd <120 ms patients. Mortality within the first year was 19% in QRSd 120-149 ms patients (ie, not significantly different from the MAGGIC risk score or SHFM prediction).Conclusions: CCM significantly improved HF control in NYHA class III HFrEF with reduced ejection fraction patients with moderately prolonged QRSd of 120-149 ms. The effect was comparable to that in patients with QRSd <120 ms.","PeriodicalId":5,"journal":{"name":"ACS Applied Materials & Interfaces","volume":null,"pages":null},"PeriodicalIF":8.3000,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"ACS Applied Materials & Interfaces","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.hrthm.2024.09.038","RegionNum":2,"RegionCategory":"材料科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MATERIALS SCIENCE, MULTIDISCIPLINARY","Score":null,"Total":0}

引用次数: 0

Abstract

Background: A subset of heart failure with reduced ejection fraction (HFrEF) patients qualifies for cardiac resynchronization therapy (CRT). However, a 30% CRT nonresponder rate persists, with patients having narrower QRS durations (ie, QRSd 120-149 ms) receiving less or inconsistent benefit. Cardiac contractility modulation (CCM) may be an important alternative therapy option but has largely been evaluated only in HFrEF patients with QRSd <120 ms.

Objectives: The purpose of this study was to evaluate the impact of CCM on HF-related hospitalizations and on left ventricular ejection fraction (LVEF) as well as quality of life in HFrEF patients with QRSd 120-149 ms compared to QRSd <120 ms.

Methods: The CCM-REG Registry enrolled a total of 503 HFrEF patients with follow-up up to 2 years. Hospitalization rates were available for 1 year preimplant. Safety was assessed by comparison of actual vs Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) risk score- or Seattle Heart Failure Model (SHFM)-predicted mortality.

Results: Among 111 of 455 patients with QRSd 120-149 ms (mean QRSd 130 ± 9 ms; 20% female; age 68 ± 11 years; LVEF 29% ± 9%; 82% New York Heart Association [NYHA] class III), CCM diminished HF-related hospitalization rate by 72% (pre- vs postimplant 0.90 vs 0.25 events per patient-year over 2 years; P <.001). LVEF improved by 7% ± 9% (P = .014 vs baseline), Minnesota Living with Heart Failure Questionnaire score by 10 ± 23 points (P = .010 vs baseline), and NYHA class by 0.5 ± 0.7 classes (<0.001 vs baseline). The effect sizes were similar to those in QRSd <120 ms patients. Mortality within the first year was 19% in QRSd 120-149 ms patients (ie, not significantly different from the MAGGIC risk score or SHFM prediction).

Conclusions: CCM significantly improved HF control in NYHA class III HFrEF with reduced ejection fraction patients with moderately prolonged QRSd of 120-149 ms. The effect was comparable to that in patients with QRSd <120 ms.

查看原文本刊更多论文

对 QRS 持续时间为 120-149 毫秒的心衰患者进行心脏收缩力调节：减少心衰住院次数并改善功能预后。

背景：一部分心力衰竭（HF）患者符合心脏再同步化治疗（CRT）的条件。然而，30% 的 CRT 无应答率持续存在，QRS 波长较窄（即 QRSd 120-149 毫秒）的患者获益较少或获益不一致。CCM 可能是一种重要的替代疗法，但目前大多只针对 QRSd 对象的 HF 患者进行了评估：与 QRSd 相比，主要评估心脏收缩力调节（CCM）对 HF 相关住院治疗的影响，其次是对 QRSd 120-149 ms HF 患者左心室 EF（LVEF）和生活质量的影响：CCM-REG 共纳入 503 名心房颤动患者，随访时间长达 2 年，提供了植入前 1 年的住院率。通过比较实际死亡率与 MAGGIC 评分或 SHFM 预测死亡率来评估安全性：结果：在 111/455 名 QRSd 为 120-149 ms 的受试者中（平均 QRSd 为 130±8 ms，年龄为 68±10 岁，20% 为女性，LVEF 为 29±9%，82% 为 NYHA III 级），CCM 将 HF 相关的住院率降低了 72%（植入前与植入后相比，2 年内每名患者每年的住院率分别为 0.90 与 0.25；P 结论：CCM 显著改善了慢性阻塞性肺病患者的病情控制：对于 QRSd 中度延长至 120-149 毫秒的 NYHA III 期 HFrEF 患者，CCM 能明显改善其对 HF 的控制。其效果与 QRSd

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

ACS Applied Materials & Interfaces 工程技术-材料科学：综合

CiteScore

16.00

自引率

6.30%

发文量

4978

审稿时长

1.8 months

期刊介绍： ACS Applied Materials & Interfaces is a leading interdisciplinary journal that brings together chemists, engineers, physicists, and biologists to explore the development and utilization of newly-discovered materials and interfacial processes for specific applications. Our journal has experienced remarkable growth since its establishment in 2009, both in terms of the number of articles published and the impact of the research showcased. We are proud to foster a truly global community, with the majority of published articles originating from outside the United States, reflecting the rapid growth of applied research worldwide.