Kosevic Dragana, Wiedemann Dominik, Vukovic Petar, Ristic Velibor, Riebandt Julia, Radak Una, Brandes Kersten, Goettel Peter, Duengen Hans-Dirk, Tahirovic Elvis, Kottmann Tatjana, Voss Hans Werner, Zdravkovic Marija, Putnik Svetozar, Schmitto Jan D, Mueller Johannes, Rame Jesus Eduardo, Peric Miodrag
Cardiovascular Institute Dedinje Belgrade, Belgrade, Serbia.
Medical University Vienna, Vienna, Austria.
ESC Heart Fail. 2021 Apr;8(2):962-970. doi: 10.1002/ehf2.13242. Epub 2021 Feb 9.
Most devices for treating ambulatory Class II and III heart failure are linked to electrical pulses. However, a steady electric potential gradient is also necessary for appropriate myocardial performance and may be disturbed by structural heart diseases. We investigated whether chronic application of electrical microcurrent to the heart is feasible and safe and improves cardiac performance. The results of this study should provide guidance for the design of a two-arm, randomized, controlled Phase II trial.
This single-arm, non-randomized pilot study involved 10 patients (9 men; mean age, 62 ± 12 years) at two sites with 6 month follow-up. All patients had New York Heart Association (NYHA) Class III heart failure and non-ischaemic dilated cardiomyopathy, with left ventricular ejection fraction (LVEF) <35%. A device was surgically placed to deliver a constant microcurrent to the heart. The following tests were performed at baseline, at hospital discharge, and at six time points during follow-up: determination of LVEF and left ventricular end-diastolic/end-systolic diameter by echocardiography; the 6 min walk test; and assessment of NYHA classification and quality of life (36-Item Short-Form Health Survey questionnaire). Microcurrent application was feasible and safe; no device-related or treatment-related adverse events occurred. During follow-up, rapid and significant signal of efficacy (P < 0.005) was present with improvements in LVEF, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, and distance walked. For eight patients, NYHA classification improved from Class III to Class I (for seven, as early as 14 days post-operatively); for one, to Class II; and for one, to Class II/III. 36-Item Short-Form Health Survey questionnaire scores also improved highly significantly.
Chronic application of microcurrent to the heart is feasible and safe and leads to a rapid and lasting improvement in heart function and a near normalization of heart size within days. The NYHA classification and quality of life improve just as rapidly.
大多数用于治疗非卧床II级和III级心力衰竭的设备都与电脉冲相关。然而,稳定的电位梯度对于适当的心肌功能也是必要的,并且可能会受到结构性心脏病的干扰。我们研究了长期对心脏施加微电流是否可行、安全以及是否能改善心脏功能。本研究结果应为双臂、随机、对照II期试验的设计提供指导。
这项单臂、非随机的试点研究涉及两个地点的10名患者(9名男性;平均年龄62±12岁),随访6个月。所有患者均患有纽约心脏协会(NYHA)III级心力衰竭和非缺血性扩张型心肌病,左心室射血分数(LVEF)<35%。通过手术植入一个设备,向心脏输送恒定的微电流。在基线、出院时以及随访期间的六个时间点进行了以下测试:通过超声心动图测定LVEF和左心室舒张末期/收缩末期直径;6分钟步行试验;以及评估NYHA分级和生活质量(36项简短健康调查问卷)。微电流应用是可行且安全的;未发生与设备相关或与治疗相关的不良事件。在随访期间,LVEF、左心室舒张末期直径、左心室收缩末期直径和步行距离均有改善,出现了快速且显著的疗效信号(P<0.005)。8名患者的NYHA分级从III级改善到I级(7名患者在术后14天就达到了);1名患者改善到II级;1名患者改善到II/III级。36项简短健康调查问卷得分也有高度显著的改善。
长期对心脏施加微电流是可行且安全的,可在数天内使心脏功能迅速且持久地改善,心脏大小几乎恢复正常。NYHA分级和生活质量也同样迅速改善。