缺血性与非缺血性心肌病患者的心肌收缩力调节：来自 MAINTAINED 观察性研究的结果。
Cardiac Contractility Modulation in Patients with Ischemic versus Non-ischemic Cardiomyopathy: Results from the MAINTAINED Observational Study.
机构信息
First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany.
Cardiovascular Research Foundation, New York, NY, USA.
出版信息
Int J Cardiol. 2021 Nov 1;342:49-55. doi: 10.1016/j.ijcard.2021.07.048. Epub 2021 Jul 27.
BACKGROUND
Cardiac contractility modulation (CCM) is an FDA-approved device-based therapy for patients with systolic heart failure and normal QRS width who are symptomatic despite optimal drug therapy. The purpose of this study was to compare the long-term therapeutic effects of CCM therapy in patients with ischemic (ICM) versus non-ischemic cardiomyopathy (NICM).
METHODS
Changes in NYHA class, KDIGO CKD stage, left ventricular ejection fraction (LVEF), tricuspid annular plane systolic excursion (TAPSE), and NT-proBNP levels were compared as functional parameters. Moreover, observed mortality rates at 1 and 3 years were compared to those predicted by the MAGGIC heart failure risk score, and observed mortality rates were compared between groups for the entire follow-up period.
RESULTS
One hundred and seventy-four consecutive patients with chronic heart failure and CCM device implantation between 2002 and 2019 were included in this retrospective analysis. LVEF was significantly higher in NICM patients after 3 years of CCM therapy (35 ± 9 vs. 30 ± 9%; p = 0.0211), and after 5 years, also TAPSE of NICM patients was significantly higher (21 ± 5 vs. 18 ± 5%; p = 0.0437). There were no differences in other effectiveness parameters. Over the entire follow-up period, 35% of all patients died (p = 0.81); only in ICM patients, mortality was lower than predicted at 3 years (35 vs. 43%, p = 0.0395).
CONCLUSIONS
Regarding improvement of biventricular systolic function, patients with NICM appear to benefit particularly from CCM therapy.
背景
心脏收缩力调节（CCM）是一种获得 FDA 批准的设备治疗方法，适用于患有收缩性心力衰竭且 QRS 波群宽度正常的患者，这些患者尽管接受了最佳药物治疗，但仍有症状。本研究的目的是比较 CCM 治疗缺血性（ICM）与非缺血性心肌病（NICM）患者的长期治疗效果。
方法
比较 NYHA 分级、KDIGO CKD 分期、左心室射血分数（LVEF）、三尖瓣环平面收缩期位移（TAPSE）和 NT-proBNP 水平的变化作为功能参数。此外，比较 1 年和 3 年观察到的死亡率与 MAGGIC 心力衰竭风险评分预测的死亡率，并比较整个随访期间各组之间的观察死亡率。
结果
本回顾性分析纳入了 2002 年至 2019 年间连续 174 例慢性心力衰竭和 CCM 设备植入患者。NICM 患者在 CCM 治疗 3 年后 LVEF 显著升高（35±9%比 30±9%；p=0.0211），5 年后 TAPSE 也显著升高（21±5%比 18±5%；p=0.0437）。其他有效性参数无差异。在整个随访期间，所有患者中有 35%死亡（p=0.81）；仅在 ICM 患者中，3 年时死亡率低于预测值（35 比 43%，p=0.0395）。
结论
在改善双心室收缩功能方面，NICM 患者似乎特别受益于 CCM 治疗。
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