基于设备的心脏收缩力调制疗法对射血分数降低的心力衰竭患者左心室整体纵向应变和心肌机械能效率的影响。
The Effects of Device-Based Cardiac Contractility Modulation Therapy on Left Ventricle Global Longitudinal Strain and Myocardial Mechano-Energetic Efficiency in Patients with Heart Failure with Reduced Ejection Fraction.
作者信息
Masarone Daniele, Kittleson Michelle M, De Vivo Stefano, D'Onofrio Antonio, Ammendola Ernesto, Nigro Gerardo, Contaldi Carla, Martucci Maria L, Errigo Vittoria, Pacileo Giuseppe
机构信息
Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy.
Department of Cardiology, Smidt Heart Institute, Cedars-Sinai, Los Angeles, CA 90048, USA.
出版信息
J Clin Med. 2022 Oct 4;11(19):5866. doi: 10.3390/jcm11195866.
BACKGROUND
Virtually all patients with heart failure with reduced ejection fraction have a reduction of myocardial mechano-energetic efficiency (MEE). Cardiac contractility modulation (CCM) is a novel therapy for the treatment of patients with HFrEF, in whom it improves the quality of life and functional capacity, reduces hospitalizations, and induces biventricular reverse remodeling. However, the effects of CCM on MEE and global longitudinal strain (GLS) are still unknown; therefore, this study aims to evaluate whether CCM therapy can improve the MEE of patients with HFrEF.
METHODS
We enrolled 25 patients with HFrEF who received an Optimizer Smart implant (the device that develops CCM therapy) between January 2018 and January 2021. Clinical and echocardiographic evaluations were performed in all patients 24 h before and six months after CCM therapy.
RESULTS
At six months, follow-up patients who underwent CCM therapy showed an increase of left ventricular ejection fraction (30.8 ± 7.1 vs. 36.1 ± 6.9%; = 0.032) as well a rise of GLS 10.3 ± 2.7 vs. -12.9 ± 4.2; = 0.018), of MEE (32.2 ± 10.1 vs. 38.6 ± 7.6 mL/s; = 0.013) and of MEE index (18.4 ± 6.3 vs. 24.3 ± 6.7 mL/s/g; = 0.022).
CONCLUSIONS
CCM therapy increased left ventricular performance, improving left ventricular ejection fraction, GLS, as well as MEE and MEEi.
背景
几乎所有射血分数降低的心力衰竭患者心肌机械能量效率（MEE）都会降低。心脏收缩力调制（CCM）是一种用于治疗射血分数降低的心力衰竭（HFrEF）患者的新型疗法，可改善患者生活质量和功能能力，减少住院次数，并诱导双心室逆向重构。然而，CCM对MEE和整体纵向应变（GLS）的影响仍不清楚；因此，本研究旨在评估CCM疗法是否能改善HFrEF患者的MEE。
方法
我们纳入了25例在2018年1月至2021年1月期间接受Optimizer Smart植入装置（开展CCM疗法的设备）的HFrEF患者。在CCM治疗前24小时和治疗后6个月对所有患者进行临床和超声心动图评估。
结果
在6个月的随访中，接受CCM治疗的患者左心室射血分数增加（30.8±7.1对36.1±6.9%；P = 0.032），GLS升高（-10.3±2.7对-12.9±4.2；P = 0.018），MEE升高（32.2±10.1对38.6±7.6 mL/s；P = 0.013），MEE指数升高（18.4±6.3对24.3±6.7 mL/s/g；P = 0.022）。
结论
CCM疗法提高了左心室性能，改善了左心室射血分数、GLS以及MEE和MEEi。
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