Raab Cornelia, Roehl Peter, Wiora Matthias, Ebelt Henning
Department of Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, 99097 Erfurt, Germany.
J Clin Med. 2025 Jun 24;14(13):4484. doi: 10.3390/jcm14134484.
Cardiac contractility modulation (CCM) is an established therapy for patients with heart failure with a reduced ejection fraction (HFrEF) who are still symptomatic despite guideline-directed medical therapy. It has been described previously that CCM leads to both an improvement of heart failure symptoms as well as of the parameters of left ventricular (LV) function, including LVEF and global longitudinal strain (GLS). However, so far there are no reports describing the effects of CCM on right ventricular (RV) or left atrial (LA) function, respectively. This might be of particular interest as RV global strain (RV GS) and LA strain are important prognostic parameters in heart failure. Adult patients with heart failure with reduced left ventricular function (LVEF <45%) and a QRS complex <130 ms despite guideline-directed medical therapy and with an indication for CCM were eligible for inclusion into this study. Patients receive a follow-up examination every 3 months, including a standardized echocardiographic examination with a special focus on strain analysis. While the effects of CCM on LV global longitudinal strain have been described before, this analysis reports the findings on the RV and LA strain. Between 30.12.2021 and 10.09.2024, 22 patients were prospectively included in the study. CCM implantation was performed in 19 patients. Under active CCM therapy, there was an improvement in right ventricular global strain (CCM: -13.7 ± 4.5 vs. no CCM: -10.1 ± 5.0; < 0.05), free wall strain (CCM: -14.6 ± 7.3 vs. no CCM: -10.3 ± 10.2; < 0.05), left atrium strain rate (CCM: 19.7 ± 1.0 vs. no CCM: 15.3 ± 10.2; < 0.05), and left atrium strain contraction (CCM: -11.5 ± 7.0 vs. no CCM: -7.1 ± 8.5; < 0.05), whereas there was no difference in left atrium strain conduit (CCM: -9.0 ± 5.0 vs. no CCM: -8.1 ± 5.4; n.s.). To determine which of these parameters are linked to an improvement of quality of life, as seen in the Kansas City Heart Failure Questionnaire (KCCQ), a regression analysis was performed. It turned out that only the parameters of left atrial (LA) strain (LAS_R and LAS_CT) were significantly associated with improved quality of life, while other echocardiographic parameters, such as LV-EF, LV-GLS, and RV-GS, showed no clear association. CCM therapy is not only associated with improvements of left ventricular function but also restores right ventricular and left atrial strain in patients with HFrEF. Regarding the improvement in quality of life, the increase of LA strain seems to be of special importance.
心脏收缩力调制（CCM）是一种针对射血分数降低的心力衰竭（HFrEF）患者的既定治疗方法，这些患者尽管接受了指南指导的药物治疗，但仍有症状。此前已有描述称，CCM可改善心力衰竭症状以及左心室（LV）功能参数，包括左心室射血分数（LVEF）和整体纵向应变（GLS）。然而，到目前为止，尚无报告分别描述CCM对右心室（RV）或左心房（LA）功能的影响。这可能特别值得关注，因为右心室整体应变（RV GS）和左心房应变是心力衰竭的重要预后参数。尽管接受了指南指导的药物治疗且有CCM指征，但左心室功能降低（LVEF<45%）且QRS波群<130 ms的成年心力衰竭患者有资格纳入本研究。患者每3个月接受一次随访检查，包括标准化超声心动图检查，特别侧重于应变分析。虽然之前已经描述了CCM对左心室整体纵向应变的影响，但本分析报告了右心室和左心房应变的研究结果。在2021年12月30日至2024年9月10日期间，前瞻性纳入了22例患者。19例患者进行了CCM植入。在积极的CCM治疗下，右心室整体应变有所改善（CCM组：-13.7±4.5，未接受CCM组：-10.1±5.0；P<0.05），游离壁应变（CCM组：-14.6±7.3，未接受CCM组：-10.3±10.2；P<0.05），左心房应变率（CCM组：19.7±1.0，未接受CCM组：15.3±10.2；P<0.05），以及左心房应变收缩（CCM组：-11.5±7.0，未接受CCM组：-7.1±8.5；P<0.05），而左心房应变传导无差异（CCM组：-9.0±5.0，未接受CCM组：-8.1±5.4；无统计学意义）。为了确定这些参数中哪些与生活质量的改善相关，如堪萨斯城心力衰竭问卷（KCCQ）所示，进行了回归分析。结果发现，只有左心房（LA）应变参数（LAS_R和LAS_CT）与生活质量改善显著相关，而其他超声心动图参数，如LV-EF、LV-GLS和RV-GS，未显示出明显关联。CCM治疗不仅与左心室功能改善相关，还能恢复HFrEF患者的右心室和左心房应变。关于生活质量的改善，左心房应变的增加似乎尤为重要。
