Matching Imaging and Remodulation Effects: Benefits of Cardiac Contractility Modulation Shown by Global Longitudinal Strain: A Case Report

Q: What are the key findings of this study?

Cardiac contractility modulation improved LVEF from 26% to 46%, global longitudinal strain from -11.0% to -15.0%, and prevented heart failure hospitalizations over 9 months.

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Heart failure with reduced ejection fraction (HFrEF) with recurrent exacerbations and narrow QRS (n=1). Intervention: Cardiac Contractility Modulation (CCM) device implantation. Primary outcome: Left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), functional capacity, and HF hospitalizations.

Q: What does this research mean for the field?

Cardiac contractility modulation improves left ventricular ejection fraction and global longitudinal strain while reducing heart failure hospitalizations in patients with HFrEF. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Andrea Matteucci; Giacomo Bonacchi; Vincenzo Mirco La Fazia; Giuseppe Stifano; Domenico Sergi

doi:10.3390/clinpract12010015

February 17, 2022Clinics and PracticeOpen Access

Matching Imaging and Remodulation Effects: Benefits of Cardiac Contractility Modulation Shown by Global Longitudinal Strain: A Case Report

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Key result

Cardiac contractility modulation improves LVEF by ~20 percentage points over 9 months.

n=1

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Key Points

To describe the clinical recovery and myocardial remodulation effects detected by speckle-tracking global longitudinal strain after cardiac contractility modulation device implantation in a patient with heart failure with reduced ejection fraction.
Documented the clinical evaluation and treatment of a 77-year-old patient with ischemic heart failure with reduced ejection fraction (baseline LVEF 25% to 26%, QRS < 130 ms) who refused an implantable cardioverter-defibrillator.
Assessed functional capacity and ventricular deformation 40 days after right coronary artery revascularization via a 6-minute walk test (50 m), Minnesota Living with Heart Failure Questionnaire (84 points), and speckle-tracking strain imaging (global longitudinal deformation -11.0%).
Implanted a cardiac contractility modulation device delivering biphasic electrical signals to the interventricular septum and followed the patient for 9 months post-discharge.
At 9 months after discharge, 0 hospital admissions for heart failure were recorded, and the patient improved to NYHA functional class II.
Echocardiographic speckle-tracking analysis revealed improved global longitudinal strain with the greatest regional remodeling in the anterior septum, anterior wall, and apex.
The patient experienced substantial clinical improvement in 6-minute walk test distance and Minnesota Living with Heart Failure Questionnaire scores, alongside successful de-escalation of diuretic therapy.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

A 77-year-old female with ischemic HFrEF (LVEF 25-26%), narrow QRS (<130 ms), and recurrent heart failure hospitalizations who refused ICD implantation, followed for 9 months.

I

Intervention

Cardiac Contractility Modulation (CCM) device implantation delivering high-voltage biphasic electrical impulses during the absolute ventricular refractory period (optimized up to 12 hours/day) added to optimal medical therapy (acetylsalicylic acid 100 mg, telmisartan 80 mg, bisoprolol 1.25 mg, atorvastatin 80 mg, furosemide, and canrenone 50 mg).

O

Outcome

Echocardiographic left ventricular remodeling (LVEF and global longitudinal strain [GLS]), functional capacity (6-minute walk test [SMWT]), quality of life (Minnesota Living with Heart Failure Questionnaire [MLWHFQ]), and heart failure hospitalizations up to 9 months.surrogate

Limitations

Single-patient case report design
Cannot exclude the contribution of right coronary artery PCI to LVEF improvement
Lack of evidence in literature regarding CCM super-responders
Cannot exclude the contribution of right coronary artery revascularization (PCI) to LVEF recovery
Lack of evidence in the literature regarding the existence of 'super responders' to CCM
Single case report requiring larger studies to confirm the benefit of CCM therapy in cardiac reverse remodeling

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Implication

This case report illustrates that Cardiac Contractility Modulation can induce substantial reverse remodeling, functional recovery, and hospitalization reduction in a patient with HFrEF and narrow QRS, with regional and global improvements effectively tracked by speckle tracking global longitudinal strain.

Abstract

Cardiac Contractility Modulation (CCM) has been proposed for inpatients affected by heart failure with reduced ejection fraction (HFrEF), with relapsing HF symptoms. We present a case of a patient treated with percutaneous coronary intervention (PCI) in the setting of acute coronary syndrome without persistent ST-segment elevation, with the best medical therapy for decompensated HF. The patient refused the implantable cardioverter-defibrillator (ICD), and to reduce the increasing number of hospitalizations for HF exacerbations, we proposed the use of the cardiac contractility modulation device. After the implant, the patient demonstrated a marked improvement in exercise effort and quality of life (QOL) with a six-minute walk test (SMWT), Minnesota Living with Heart Failure Questionnaire (MLWHFQ), and echocardiographic parameters. At 9 months after discharge, no hospital admissions for HF were recorded. We showed with the speckle tracking imaging how the improvement in global longitudinal strain (GLS) correlates with the remodeling effects on myocardial cells.

Discussion

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Cite This Study

Matteucci et al. (2022) conducted a case report in Heart failure with reduced ejection fraction (HFrEF) with recurrent exacerbations and narrow QRS (n=1). Cardiac Contractility Modulation (CCM) device implantation was evaluated on Left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), functional capacity, and HF hospitalizations. Cardiac contractility modulation improved LVEF from 26% to 46%, global longitudinal strain from -11.0% to -15.0%, and prevented heart failure hospitalizations over 9 months.

synapsesocial.com/papers/6a81a376384c34531b775d50 https://doi.org/10.3390/clinpract12010015

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Matching Imaging and Remodulation Effects: Benefits of Cardiac Contractility Modulation Shown by Global Longitudinal Strain: A Case Report

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Matching Imaging and Remodulation Effects: Benefits of Cardiac Contractility Modulation Shown by Global Longitudinal Strain: A Case Report

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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