Why the study?
Cardiac contractility modulation (CCM) therapy can address symptomatic chronic HF despite medical treatment, but outcome differences between early versus late implementation had not been investigated.
Does early implementation of cardiac contractility modulation (< 13 months after heart failure diagnosis) improve survival, LVEF, NYHA class, and reduce heart failure hospitalizations compared to late implementation (≥ 13 months) in symptomatic heart failure patients aged ≤ 70 years?
Observational (n=131)
Open-label
No
Does early implementation of cardiac contractility modulation (< 13 months after heart failure diagnosis) improve survival, LVEF, NYHA class, and reduce heart failure hospitalizations compared to late implementation (≥ 13 months) in symptomatic heart failure patients aged ≤ 70 years?
Both early and late cardiac contractility modulation (CCM) implantation improve functional status and LVEF in symptomatic heart failure patients, though early implementation within the first year of diagnosis yields superior LVEF recovery, fewer heart failure hospitalizations, and modestly better survival.
Early CCM implantation was associated with better survival and fewer hospitalizations; leaves open whether randomized trials should test optimal timing.
Aims Symptomatic chronic heart failure (HF) despite medical treatment can be addressed with cardiac contractility modulation (CCM) therapy, which has yet to have been investigated regarding outcome differences between early versus late implementation. Methods and Results CCM recipients from the Mannheim Cardiac Contractility Modulation Observational Registry (MAINTAINED) aged ≤ 70 years at implantation were grouped with regard to implantation time after the first diagnosis of CCM indicating HF (New York Heart Association classification (NYHA) ≥ 2 and left ventricular ejection fraction (LVEF) = 25%–45%) into either Early‐ (EC, n = 50, implantation < 13 months after diagnosis) or Late‐Implantation Group (LC, n = 81, implantation ≥ 13 months after diagnosis). Both groups were compared regarding survival, NYHA, LVEF, and HF‐related hospitalizations for up to 60 months. The mean implantation time after the first diagnosis were 5.85 ± 3.1 versus 92 ± 70.2 months (first values EC, p < 0.05). Mean survival was better for EC (55.2 ± 1.7 vs. 52.8 ± 1.6 months, p < 0.05). Improvements in NYHA (2.98 ± 0.47 to 2.0 ± 0.73 vs. 3.01 ± 0.46 to 2.25 ± 0.8, both p < 0.05) and LVEF (23.2 ± 7.5 to ± 38.82 ± 12.85 vs. 23.9 ± 7 to 29.92 ± 8.9%, each p < 0.05) were comparable, with differences in terms of grouping. Hospitalizations due to HF were more frequent to LC patients (39 vs. 110 events, Odds Ratio 2.1). Conclusions Heart failure patients might experience improvements in functional status and left ventricular reverse remodeling following CCM therapy, regardless of the timing of implantation. Early implementation of CCM within the first year of CCM suitable HF might provide additional benefits regarding survival, left ventricular systolic recovery and protection against heart failure hospitalizations.
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Yücel et al. (2026) conducted an observational in Symptomatic chronic heart failure treated with cardiac contractility modulation (CCM) (n=131). Early cardiac contractility modulation (CCM) implantation (<13 months after HF diagnosis) vs. Late CCM implantation (≥13 months after HF diagnosis) was evaluated on Heart failure-related hospitalizations over 60 months (OR 2.1, p=<0.0001).
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