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Cardiac contractility modulation improves outcome in heart failure with reduced ejection fraction

Heart Failure

Gerd Hasenfuss.jpgProf. Gerd Hasenfuss

Cardiac contractility modulation (CCM) has been shown to improve exercise tolerance and quality of life (QoL) in patients with heart failure with reduced ejection fraction. In yesterday’s late-breaking trial presentation, Professor Gerd Hasenfuss (Universitätsmedizin Göttingen, Göttingen, Germany) reported study and registry results confirming the long-term benefits of CCM in a real-world setting (LBT14).

Prof. Hasenfuss describes the populations investigated: 160 in the 24-week (peak VO2) efficacy study and 140 patients in the multicentre registry, which had a three-year follow-up. “Patients had New York Heart Association (NYHA) class III or IV symptoms, a left ventricular ejection fraction (LVEF) of between 25–45% and a QRS duration of less than 130 ms. Ejection fractions below 25% are likely to be associated with significant cardiac scarring, which impedes the activity of the CCM device, and patients with QRS intervals wider than 130 ms should be treated in the first instance with cardiac resynchronisation therapy,” he says. In addition to significant improvements in the Minnesota Living with Heart Failure Questionnaire (MLHFQ), NYHA class and six-minute walk distance, says Prof. Hasenfuss, “CCM led to a significant, and clinically relevant, increase of 0.84 mL/kg/min in peak VO2, the most important objective cardiorespiratory measurement.” Long-term findings were very positive. “We saw a dramatic 75% reduction in hospitalisation rates,” says Prof. Hasenfuss, “falling from 1.2/patient-year in the year before device implantation to 0.35/patient-year following implantation (p<0.0001). Also, at two years, the significant benefits of CCM on MLHFQ and NYHA class were confirmed and there was a significant improvement in LVEF.” Although there was no statistically significant difference over the whole population in three-year overall survival rates between patients receiving CCM (82.8%) and Seattle Heart Failure Model (SHFM) predictions (76.7%), significant survival benefits were observed in patients with an LVEF of at least 35%, explains Prof. Hasenfuss,

“Three-year overall survival rates were significantly better with CCM (88.0%) compared with SHFM predictions (74.7%, p<0.05) in a subgroup of patients with LVEF 35–45%.”

Prof. Hassenfus is confident that the results will have an impact on clinical practice. “The results provide subjective and objective measures of outcome improvement, in terms of exercise capacity, QoL, hospitalisation rates and mortality, with the use of CCM in this group of patients,” he says. “The existing ESC heart failure guidelines1 suggest that CCM may be considered in selected patients with heart failure but that effects on heart failure morbidity and mortality remain to be established. The results from our study support the use of CCM in patients with NYHA class III or IV heart failure and LVEF 25–45% and I think they will serve to strengthen the current recommendation.”

  1. Ponikowski P, et al. Eur Heart J 2016;37:2129–2200.