Cardiac resynchronization therapy: results, challenges and perspectives for the future

Enhancing myocardial function with cardiac contractility modulation: potential and challenges

Cardiac contractility modulation (CCM) offers a novel therapeutic avenue for heart failure patients, particularly those unresponsive to cardiac resynchronization therapy within specific QRS duration ranges. This review elucidates CCM's mechanistic underpinnings, its impact on myocardial function, and utility across patient demographics. However, CCM is limited by insufficient data on mortality and hospitalization rate reductions, as well as the need for specialized device implantation skills. While prevailing research has concentrated on left ventricular effects, a knowledge gap persists for other patient subsets. Future inquiries should address combinatory treatment strategies, extended usage and the impact of atrial fibrillation on device implantation. Such expanded studies could refine therapeutic outcomes and widen the scope of beneficiaries.

Prognostication of Poor Survival After Cardiac Resynchronization Therapy

Background and Objectives: Cardiac resynchronization therapy (CRT) is a successful treatment option for appropriately selected patients. However, one–third of recipients do not experience any positive outcome or their condition even declines. We aimed to assess preimplantation factors associated with worse survival after the CRT. Materials and Methods: This was a retrospective unicenter trial. The study cohort included 183 consecutive CRT-treated patients. Baseline demographic, clinical, electrocardiographic, and echocardiographic characteristics were analyzed. Results: After the median follow-up of 15.6 months (9.3–26.3), 20 patients had died (11%). In multivariate Cox regression analysis, ischemic origin of heart failure (HF) was a significant predictor of poor survival (adjusted hazard ratio (aHR) 15.235, 95% confidence interval (CI) (1.999–116.1), p = 0.009). In univariate Cox regression, tricuspid annular plane systolic excursion (TAPSE) <15.5 mm (sensitivity 0.824, specificity 0.526; HR 5.019, 95% CI (1.436–17.539), p = 0.012), post-implantation prescribed antiplatelet agents (HR 2.569, 95% CI (1.060–6.226), p = 0.037), statins (HR 2.983, 95% CI (1.146–7.764), p = 0.025), and nitrates (HR 3.694, 95% CI (1.342–10.171), p = 0.011) appeared to be related with adverse outcome. Conclusions: ischemic etiology of HF is a significant factor associated with worse survival after the CRT. Decreased TAPSE is also related to poor survival.