1
|
Alfieri M, Bruscoli F, Di Vito L, Di Giusto F, Scalone G, Marchese P, Delfino D, Silenzi S, Martoni M, Guerra F, Grossi P. Novel Medical Treatments and Devices for the Management of Heart Failure with Reduced Ejection Fraction. J Cardiovasc Dev Dis 2024; 11:125. [PMID: 38667743 PMCID: PMC11050600 DOI: 10.3390/jcdd11040125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/13/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
Heart failure (HF) is a growing issue in developed countries; it is often the result of underlying processes such as ischemia, hypertension, infiltrative diseases or even genetic abnormalities. The great majority of the affected patients present a reduced ejection fraction (≤40%), thereby falling under the name of "heart failure with reduced ejection fraction" (HFrEF). This condition represents a major threat for patients: it significantly affects life quality and carries an enormous burden on the whole healthcare system due to its high management costs. In the last decade, new medical treatments and devices have been developed in order to reduce HF hospitalizations and improve prognosis while reducing the overall mortality rate. Pharmacological therapy has significantly changed our perspective of this disease thanks to its ability of restoring ventricular function and reducing symptom severity, even in some dramatic contexts with an extensively diseased myocardium. Notably, medical therapy can sometimes be ineffective, and a tailored integration with device technologies is of pivotal importance. Not by chance, in recent years, cardiac implantable devices witnessed a significant improvement, thereby providing an irreplaceable resource for the management of HF. Some devices have the ability of assessing (CardioMEMS) or treating (ultrafiltration) fluid retention, while others recognize and treat life-threatening arrhythmias, even for a limited time frame (wearable cardioverter defibrillator). The present review article gives a comprehensive overview of the most recent and important findings that need to be considered in patients affected by HFrEF. Both novel medical treatments and devices are presented and discussed.
Collapse
Affiliation(s)
- Michele Alfieri
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital “Umberto I-Lancisi-Salesi”, 60121 Ancona, Italy; (M.A.); (F.G.)
| | - Filippo Bruscoli
- Cardiology Unit, C. and G. Mazzoni Hospital, AST Ascoli Piceno, 63100 Ascoli Piceno, Italy; (F.B.); (F.D.G.); (G.S.); (P.M.); (D.D.); (S.S.); (P.G.)
| | - Luca Di Vito
- Cardiology Unit, C. and G. Mazzoni Hospital, AST Ascoli Piceno, 63100 Ascoli Piceno, Italy; (F.B.); (F.D.G.); (G.S.); (P.M.); (D.D.); (S.S.); (P.G.)
| | - Federico Di Giusto
- Cardiology Unit, C. and G. Mazzoni Hospital, AST Ascoli Piceno, 63100 Ascoli Piceno, Italy; (F.B.); (F.D.G.); (G.S.); (P.M.); (D.D.); (S.S.); (P.G.)
| | - Giancarla Scalone
- Cardiology Unit, C. and G. Mazzoni Hospital, AST Ascoli Piceno, 63100 Ascoli Piceno, Italy; (F.B.); (F.D.G.); (G.S.); (P.M.); (D.D.); (S.S.); (P.G.)
| | - Procolo Marchese
- Cardiology Unit, C. and G. Mazzoni Hospital, AST Ascoli Piceno, 63100 Ascoli Piceno, Italy; (F.B.); (F.D.G.); (G.S.); (P.M.); (D.D.); (S.S.); (P.G.)
| | - Domenico Delfino
- Cardiology Unit, C. and G. Mazzoni Hospital, AST Ascoli Piceno, 63100 Ascoli Piceno, Italy; (F.B.); (F.D.G.); (G.S.); (P.M.); (D.D.); (S.S.); (P.G.)
| | - Simona Silenzi
- Cardiology Unit, C. and G. Mazzoni Hospital, AST Ascoli Piceno, 63100 Ascoli Piceno, Italy; (F.B.); (F.D.G.); (G.S.); (P.M.); (D.D.); (S.S.); (P.G.)
| | - Milena Martoni
- Medical School, Università degli Studi “G. d’Annunzio”, 66100 Chieti, Italy;
| | - Federico Guerra
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital “Umberto I-Lancisi-Salesi”, 60121 Ancona, Italy; (M.A.); (F.G.)
| | - Pierfrancesco Grossi
- Cardiology Unit, C. and G. Mazzoni Hospital, AST Ascoli Piceno, 63100 Ascoli Piceno, Italy; (F.B.); (F.D.G.); (G.S.); (P.M.); (D.D.); (S.S.); (P.G.)
| |
Collapse
|
2
|
Li Z, Liu Q, Zhou S, Xiao Y. Enhancing myocardial function with cardiac contractility modulation: potential and challenges. ESC Heart Fail 2024; 11:1-12. [PMID: 37947013 PMCID: PMC10804199 DOI: 10.1002/ehf2.14575] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 10/04/2023] [Accepted: 10/19/2023] [Indexed: 11/12/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Zihan Li
- Department of Cardiovascular Medicine, Second Xiangya HospitalCentral South UniversityChangshaChina
- Xiangya School of MedicineCentral South UniversityChangshaChina
| | - Qiming Liu
- Department of Cardiovascular Medicine, Second Xiangya HospitalCentral South UniversityChangshaChina
| | - Shenghua Zhou
- Department of Cardiovascular Medicine, Second Xiangya HospitalCentral South UniversityChangshaChina
| | - Yichao Xiao
- Department of Cardiovascular Medicine, Second Xiangya HospitalCentral South UniversityChangshaChina
| |
Collapse
|
3
|
Heyer M, Trivedi A, Fata M, Mody K, Jamal SM. A tale of two technologies: Use of cardiac contractility modulator with wearable cardiac defibrillator. HeartRhythm Case Rep 2024; 10:45-48. [PMID: 38264103 PMCID: PMC10801011 DOI: 10.1016/j.hrcr.2023.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Affiliation(s)
- Marissa Heyer
- Department of Internal Medicine, Hackensack University Medical Center, Hackensack, New Jersey
| | - Anish Trivedi
- New York Institute of Technology – Long Island Campus, Old Westbury, New York
| | - Matthew Fata
- Department of Internal Medicine, Division of Cardiology, Hackensack University Medical Center, Hackensack, New Jersey
| | - Kanika Mody
- Heart Failure and Mechanical Circulatory Support, Hackensack University Medical Center, Hackensack, New Jersey
| | - Sameer M. Jamal
- Division of Cardiac Electrophysiology, Department of Cardiology, Hackensack University Medical Center, Hackensack, New Jersey
- Hackensack Meridian School of Medicine, Nutley, New Jersey
| |
Collapse
|
4
|
Salehin S, Harmouch W, Yaqub M, Khan U, Merie A, Salehin S, Hasan SM, Khalife WI, Sabayon MD, Chatila K, Raja M. Cardiac Contractility Modulation in Patients with Advanced Heart Failure: A Comprehensive Review of Literature. Curr Probl Cardiol 2024; 49:102102. [PMID: 37741596 DOI: 10.1016/j.cpcardiol.2023.102102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 09/25/2023]
Abstract
Heart failure is a significant cause of morbidity and mortality worldwide. Despite advancements in guideline-directed medical therapy and improvements in device-based therapies, patients with advanced heart failure have high rates of mortality regardless of ejection fraction. For patients with reduced ejection fraction who meet criteria, cardiac resynchronization therapy or implantable cardiac defibrillators are options available to improve outcomes. However, not all heart failure patients meet those criteria. Cardiac contractility modulation is an innovative therapy that serves to improve functional outcomes and quality of life, while also modifying pathologic gene expression and preventing further remodeling. In this article, we aim to discuss the major clinical trials investigating cardiac contractility modulation as a suitable therapy for patients with advanced heart failure.
Collapse
Affiliation(s)
- Salman Salehin
- Department of Cardiology, University of Texas Medical Branch, Galveston, TX.
| | - Wissam Harmouch
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX
| | - Maha Yaqub
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX
| | - Umer Khan
- Department of Internal Medicine, University of Texas at Austin (Dell Medical School), Austin, TX
| | - Anwar Merie
- Department of Internal Medicine, University of Texas at Austin (Dell Medical School), Austin, TX
| | - Shahran Salehin
- School of Medicine, Holy Family Red Crescent Medical College Hospital, Dhaka, Bangladesh
| | | | - Wissam I Khalife
- Department of Cardiology, University of Texas Medical Branch, Galveston, TX
| | - Muhie Dean Sabayon
- Department of Cardiology, University of Texas Medical Branch, Galveston, TX
| | - Khaled Chatila
- Department of Cardiology, University of Texas Medical Branch, Galveston, TX
| | - Muhammad Raja
- Department of Cardiology, University of Texas Medical Branch, Galveston, TX
| |
Collapse
|
5
|
Ziacchi M, Spadotto A, Ghio S, Pellegrino M, Potena L, Masarone D, Merlo M, Stolfo D, Caracciolo MM, Inserra C, Ammirati F, Ciccarelli M, Colivicchi F, Bianchi S, Patti G, Oliva F, Arcidiacono G, Rordorf R, Pini D, Pacileo G, D'Onofrio A, Forleo GB, Mariani M, Adamo F, Alonzo A, Ruzzolini M, Ghiglieno C, Cipriani M, Firetto G, Aspromonte N, Clemenza F, Maria De Ferrari G, Senni M, Grazia Bongiorni M, Tondo C, Grimaldi M, Giallauria F, Rametta F, Marchese P, Biffi M, Sinagra G. Bridging the gap in the symptomatic heart failure patient journey: insights from the Italian scenario. Expert Rev Med Devices 2023; 20:951-961. [PMID: 37712650 DOI: 10.1080/17434440.2023.2258786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/19/2023] [Accepted: 08/05/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND The prognosis for heart failure (HF) patients remains poor, with a high mortality rate, and a marked reduction in quality of life (QOL) and functional status. This study aims to explore the ongoing needs of HF management and the epidemiology of patients followed by Italian HF clinics, with a specific focus on cardiac contractility modulation (CCM). RESEARCH DESIGN AND METHODS Data from patients admitted to 14 HF outpatients clinics over 4 weeks were collected and compared to the results of a survey open to physicians involved in HF management operating in Italian centers. RESULTS One hundred and five physicians took part in the survey. Despite 94% of patients receive a regular follow-up every 3-6 months, available therapies are considered insufficient in 30% of cases. Physicians reported a lack of treatment options for 23% of symptomatic patients with reduced ejection fraction (EF) and for 66% of those without reduced EF. Approximately 3% of HF population (two patients per month per HF clinic) meets the criteria for immediate CCM treatment, which is considered a useful option by 15% of survey respondents. CONCLUSIONS Despite this relatively small percentage, considering total HF population, CCM could potentially benefit numerous HF patients, particularly the elderly, by reducing hospitalizations, improving functional capacity and QOL.
Collapse
Affiliation(s)
- Matteo Ziacchi
- Cardiology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Alberto Spadotto
- Cardiology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Stefano Ghio
- Division of Cardiology, Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marta Pellegrino
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Luciano Potena
- Cardiology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Daniele Masarone
- Heart Failure Unit, AORN dei Colli, Monaldi Hospital, Naples, Italy
| | - Marco Merlo
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University of Trieste, Trieste, Italy
| | - Davide Stolfo
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University of Trieste, Trieste, Italy
| | | | - Corinna Inserra
- Department of Cardiovascular Disease, Unit of Cardiology, Ospedale Civile di Legnano, Legnano, Italy
| | - Fabrizio Ammirati
- Cardiology Division, Presidio Ospedaliero GB Grassi Ostia Lido, Rome, Italy
| | - Michele Ciccarelli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | | | - Stefano Bianchi
- UOC Cardiologia, Ospedale Fatebenefratelli Isola Tiberina, Rome, Italy
| | - Giuseppe Patti
- Università del Piemonte Orientale, Azienda Ospedaliero Universitaria "Maggiore Della Carita", Novara, Italy
| | - Fabrizio Oliva
- De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
| | - Giuseppe Arcidiacono
- Dipartimento di Medicina clinica e Sperimemtale, University of Messina, Messina, Italy
| | - Roberto Rordorf
- Division of Cardiology, Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Daniela Pini
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Giuseppe Pacileo
- Heart Failure Unit, AORN dei Colli, Monaldi Hospital, Naples, Italy
| | | | | | - Matteo Mariani
- Department of Cardiovascular Disease, Unit of Cardiology, Ospedale Civile di Legnano, Legnano, Italy
| | - Francesco Adamo
- Cardiology Division, Presidio Ospedaliero GB Grassi Ostia Lido, Rome, Italy
| | | | - Matteo Ruzzolini
- UOC Cardiologia, Ospedale Fatebenefratelli Isola Tiberina, Rome, Italy
| | - Chiara Ghiglieno
- Università del Piemonte Orientale, Azienda Ospedaliero Universitaria "Maggiore Della Carita", Novara, Italy
| | | | - Giorgio Firetto
- Dipartimento di Medicina clinica e Sperimemtale, University of Messina, Messina, Italy
| | - Nadia Aspromonte
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy
| | - Francesco Clemenza
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy
| | - Gaetano Maria De Ferrari
- AOU Città della Salute e della Scienza di Torino and Department of Medical Sciences, University Cardiology, Torino, Italy
| | - Michele Senni
- Cardiology Division, Cardiovascular Department, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Department of Biomedical, Surgical and Dentist Sciences, University of Milan, Milan, Italy
| | - Massimo Grimaldi
- Department of Cardiology, Ospedale Generale Regionale F. Muilli, Acquaviva delle Fonti, Italy
| | - Francesco Giallauria
- Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | | | - Procolo Marchese
- Department of Cardiology, Mazzoni Civil Hospital, Ascoli Piceno, Italy
| | - Mauro Biffi
- Cardiology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University of Trieste, Trieste, Italy
| |
Collapse
|
6
|
Riccardi M, Sammartino AM, Adamo M, Inciardi RM, Lombardi CM, Pugliese NR, Tomasoni D, Vizzardi E, Metra M, Coats AJS, Pagnesi M. Cardiac contractility modulation: an effective treatment strategy for heart failure beyond reduced left ventricular ejection fraction? Heart Fail Rev 2023:10.1007/s10741-023-10315-4. [PMID: 37198505 DOI: 10.1007/s10741-023-10315-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/12/2023] [Indexed: 05/19/2023]
Abstract
Heart failure (HF) with preserved ejection fraction (HFpEF) causes a progressive limitation of functional capacity, poor quality of life (QoL) and increased mortality, yet unlike HF with reduced ejection fraction (HFrEF) there are no effective device-based therapies. Both HFrEF and HFpEF are associated with dysregulations in myocardial cellular calcium homeostasis and modifications in calcium-handling proteins, leading to abnormal myocardial contractility and pathological remodelling. Cardiac contractility modulation (CCM) therapy, based on a pacemaker-like implanted device, applies extracellular electrical stimulation to myocytes during the absolute refractory period of the action potential, which leads to an increase in cytosolic peak calcium concentrations and thereby the force of isometric contraction promoting positive inotropism. Subgroup analysis of CCM trials in HFrEF has demonstrated particular benefits in patients with LVEF between 35% and 45%, suggesting its potential effectiveness also in patients with higher LVEF values. Available evidence on CCM in HFpEF is still preliminary, but improvements in terms of symptoms and QoL have been observed. Future large, dedicated, prospective studies are needed to evaluate the safety and efficacy of this therapy in patients with HFpEF.
Collapse
Affiliation(s)
- Mauro Riccardi
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Antonio M Sammartino
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marianna Adamo
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Riccardo M Inciardi
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Carlo M Lombardi
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Nicola R Pugliese
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Daniela Tomasoni
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Enrico Vizzardi
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marco Metra
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
| | | | - Matteo Pagnesi
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| |
Collapse
|
7
|
Cardiac Contractility Modulation Therapy in Patients with Amyloid Cardiomyopathy and Heart Failure, Case Report, Review of the Biophysics of CCM Function, and AMY-CCM Registry Presentation. J Clin Med 2023; 12:jcm12031184. [PMID: 36769832 PMCID: PMC9917884 DOI: 10.3390/jcm12031184] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/27/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
Cardiac amyloidosis may result in an aggressive form of heart failure (HF). Cardiac contractility modulation (CCM) has been shown to be a concrete therapeutic option in patients with symptomatic HF, but there is no evidence of its application in patients with cardiac amyloidosis. We present the case of TTR amyloidosis, where CCM therapy proved to be effective. The patient had a history of multiple HF hospitalizations due to an established diagnosis of wild type TTR-Amyloidosis with significant cardiac involvement. Since he was highly symptomatic, except during continuous dobutamine and diuretic infusion, it was opted to pursue CCM therapy device implantation. At follow up, a significant improvement in clinical status was reported with an increase of EF, functional status (6 min walk test improved from zero meters at baseline, to 270 m at 1 month and to 460 m at 12 months), and a reduction in pulmonary pressures. One year after device implantation, no other HF hospital admission was needed. CCM therapy may be effective in this difficult clinical setting. The AMY-CCM Registry, which has just begun, will evaluate the efficacy of CCM in patients with HF and diagnosed TTR amyloidosis to bring new evidence on its potential impact as a therapeutic option.
Collapse
|
8
|
One-Year Outcome of Cardiac Contractility Modulation in Patients With Reduced Ejection Fraction, Atrial Fibrillation, and Previous Resynchronization: A Pilot Study. Am J Ther 2023; 30:e10-e16. [PMID: 36367992 DOI: 10.1097/mjt.0000000000001579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND After 6 months of therapy, cardiac contractility modulation (CCM) has been shown to improve symptoms, exercise tolerance, and quality of life as well as reduce the rate of hospitalizations in patients with heart failure with reduced left ventricular ejection fraction (HFrEF), but long-term effects data are lacking, with no randomized trial to date. STUDY QUESTION What is the long-term benefit of the CCM device implantation in symptomatic patients with severe, optimally treated HFrEF? STUDY DESIGN We conducted a prospective trial involving patients with symptomatic HFrEF [New York Heart Association (NYHA) Class III or IV, left ventricular ejection fraction (LVEF) ≤35%] who were supported by a CCM device. RESULTS Twenty patients (19 men), aged 66.5 ± 6.9 years, were provided with CCM therapy and followed up for an average duration of 321.7 ± 113.5 days. The etiology of heart failure was ischemic in 16 patients (80%), 9 patients (45%) had atrial fibrillation, 6 patients (30%) had diabetes mellitus, and mean creatinine clearance value was 54.8 ± 13.0 mL/min. Eleven patients (60%) had LVEF ≤25%. Although all the patients had an implanted cardioverter-defibrillator, 6 of them (30%) also had resynchronization therapy. The pharmacological treatment has been optimized in all patients. One year after implantation, the LVEF increased from 24.68% ± 4.5 to 34.6 ± 5 ( P < 0.0001), NYHA class improved from 3.2 ± 0.5 to 1.4 ± 0.5 ( P < 0.0001), and exercise tolerance evaluated with a 6-Minute Walk Test increased (from 307.9 ± 74.1 m to 567 ± 99.5 m; P < 0.00001). These improvements were largely seen in the first 6 months. CONCLUSIONS Over the course of a year, CCM therapy was associated with improved LVEF and NYHA class, as well as significantly better exercise tolerance, even in patients with atrial fibrillation and cardiac resynchronization therapy and did not seem to be associated with additional significant device-related problems.
Collapse
|
9
|
Feaster TK, Feric N, Pallotta I, Narkar A, Casciola M, Graziano MP, Aschar-Sobbi R, Blinova K. Acute effects of cardiac contractility modulation stimulation in conventional 2D and 3D human induced pluripotent stem cell-derived cardiomyocyte models. Front Physiol 2022; 13:1023563. [PMID: 36439258 PMCID: PMC9686332 DOI: 10.3389/fphys.2022.1023563] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/28/2022] [Indexed: 11/11/2022] Open
Abstract
Cardiac contractility modulation (CCM) is a medical device therapy whereby non-excitatory electrical stimulations are delivered to the myocardium during the absolute refractory period to enhance cardiac function. We previously evaluated the effects of the standard CCM pulse parameters in isolated rabbit ventricular cardiomyocytes and 2D human induced pluripotent stem cell-derived cardiomyocyte (hiPSC-CM) monolayers, on flexible substrate. In the present study, we sought to extend these results to human 3D microphysiological systems to develop a robust model to evaluate various clinical CCM pulse parameters in vitro. HiPSC-CMs were studied in conventional 2D monolayer format, on stiff substrate (i.e., glass), and as 3D human engineered cardiac tissues (ECTs). Cardiac contractile properties were evaluated by video (i.e., pixel) and force-based analysis. CCM pulses were assessed at varying electrical ‘doses’ using a commercial pulse generator. A robust CCM contractile response was observed for 3D ECTs. Under comparable conditions, conventional 2D monolayer hiPSC-CMs, on stiff substrate, displayed no contractile response. 3D ECTs displayed enhanced contractile properties including increased contraction amplitude (i.e., force), and accelerated contraction and relaxation slopes under standard acute CCM stimulation. Moreover, 3D ECTs displayed enhanced contractility in a CCM pulse parameter-dependent manner by adjustment of CCM pulse delay, duration, amplitude, and number relative to baseline. The observed acute effects subsided when the CCM stimulation was stopped and gradually returned to baseline. These data represent the first study of CCM in 3D hiPSC-CM models and provide a nonclinical tool to assess various CCM device signals in 3D human cardiac tissues prior to in vivo animal studies. Moreover, this work provides a foundation to evaluate the effects of additional cardiac medical devices in 3D ECTs.
Collapse
Affiliation(s)
- Tromondae K. Feaster
- Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD, United States
| | - Nicole Feric
- Valo Health Inc, Alexandria Center for Life Sciences, New York, NY, United States
| | - Isabella Pallotta
- Valo Health Inc, Alexandria Center for Life Sciences, New York, NY, United States
| | - Akshay Narkar
- Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD, United States
| | - Maura Casciola
- Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD, United States
| | - Michael P. Graziano
- Valo Health Inc, Alexandria Center for Life Sciences, New York, NY, United States
| | - Roozbeh Aschar-Sobbi
- Valo Health Inc, Alexandria Center for Life Sciences, New York, NY, United States
| | - Ksenia Blinova
- Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD, United States
- *Correspondence: Ksenia Blinova,
| |
Collapse
|
10
|
Ramadan MS, Gallo R, Patauner F, Bertolino L, Durante-Mangoni E. Emerging Concepts on Infection of Novel Cardiac Implantable Devices. Rev Cardiovasc Med 2022; 23:277. [PMID: 39076625 PMCID: PMC11266971 DOI: 10.31083/j.rcm2308277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/10/2022] [Accepted: 06/27/2022] [Indexed: 07/31/2024] Open
Abstract
Novel cardiac devices, including the MitraClip system, occluder devices, leadless pacemakers, and subcutaneous implantable cardioverter defibrillators (S-ICD), are mostly used in the management of patients who are at high risk for surgery and/or developing infections. Several mechanisms render most of these devices resistant to infection, including avoiding long transvenous access and novel manufacturing material. Since subjects who use these devices already endure several comorbid conditions, uncommon cases of device-associated infection could result in serious complications and increased mortality. In this review, we aim to summarize the current state of evidence on the incidence, clinical presentation, management, and prognosis of new cardiac devices' associated infection.
Collapse
Affiliation(s)
- Mohammad Said Ramadan
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’ Napoli, Italy and Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Napoli, Italy
| | - Raffaella Gallo
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’ Napoli, Italy and Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Napoli, Italy
| | - Fabian Patauner
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’ Napoli, Italy and Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Napoli, Italy
| | - Lorenzo Bertolino
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’ Napoli, Italy and Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Napoli, Italy
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’ Napoli, Italy and Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Napoli, Italy
| |
Collapse
|
11
|
Mosoiu D, Rogozea L, Landon A, Bisoc A, Tint D. Palliative Care in Heart Failure: A Public Health Emergency. Am J Ther 2020; 27:e204-e223. [PMID: 31688067 DOI: 10.1097/mjt.0000000000001067] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Palliative care (PC) is the holistic care of patients with life-limiting illnesses focused on relief of suffering and maximizing quality of life for patients and their families. Patients with heart failure (HF) are the largest group eligible for PC services, but only a small percentage of them receive PC. AREAS OF UNCERTAINTY The optimal content and method of delivery of PC interventions to HF patients in resource-limited countries remain unknown. The integration of PC into existing HF disease management continues to be a challenge. DATA SOURCES PUBMED was searched to identify articles on the topic published in the last 5 years (2014-April 2019). One hundred thirty-six articles were identified-14 articles out of were included in the revision. THERAPEUTIC ADVANCES Research concerning PC in HF is still scarce and comes predominantly from developed countries. PC in HF improves patients' and caregivers' outcomes in terms of dyspnea, sleep, depression, communication, coping, and care-giving burden. Specialized home-based PC services have a positive impact on patients' physical and emotional wellbeing while decreasing utilization of medical services. Fatigue, dyspnea, and pain are frequent symptoms. Evidence concerning use of opioids for dyspnea is increasing. Family caregivers offer a considerable amount of care during the disease trajectory. There is often incongruence between the carer's and the patient's wishes in terms of treatment decisions and preferences. Carers should be assessed for risk and supported in their roles in care management and care coordination. CONCLUSIONS Because of the unpredictability of the disease and difficulty in prognostication, PC should be introduced at the point of diagnosis of HF. Basic education in PC needs to be introduced early in the training of cardiology staff, focused on concept definition, differencing PC and terminal care, symptom management, communication, and decision-making.
Collapse
Affiliation(s)
- Daniela Mosoiu
- Transilvania University of Brasov, Faculty of Medicine, Brasov, Romania.,Education and National Development Department, Hospice Casa Sperantei, Brasov, Romania
| | - Liliana Rogozea
- Transilvania University of Brasov, Faculty of Medicine, Brasov, Romania
| | | | - Alina Bisoc
- Transilvania University of Brasov, Faculty of Medicine, Brasov, Romania.,Emergency County Clinical Hospital, Brasov, Romania; and
| | - Diana Tint
- Transilvania University of Brasov, Faculty of Medicine, Brasov, Romania.,ICCO Clinics, Brasov, Romania
| |
Collapse
|
12
|
Barnes A, Campbell C, Weiss R, Kahwash R. Cardiac Contractility Modulation in Heart Failure: Mechanisms and Clinical Evidence. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00852-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
13
|
Muir WW, Hamlin RL. Myocardial Contractility: Historical and Contemporary Considerations. Front Physiol 2020; 11:222. [PMID: 32296340 PMCID: PMC7137917 DOI: 10.3389/fphys.2020.00222] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 02/26/2020] [Indexed: 12/17/2022] Open
Abstract
The term myocardial contractility is thought to have originated more than 125 years ago and has remained and enigma ever since. Although the term is frequently used in textbooks, editorials and contemporary manuscripts its definition remains illusive often being conflated with cardiac performance or inotropy. The absence of a universally accepted definition has led to confusion, disagreement and misconceptions among physiologists, cardiologists and safety pharmacologists regarding its definition particularly in light of new discoveries regarding the load dependent kinetics of cardiac contraction and their translation to cardiac force-velocity and ventricular pressure-volume measurements. Importantly, the Starling interpretation of force development is length-dependent while contractility is length independent. Most historical definitions employ an operational approach and define cardiac contractility in terms of the hearts mechanical properties independent of loading conditions. Literally defined the term contract infers that something has become smaller, shrunk or shortened. The addition of the suffix “ility” implies the quality of this process. The discovery and clinical investigation of small molecules that bind to sarcomeric proteins independently altering force or velocity requires that a modern definition of the term myocardial contractility be developed if the term is to persist. This review reconsiders the historical and contemporary interpretations of the terms cardiac performance and inotropy and recommends a modern definition of myocardial contractility as the preload, afterload and length-independent intrinsic kinetically controlled, chemo-mechanical processes responsible for the development of force and velocity.
Collapse
Affiliation(s)
- William W Muir
- College of Veterinary Medicine, Lincoln Memorial University, Harrogate, TN, United States
| | - Robert L Hamlin
- College of Veterinary Medicine, The Ohio State University, Columbus, OH, United States
| |
Collapse
|
14
|
Campbell CM, Kahwash R, Abraham WT. Optimizer Smart in the treatment of moderate-to-severe chronic heart failure. Future Cardiol 2020; 16:13-25. [DOI: 10.2217/fca-2019-0044] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Cardiac contractility modulation, also referred to as CCM™, by the Optimizer Smart device is an innovative intracardiac device-based therapy that has been recently US FDA-approved for the treatment of patients with chronic heart failure, left ventricular ejection fraction (LVEF) between 25 and 45%, QRS <130 ms who remain symptomatic despite optimal medical therapy. Clinical trials demonstrate that CCM therapy is safe and effective in reducing heart failure hospitalization and improving heart failure symptoms, quality of life and functional performance. This novel device-based therapeutic offers benefits to patients who do not otherwise qualify for cardiac resynchronization therapy. CCM expands the indication beyond the traditional LVEF cutoff of 35% to a newer group including patients who fall in midrange LVEF group, up to 45%.
Collapse
Affiliation(s)
- Courtney M Campbell
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, 200 Davis Heart & Lung Institute, 473 W 12th Ave, Columbus, OH 43210, USA
| | - Rami Kahwash
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, 200 Davis Heart & Lung Institute, 473 W 12th Ave, Columbus, OH 43210, USA
| | - William T Abraham
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, 200 Davis Heart & Lung Institute, 473 W 12th Ave, Columbus, OH 43210, USA
| |
Collapse
|