Cardiac Contractility Monitoring: an Important Therapy in the Treatment of Advanced Heart Failure
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HEART FAILURE (HJ EISEN, SECTION EDITOR)
Cardiac Contractility Monitoring: an Important Therapy in the Treatment of Advanced Heart Failure Jonathan B. Edelson 1 & Michael V. Genuardi 2 & Pasquale Santangeli 2 & Edo Y. Birati 2
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review This review highlights the mechanisms of action of cardiac contractility modulation (CCM) and the clinical data which supports its use for the appropriate patient population. Recent Findings CCM has beneficial effects on myocardial calcium handling and reverse remodeling of abnormal genetic programs. Clinical trials show sustained improvements in quality of life, exercise tolerance, and heart failure symptoms. Summary Heart failure is a global epidemic that is expected to increase in prevalence over the coming years. Despite improvements in, and the standardization of, optimal medical therapy (OMT), morbidity and mortality remain unacceptably high, with a 5-year mortality rate of 50%. While more recent advances in device therapies, including chronic resynchronization therapy (CRT), and left ventricular assist devices (LVADs), have changed the care of advanced heart failure for a certain subset of patients, there remains a therapeutic gap in the treatment of patients with heart failure and reduced ejection fraction (HFrEF) who are not candidates for CRT. CCM is a novel device-based therapy which delivers an electrical stimulus during the absolute refractory period and has been shown to improve heart failure symptoms, exercise tolerance, and quality of life. Keywords Heart failure . Cardiac contractility modulation . Device therapy
Introduction Heart failure is a global epidemic which affects 25 million adults worldwide [1], and is one of the leading causes of inpatient admissions and mortality in western countries [2], This article is part of the Topical Collection on Heart Failure * Jonathan B. Edelson [email protected] Michael V. Genuardi [email protected] Pasquale Santangeli [email protected] Edo Y. Birati [email protected] 1
Division of Cardiology, Cardiac Center, the Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
2
Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
with 1 in 9 death certificates in the USA describing the presence of heart failure. With improvements in the care of acute coronary syndrome, an increasing prevalence of diabetes, hypertension and atherosclerotic disease, and an aging population, the worldwide impact of heart failure promises to continue to grow higher still, prompting some to describe it as this century’s “cardiovascular epidemic” [3,4]. The past several decades have seen significant progress in the standardization of optimal medical therapy (OMT) [5–8], and the use of device therapy including internal cardiac defibrillators (ICDs) [9,10], chronic
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