Heart failure patients may improve in functional status and left ventricular reverse remodeling after CCM therapy regardless of implantation timing, but implantation within the first year of CCM-suitable HF might provide additional benefits for survival, left ventricular systolic recovery and protection against heart failure hospitalizations.
Key Findings
Methods
In a registry cohort of 131 CCM recipients aged 70 years or younger, patients were split by time from first diagnosis of CCM-indicating heart failure to implantation into an early group (n=50, <13 months) and a late group (n=81, ≥13 months).
Data came from the Mannheim Cardiac Contractility Modulation Observational Registry (MAINTAINED).
CCM-indicating HF was defined as NYHA class ≥2 and LVEF of 25%-45%.
Outcomes (survival, NYHA, LVEF, HF-related hospitalizations) were compared for up to 60 months.
Results
The groups differed markedly in mean time from first diagnosis to implantation.
Early group: 5.85 ± 3.1 months versus late group: 92 ± 70.2 months (p < 0.05).
Results
Mean survival over follow-up was longer in the early-implantation group than in the late-implantation group.
55.2 ± 1.7 months for the early group versus 52.8 ± 1.6 months for the late group (p < 0.05).
Results
NYHA class improved significantly in both groups after CCM implantation, with improvement comparable between groups.
Early group: 2.98 ± 0.47 to 2.0 ± 0.73.
Late group: 3.01 ± 0.46 to 2.25 ± 0.8.
Both changes were reported as p < 0.05.
Results
LVEF improved significantly in both groups, with a larger final value in the early group.
Early group: 23.2 ± 7.5% to 38.82 ± 12.85%.
Late group: 23.9 ± 7% to 29.92 ± 8.9%.
Each change was reported as p < 0.05, with differences in terms of grouping.
Results
Heart failure hospitalizations were more frequent in the late-implantation group.
39 events in the early group versus 110 events in the late group.
Odds ratio 2.1 for the late group.
Conclusions
The authors conclude that functional and remodeling benefits occur regardless of timing, while early implantation may add benefits in survival, LV systolic recovery and HF hospitalization protection.
Early implementation was defined as within the first year of CCM-suitable HF.
This is the first investigation of early versus late CCM implementation outcomes, per the abstract.
What This Means
This study looked at patients with long-term heart failure who got a cardiac contractility modulation (CCM) device, which delivers electrical signals to help the heart pump more strongly. Using a registry of 131 patients aged 70 or younger, researchers compared those who received the device within about a year of becoming eligible (50 patients) with those who received it later (81 patients, on average about 7.7 years after eligibility).
Both groups felt better and had better heart pumping function after the device, as measured by symptom class and ejection fraction. However, the early group had slightly longer average survival over up to 60 months (55.2 vs 52.8 months), a larger improvement in heart pumping function, and far fewer hospital stays for heart failure (39 vs 110 events).
This research suggests that getting CCM sooner after becoming eligible might offer extra benefits beyond those seen with later implantation. Because this was an observational registry study with a modest number of patients, it cannot prove that early timing caused the better outcomes, and the findings would need confirmation in larger studies.