title: The effect of device-based cardiac contractility modulation therapy on myocardial efficiency and oxidative metabolism in patients with heart failure.
abstract: OBJECTIVE
  Cardiac contractility modulation (CCM) is a device-based therapy that involves delivery of nonexcitatory electrical signals resulting in improved ventricular function and a reversal of maladaptive cardiac fetal gene programmes. Our aim was to evaluate whether acute application of CCM leads to an increase in myocardial oxygen consumption (MVO(2)) in patients with chronic heart failure using (11)C-acetate positron emission tomography (PET).
  
  
  METHODS
  We prospectively enrolled 21 patients with severe heart failure. (11)C-acetate PET was performed before and after activation of the CCM device. In 12 patients an additional stress study with dobutamine was performed.
  
  
  RESULTS
  Under resting conditions, the values of myocardial blood flow (MBF), MVO(2) and work metabolic index (WMI, reflecting myocardial efficiency) with the CCM device activated did not differ significantly from the values with the device deactivated. MBF was 0.81 ± 0.18 ml min(-1) g(-1) with the device off and 0.80 ± 0.15 ml min(-1) g(-1) with the device on (p = 0.818), MVO(2) was 6.81 ± 1.69 ml/min/100 g with the device off and 7.15 ± 1.62 ml/min/100 g with the device on (p = 0.241) and WMI was 4.94 ± 1.14 mmHg ml/m(2) with the device off and 5.21 ± 1.36 mmHg ml/m(2) with the device on (p = 0.344). Under dobutamine stress, the values of MBF, MVO(2) and WMI with the CCM device activated did not differ from the values with the device deactivated, but were significantly increased compared with the values obtained under resting conditions.
  
  
  CONCLUSIONS
  These results indicate that CCM does not induce increased MVO(2), even under stress conditions.
authors.affiliation: Department of Cardiology, Vienna General Hospital/Medical University of Vienna, Vienna, Austria. georg.goliasch@meduniwien.ac.at
authors.forename: Georg
authors.initials: G
authors.lastname: Goliasch
authors.forename: Aliasghar
authors.initials: A
authors.lastname: Khorsand
authors.forename: Matthias
authors.initials: M
authors.lastname: Schütz
authors.forename: Georgios
authors.initials: G
authors.lastname: Karanikas
authors.forename: Cesar
authors.initials: C
authors.lastname: Khazen
authors.forename: Heinz
authors.initials: H
authors.lastname: Sochor
authors.forename: Herwig
authors.initials: H
authors.lastname: Schmidinger
authors.forename: Michael
authors.initials: M
authors.lastname: Wolzt
authors.forename: Senta
authors.initials: S
authors.lastname: Graf
mesh_terms: D000085:Acetates; D000368:Aged; D002250:Carbon Radioisotopes; D004734:Energy Metabolism; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000378:metabolism / Q000503:physiopathology* / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D009206:Myocardium / Q000378:metabolism*; D010084:Oxidation-Reduction; D010100:Oxygen / Q000378:metabolism; D049268:Positron-Emission Tomography; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000085:Acetates; D002250:Carbon Radioisotopes; D010100:Oxygen
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