title: Efficacy and survival in patients with cardiac contractility modulation: long-term single center experience in 81 patients.
abstract: OBJECTIVE
  To analyze long-term efficacy and survival in patients with chronic heart failure treated with cardiac contractility modulation.
  
  
  METHODS
  81 patients implanted with a CCM device between 2004 and 2012 were included in this retrospective analysis. Changes in NYHA class, ejection fraction (EF), Minnesota Living with Heart Failure Questionnaire, NT-proBNP and peak VO₂ were analyzed during a mean follow up of 34.2 ± 28 months (6-123 months). Observed mortality rate was compared with that predicted by the MAGGIC Score.
  
  
  RESULTS
  Patients were 61 ± 12 years old with EF 23 ± 7%. Heart failure was due to ischemic (n=48, 59.3%) or idiopathic dilated (n=33, 40.7%) cardiomyopathy. EF increased from 23.1 ± 7.9 to 29.4 ± 8.6% (p<0.05), mean NT-proBNP decreased from 4395 ± 3818 to 2762 ± 3490 ng/l (p<0.05) and mean peak VO2 increased from 13.9 ± 3.3 to 14.6 ± 3.5 ml/kg/min (p=0.1). The overall clinical responder rate (at least 1 class improvement of NYHA within 6 months or last follow-up) was 74.1%. 21 (25.9%) patients died during follow up, 11 (52.4%) due to cardiac conditions and 10 (47.6%) due to non-cardiac conditions. Mortality rates at 1 and 3 years were 5.2% and 29.5% compared to mortality rates estimated from the MAGGIC risk score of 18.4% (p<0.001) and 40% (p=ns), respectively. Log-Rank analysis of all events through 3 years of follow-up, however, was significantly less than predicted (p=0.022).
  
  
  CONCLUSIONS
  CCM therapy improved quality of life, exercise capacity, NYHA class, EF and NT-proBNP levels during long-term follow up. Mortality rates appeared to be lower than estimated from the MAGGIC score.
authors: University Medical Centre, I. Medical Department, Mannheim, Germany. Electronic address: juergen.kuschyk@umm.de.
authors: Jürgen
authors: J
authors: Kuschyk
authors: University Medical Centre, I. Medical Department, Mannheim, Germany.
authors: Susanne
authors: S
authors: Roeger
authors: University Medical Centre, I. Medical Department, Mannheim, Germany.
authors: Raphaela
authors: R
authors: Schneider
authors: University Medical Centre, I. Medical Department, Mannheim, Germany.
authors: Florian
authors: F
authors: Streitner
authors: University Medical Centre, I. Medical Department, Mannheim, Germany.
authors: Ksenija
authors: K
authors: Stach
authors: University Medical Centre, I. Medical Department, Mannheim, Germany.
authors: Boris
authors: B
authors: Rudic
authors: University Medical Centre, Institute for Medical Statistics, Mannheim, Germany.
authors: Christel
authors: C
authors: Weiß
authors: University Medical Centre, I. Medical Department, Mannheim, Germany.
authors: Rainer
authors: R
authors: Schimpf
authors: University Medical Centre, I. Medical Department, Mannheim, Germany.
authors: Theano
authors: T
authors: Papavasilliu
authors: IMPULSE Dynamics, Orangeburg, NY, USA.
authors: Benny
authors: B
authors: Rousso
authors: Columbia University, Cardiology, NY, USA.
authors: Daniel
authors: D
authors: Burkhoff
authors: University Medical Centre, I. Medical Department, Mannheim, Germany.
authors: Martin
authors: M
authors: Borggrefe
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Cardiac contractility modulation; Device therapy; Heart failure