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Role of Cardiac Contractility Modulation in Heart Failure With a Higher Ejection Fraction

Published:September 16, 2022DOI:https://doi.org/10.1016/j.cardfail.2022.08.013

      Highlights

      • In subgroup analysis of cardiac contractility modulation (CCM) trials in heart failure with reduced ejection fraction, benefits were observed in patients with higher ejection fraction and mildly reduced ejection fraction.
      • Growing evidence demonstrates both an inotropic and lusitropic effect of CCM therapy, which may translate to a therapeutic benefit in heart failure with preserved ejection fraction.
      • A randomized controlled trial is warranted to further investigate the efficacy of CCM therapy in heart failure with mildly reduced and preserved ejection fraction.

      ABSTRACT

      Cardiac contractility modulation (also known as CCM) is a novel device therapy that delivers nonexcitatory electric stimulation to cardiac myocytes during the absolute refractory period, and it has been shown to improve functional status and clinical outcomes in patients with heart failure (HF) with reduced ejection fraction (HFrEF). CCM therapy is currently recommended for a subset of patients with advanced HFrEF who are not candidates for cardiac resynchronization therapy. A growing body of evidence demonstrates the benefit of CCM therapy in patients with HFrEF and with ejection fraction at the upper end of the spectrum and in patients with HF and with mildly reduced ejection fraction (HFmrEF). Experimental studies have also observed reversal of pathological biomolecular intracellular changes with CCM therapy in HF with preserved ejection fraction (HFpEF), indicating the potential for clinically meaningful benefits of CCM therapy in these patients. In this review, we sought to discuss the basis of CCM therapy and its potential for management of patients with HF with higher ejection fractions.

      Graphical Abstract

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