PMID- 20083066
OWN - NLM
STAT- MEDLINE
DCOM- 20100329
LR  - 20161125
IS  - 1876-7591 (Electronic)
IS  - 1876-7591 (Linking)
VI  - 2
IP  - 12
DP  - 2009 Dec
TI  - Impact of cardiac contractility modulation on left ventricular global and 
      regional function and remodeling.
PG  - 1341-9
LID - 10.1016/j.jcmg.2009.07.011 [doi]
AB  - OBJECTIVES: This study aimed to evaluate the impact of cardiac contractility 
      modulation (CCM) on left ventricular (LV) size and myocardial function. 
      BACKGROUND: CCM is a device-based therapy for patients with advanced heart 
      failure. Previous studies showed that CCM improved symptoms and exercise 
      capacity; however, comprehensive assessment of LV structure, function, and 
      reverse remodeling is not available. METHODS: Thirty patients (60 + or - 11 
      years, 80% male) with New York Heart Association (NYHA) functional class III 
      heart failure, ejection fraction <35%, and QRS <120 ms were assessed at baseline 
      and 3 months. LV reverse remodeling was measured by real-time 3-dimensional 
      echocardiography. Using tissue Doppler imaging, the peak systolic velocity (Sm) 
      and peak early diastolic velocity (Em) were calculated for LV function, while the 
      standard deviation of the time to peak systolic velocity (Ts-SD) and the time to 
      peak early diastolic velocity (Te-SD) were calculated for mechanical 
      dyssynchrony. RESULTS: LV reverse remodeling was evident, with a reduction in LV 
      end-systolic volume by -11.5 + or - 10.5% and a gain in ejection fraction by 4.8 
      + or - 3.6% (both p < 0.001). Myocardial contraction was improved in all LV 
      walls, including sites remote from CCM delivery (all p < 0.05); hence, the mean 
      Sm of 12 (2.2 + or - 0.6 cm/s vs. 2.5 + or - 0.7 cm/s) or 6 basal LV segments 
      (2.5 + or - 0.6 cm/s vs. 3.0 + or - 0.7 cm/s) were increased significantly (both 
      p < 0.001). In contrast, CCM had no impact on regional or global Em (2.9 + or - 
      1.3 cm/s vs. 2.9 + or - 1.1 cm/s), whereas Ts-SD (28.2 + or - 11.2 ms vs. 27.9 + 
      or - 12.7 ms) and Te-SD (30.0 + or - 18.3 ms vs. 30.1 + or - 20.7 ms) remained 
      unchanged (all p = NS). Mitral regurgitation was reduced (22 + or - 14% vs. 17 + 
      or - 15%, p = 0.02). Clinically, there was improvement of NYHA functional class 
      (p < 0.001) and 6-min hall walk distance (p = 0.015). A 24-h Holter monitor 
      showed that premature ventricular contractions were not increased during CCM. 
      CONCLUSIONS: CCM improves both global and regional LV contractility, including 
      regions remote from the impulse delivery, and may contribute to LV reverse 
      remodeling and gain in systolic function. Such improvement is unrelated to 
      diastolic function or mechanical dyssynchrony.
FAU - Yu, Cheuk-Man
AU  - Yu CM
AD  - Institute of Vascular Medicine and Division of Cardiology, Department of Medicine 
      and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, 
      Hong Kong, China. cmyu@cuhk.edu.hk
FAU - Chan, Joseph Yat-Sun
AU  - Chan JY
FAU - Zhang, Qing
AU  - Zhang Q
FAU - Yip, Gabriel W K
AU  - Yip GW
FAU - Lam, Yat-Yin
AU  - Lam YY
FAU - Chan, Anna
AU  - Chan A
FAU - Burkhoff, Daniel
AU  - Burkhoff D
FAU - Lee, Pui-Wai
AU  - Lee PW
FAU - Fung, Jeffrey Wing-Hong
AU  - Fung JW
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - JACC Cardiovasc Imaging
JT  - JACC. Cardiovascular imaging
JID - 101467978
SB  - IM
MH  - Aged
MH  - Echocardiography, Doppler, Color
MH  - Echocardiography, Three-Dimensional
MH  - *Electric Stimulation Therapy/instrumentation
MH  - Electrocardiography, Ambulatory
MH  - Exercise Tolerance
MH  - Female
MH  - Heart Failure/diagnostic imaging/physiopathology/*therapy
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - *Myocardial Contraction
MH  - Recovery of Function
MH  - Severity of Illness Index
MH  - Stroke Volume
MH  - Time Factors
MH  - Treatment Outcome
MH  - *Ventricular Function, Left
MH  - *Ventricular Remodeling
MH  - Walking
EDAT- 2010/01/20 06:00
MHDA- 2010/03/30 06:00
CRDT- 2010/01/20 06:00
PHST- 2009/05/25 00:00 [received]
PHST- 2009/07/07 00:00 [accepted]
PHST- 2010/01/20 06:00 [entrez]
PHST- 2010/01/20 06:00 [pubmed]
PHST- 2010/03/30 06:00 [medline]
AID - S1936-878X(09)00661-5 [pii]
AID - 10.1016/j.jcmg.2009.07.011 [doi]
PST - ppublish
SO  - JACC Cardiovasc Imaging. 2009 Dec;2(12):1341-9. doi: 10.1016/j.jcmg.2009.07.011.