左主干暨冠状动脉分叉病变峰会，CBS2019 - CBS 2019

充血性心力衰竭

Guideline‐Directed Medical Therapy for Patients With Heart Failure With Midrange Ejection Fraction: A Patient‐Pooled Analysis From the KorHF and KorAHF Registries Frequency, predictors, and prognosis of ejection fraction improvement in heart failure: an echocardiogram-based registry study The Hospital Readmissions Reduction Program Nationwide Perspectives and Recommendations: A JACC: Heart Failure Position Paper The prevalence and importance of frailty in heart failure with reduced ejection fraction - an analysis of PARADIGM-HF and ATMOSPHERE Angiotensin–Neprilysin Inhibition in Heart Failure with Preserved Ejection Fraction Percutaneous Atriotomy for Levoatrial–to–Coronary Sinus Shunting in Symptomatic Heart Failure: First-in-Human Experience Empagliflozin Increases Cardiac Energy Production in Diabetes - Novel Translational Insights Into the Heart Failure Benefits of SGLT2 Inhibitors Is Acute heart failure a distinctive disorder? An analysis from BIOSTAT-CHF In acute HF and iron deficiency, IV ferric carboxymaltose reduced HF hospitalizations, but not CV death, at 1 y Age-Related Characteristics and Outcomes of Patients With Heart Failure With Preserved Ejection Fraction

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Clinical TrialVolume 6, Issue 10, October 2018

JOURNAL：JACC: Heart Failure Article Link

A Randomized Controlled Trial to Evaluate the Safety and Efficacy of Cardiac Contractility Modulation

Abraham WT, Kuck KH, FIX-HF-5 Investigators and Coordinators. Keywords: heart failure; exercise tolerance; peak Vo2; QRS duration; quality of life

ABSTRACT

OBJECTIVES - This study sought to confirm a subgroup analysis of the prior FIX-HF-5 (Evaluate Safety and Efficacy of the OPTIMIZER System in Subjects With Moderate-to-Severe Heart Failure) study showing that cardiac contractility modulation (CCM) improved exercise tolerance (ET) and quality of life in patients with ejection fractions between 25% and 45%.

BACKGROUND - CCM therapy for New York Heart Association (NYHA) functional class III and IV heart failure (HF) patients consists of nonexcitatory electrical signals delivered to the heart during the absolute refractory period.

METHODS - A total of 160 patients with NYHA functional class III or IV symptoms, QRS duration <130 ms, and ejection fraction ≥25% and ≤45% were randomized to continued medical therapy (control, n = 86) or CCM (treatment, n = 74, unblinded) for 24 weeks. Peak Vo2 (primary endpoint), Minnesota Living With Heart Failure questionnaire, NYHA functional class, and 6-min hall walk were measured at baseline and at 12 and 24 weeks. Bayesian repeated measures linear modeling was used for the primary endpoint analysis with 30% borrowing from the FIX-HF-5 subgroup. Safety was assessed by the percentage of patients free of device-related adverse events with a pre-specified lower bound of 70%.

RESULTS - The difference in peak Vo2 between groups was 0.84 (95% Bayesian credible interval - 0.123 to 1.552) ml O2/kg/min, satisfying the primary endpoint. Minnesota Living With Heart Failure questionnaire (p < 0.001), NYHA functional class (p < 0.001), and 6-min hall walk (p = 0.02) were all better in the treatment versus control group. There were 7 device-related events, yielding a lower bound of 80% of patients free of events, satisfying the primary safety endpoint. The composite of cardiovascular death and HF hospitalizations was reduced from 10.8% to 2.9% (p = 0.048).

CONCLUSIONS - CCM is safe, improves exercise tolerance and quality of life in the specified group of HF patients, and leads to fewer HF hospitalizations. (Evaluate Safety and Efficacy of the OPTIMIZER System in Subjects With Moderate-to-Severe Heart Failure; NCT01381172).

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A Randomized Controlled Trial to Evaluate the Safety and Efficacy of Cardiac Contractility Modulation

ABSTRACT