第五代心肌收缩力调节器在慢性心力衰竭患者中的应用4例

Application of the fifth generation cardiac contractility modulation in 4 patients with chronic heart failure

目的总结4例植入第五代心肌收缩力调节器(CCM)治疗慢性心力衰竭患者的临床经验。方法本研究为回顾性研究,连续入选2022年2—5月在武汉亚心总医院接受CCM植入术的患者。收集患者的一般临床基线资料、影像学资料、CCM术中资料、住院期间以及术后1个月的临床随访结果。结果本研究共纳入4例患者,均为男性,年龄39~72岁。2例患者基础疾病为缺血性心肌病,2例为扩张型心肌病,纽约心脏病协会(NYHA)心功能分级Ⅲ~Ⅳ级。其中3例患者术前基线左心室射血分数(LVEF)为25%~31%,1例患者LVEF<25%;QRS波宽度为108~122 ms。4例患者均接受了3个月以上的优化心力衰竭药物治疗。1例患者在CCM植入术中“一站式”完成植入式心律转复除颤器植入手术。4例患者CCM植入后即刻LVEF均有改善。术后30 d随访时,3例患者LVEF较术前均有显著改善,左心室舒张末期内径(LVEDd)较术前减小,NYHA心功能分级较术前下降一级,1例患者LVEF、LVEDd和NYHA心功能分级均无改善。4例患者术后30 d随访时6 min步行试验距离为224~417 m,患者自诉活动耐量较术前改善。结论CCM可改善心力衰竭患者的功能状态、LVEF、运动耐量,是症状性心力衰竭患者的器械治疗方法之一,可在具备相关条件的中心进行。

Objective To summarize the clinical experience of 4 patients with chronic heart failure treated by implantation of the fifth generation cardiac contractility modulation.Methods This study was a retrospective study of consecutive patients who received cardiac contractility modulation(CCM)implantation in Wuhan Yaxin General Hospital from February to May 2022.The general clinical baseline data,imaging data,intraoperative data of CCM,clinical follow-up results during hospitalization and 1 month after operation were collected.Results A total of 4 patients were included in this study,all of male and aged from 39 to 72 years.The underlying diseases of 2 patients were ischemic cardiomyopathy and 2 patients were dilated cardiomyopathy with New York Heart Association(NYHA)cardiac function gradeⅢ-Ⅳ.The preoperative left ventricular ejection fraction(LVEF)of 3 patients was between 25%and 31%,and the LVEF of 1 patient was less than 25%with the QRS width of 108-122 ms.All the 4 patients received optimized drug treatment for heart failure for more than 3 months.One patient underwent implantable cardioverter defibrillator(ICD)implantation“one stop”during CCM implantation.The LVEF of 4 patients improved immediately after CCM implantation.During the follow-up 30 days after operation,the LVEF of 3 patients were significantly improved,the left ventricular end diastolic diameter(LVEDd)was lower than that before operation,and the NYHA cardiac function grade was one grade lower than that before operation.There was no improvement in LVEF,LVEDd and NYHA cardiac function grade in 1 patient.During the follow-up 30 days after operation,4 patients had a 6-minute walking distance ranging from 224-417 m,the patient’s self-reported activity tolerance improved compared with that before operation.Conclusions CCM can improve the functional status,LVEF and exercise tolerance of patients with heart failure.It is one of the instrument treatment methods for patients with symptomatic heart failure and can be carried out in the center with related conditions.