心肌收缩力调节器治疗心力衰竭临床应用

Clinical application of cardiac contractility modulation for treating chronic heart failure in Chinese patients

目的评价心肌收缩力调节器(CCM)用于治疗药物无反应心力衰竭患者的初步疗效。方法本文为回顾性研究。连续收集全国46个中心2021年1月至2022年5月行CCM植入的71例患者资料,分析术前以及术后出院前左心室射血分数(LVEF)、左心室收缩末期内径(LVESD)及左心室舒张末期内径(LVEDD)的变化情况。结果最终纳入65例基线资料齐全的患者,年龄(56.5±13.8)岁,其中男50例(50/65,76.9%)。术后患者的LVEF由29.0%±5.9%升高至38.5%±8.5%,提高9.5%±8.8%(P<0.001);LVESD由(58.3±7.0)mm减小至(52.0±8.2)mm,降低(6.2±6.4)mm(P<0.001);LVEDD由(66.6±6.3)mm减小至(63.4±6.7)mm,降低(3.1±4.9)mm(P=0.001)。无严重手术相关并发症发生。结论CCM植入后能迅速且有效改善慢性心力衰竭患者心功能,逆转心脏重构。

Objective To investigate the effectiveness of cardiac contractility modulation(CCM)for treating advanced heart failure patients.Methods We retrospectively and consecutively enrolled 71patients who underwent CCM implantation in 46 centers in China through January 2021 to May 2022.Left ventricular ejection fraction,left ventricular end-systolic diameter,and left ventricular end-diastolic diameter before and after implantation of patients were collected and compared.Results After excluding 6 patients with missing baseline information,a total of 65 patients were finally enrolled.Fifty(50/65,76.9%)of them were male,with a mean age of(56.5±13.8)years.Compared to pre-implantation,mean left ventricular ejection fraction of patients before discharge increased from 29.0%±5.9%to 38.5%±8.5%(mean difference of 9.5%±8.8%,P<0.001).Meanwhile,left ventricular end systolic diameter decreased from(58.3±7.0)mm to(52.0±8.2)mm[mean difference of(6.2±6.4)mm,P<0.001],and left ventricular end diastolic diameter decreased from(66.6±6.3)mm to(63.4±6.7)mm[mean difference of(3.1±4.9)mm,P=0.001].Conclusion CCM could promptly and effectively contributing to structural and functional reverse remodeling in chronic heart failure patients.