Clinical analysis of eight patients with chronic heart failure implanted with cardiac contractility modulation
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摘要: 目的 探讨心肌收缩力调节器(CCM)对慢性心力衰竭的临床疗效。方法 回顾性分析2022年5月-2023年5月在苏州大学附属第一医院心内科植入CCM的8例慢性心力衰竭患者的临床资料, 比较其术前与术后6个月左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左心房内径(LAD)、肺动脉压收缩压(PASP)、NYHA心功能分级的差异, 同时观察患者的临床症状变化。结果 与术前相比, 患者植入CCM 6个月后的所有观察指标均有所改善: LVEF从术前的(25.6±4.7)%提高至(35.6±5.6)%(t=-7.5, P < 0.05);LVEDD从(70.0±2.4) mm降至(65.1±3.9) mm (t=4.2, P < 0.05);LAD从(53.0±6.2) mm降至(48.4±7.0) mm (t=2.1, P>0.05), PASP从[27.0(19.5, 37.8)]mmHg降至[23.5(19.8, 26.8)]mmHg (1 mmHg=0.133 kPa, Z=-1.7, P>0.05)。所有患者都达到了NYHA心功能Ⅱ级, 胸闷、气喘等症状均得到明显改善。结论 CCM可有效提高慢性心力衰竭患者的LVEF并逆转心室重构。Abstract: Objective To explore the clinical efficacy of cardiac contractility modulation (CCM) in patients with chronic heart failure.Methods This study retrospectively analyzed the clinical data of eight patients with chronic heart failure who underwent CCM implantation in the Department of Cardiology, The First Affiliated Hospital of Soochow University from May 2022 to May 2023.The differences in left ventricular ejection fraction (LVEF), left ventricular end-diastolic dimension (LVEDD), left atrium diameter (LAD), pulmonary artery systolic pressure (PASP), and NYHA functional classification before and after 6 months of treatment were compared to observe changes in clinical symptoms.Results Compared to pre-implantation, all observed indicators of patients improved six months after CCM implantation: LVEF increased from (25.6 ± 4.7)% to (35.6 ± 5.6)%(t=-7.5, P < 0.05), LVEDD decreased from (70.0 ± 2.4) mm to (65.1±3.9) mm (t=4.2, P < 0.05), LAD decreased from (53.0 ± 6.2) mm to (48.4 ± 7.0) mm (t=2.1, P>0.05), and PASP decreased from[27.0(19.5, 37.8)]mmHg to[23.5(19.8, 26.8)]mmHg (Z=-1.7, P>0.05).All patients reached NYHA functional classification Ⅱ.Symptoms such as chest tightness and dyspnea showed significant improvement.Conclusion CCM effectively improves the left ventricular ejection fraction in patients with chronic heart failure and reverses ventricular remodeling.
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图 1 LVEF、LVEDD、LAD及PASP在随访期间的变化趋势
Figure 1. Changes in LVEF, LVEDD, LAD, and PASP during follow-up period
表 1 CCM参数设置
Table 1. CCM parameters
患者编号 RV电极 LS电极 CCM脉冲电压/V 感知/mV 阈值/V 阻抗/Ω 感知/mV 阈值/V 阻抗/Ω 1 17 0.5 620 17 0.5 740 6.5 2 8.5 0.8 489 9.4 0.7 550 7.5 3 >20 0.5 880 >20 0.6 1002 7.5 4 >20 0.3 580 >20 0.2 640 6.5 5 >20 0.6 980 >20 0.7 1100 6.5 6 12 0.4 920 >20 0.4 1200 7 7 >20 0.5 880 >20 0.5 900 6.5 8 >20 0.6 980 18 0.8 840 6 
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表 2 患者的基线数据及用药情况
Table 2. Baseline data and medication history
项目 患者1 患者2 患者3 患者4 患者5 患者6 患者7 患者8 性别 男性 男性 男性 男性 男性 女性 男性 男性 年龄/岁 57 69 65 59 74 64 67 41 LVEF/% 24 30 20 25 21 31 22 32 NYHA心功能分级 Ⅲ Ⅱ Ⅲ Ⅲ Ⅲ Ⅲ Ⅱ Ⅲ 心肌病分类 非缺血性 非缺血性 非缺血性 非缺血性 缺血性 非缺血性 非缺血性 非缺血性 房颤 否 是 是 否 是 否 是 否 高血压 否 是 是 是 否 否 是 否 QRS间期/ms 106 124 128 92 110 90 115 94 二尖瓣反流 轻度 中度 中度 轻度 中度 轻度 轻度 轻度 三尖瓣反流 否 轻度 中度 否 轻度 否 否 否 术前用药情况 β受体阻滞剂 是 是 是 是 是 是 是 是 沙库巴曲缬沙坦 是 是 是 是 是 是 是 是 醛固酮抑制剂 是 是 否 是 否 是 是 否 利尿剂 是 是 是 否 是 是 是 否 左西孟旦 是 是 是 是 是 是 是 是 抗凝剂 否 是 是 否 是 否 是 否 他汀类 是 是 是 是 是 是 是 是 达格列净 是 是 是 是 是 是 是 是 维立西呱 否 是 否 是 是 否 是 否
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表 3 CCM植入前后各观察指标的变化
Table 3. Changes in observed indicators before and after CCM implantation
X±S，M(Q1，Q3) 项目 患者1 患者2 患者3 患者4 患者5 患者6 患者7 患者8 平均值 LVEF/% 术前 24 30 20 25 21 31 22 32 25.6±4.7 术后6个月 32 37 38 32 29 41 31 45 35.6±5.6 LVEDD/mm 术前 73 71 70 70 66 67 72 71 70.0±2.4 术后6个月 66 69 60 70 62 62 69 63 65.1±3.9 LAD/mm 术前 52 63 60 49 56 45 51 48 53.0±6.2 术后6个月 41 61 44 54 53 42 47 45 48.4±7.0 PASP/mmHg 术前 21 63 40 26 31 16 19 28 27.0(19.5，37.8) 术后6个月 19 45 27 23 26 22 16 24 23.5(19.8，26.8) NYHA心功能分级 术前 Ⅲ Ⅱ Ⅲ Ⅲ Ⅲ Ⅲ Ⅱ Ⅲ 术后6个月 Ⅱ Ⅱ Ⅱ Ⅱ Ⅱ Ⅱ Ⅱ Ⅱ
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