心脏收缩性调节治疗心力衰竭的研究进展

张飞飞; 党懿; 齐晓勇

doi:10.13201/j.issn.1001-1439.2015.01.002

心脏收缩性调节治疗心力衰竭的研究进展

- 河北省人民医院心脏中心 (石家庄, 050051)
基金项目:
河北省自然科学基金项目（No：C2010001631）

详细信息

通讯作者: 齐晓勇,E-mail:HBGHxiaoyong_Q@126.com

中图分类号: R541.6

收稿日期: 2014-04-04

Cardiac contractility modulation improves heart failure

- Heart Center, People's Hospital in Hebei Provence, Shijiazhuang, 050051, China

More Information

Corresponding author: QI Xiaoyong, E-mail: HBGHxiaoyong_Q@126.com

Received Date: 04 April 2014

摘要

摘要: 心脏收缩性调节（cardiac contractility modulation，CCM）是一种新兴的非药物治疗心力衰竭技术，是心肌在绝对不应期接受的高能量电信号。CCM能够增强心肌收缩力，不增加心肌的氧需求量。与传统正性肌力药物作用机制不同，CCM通过改善心肌组织中异常表达的基因，及调节相关蛋白的功能，从而影响心肌细胞的钙循环，增强心肌的收缩力。临床研究中通过观察峰值氧摄取及明尼苏达生活质量评分发现CCM能改善心力衰竭患者的运动耐量及生活质量。
- 心力衰竭 /
- 心脏收缩力调节
Abstract: Cardiac contractility modulation (CCM) is a novel device-based therapy for heart failure that involves applying high energy electrical signals during absolute refractory period of the myocardial action potential. CCM has been shown to argument the strength of ventricular contraction independent of myocardial oxygen consumption. The mechanism underlying CCM is to shift abnormally expressed genes and positively affecting proteins that regulate calcium cycling, which is beyond the traditional pharmacological effects of inotropic agents. Clinical trials showed CCM improves exercise tolerance, as measured by VO2, peak and quality of life, assessed by the Minnesota Living with Heart Failure Questionnaire.
- heart failure /
- cardiac contractility modulation

HTML全文

参考文献(28)

[1]	SHENKMAN H J, PAMPATI V, KHANDELWAL A K, et al. Congestive heart failure and QRS duration:establishing prognosis study[J]. Chest, 2002, 122:528-534.
[2]	WINTER J, BRACK K E, NG G A. Cardiac contractility modulation in the treatment of heart failure:initial results and unanswered questions[J]. Eur J Heart Fail, 2011, 13:700-710.
[3]	CHOUDHURY A K, PAUL G K, RAHMAN M Z. Cardiac contractility modulation device-new hope for refractory heart failure patients[J]. Mymensingh Med J, 2012, 21:580-582.
[4]	MOHRI S, SHIMIZU J, MIKA Y, et al. Electric currents applied during refractory period enhance contractility and systolic calcium in the ferret heart[J]. Am J Physiol Heart Circ Physiol, 2003, 284:H1119-1123.
[5]	BRUNCKHORST C B, SHEMER I, MIKA Y, et al. Cardiac contractility modulation by non-excitatory currents:studies in isolated cardiac muscle[J]. Eur J Heart Fail, 2006, 8:7-15.
[6]	IMAI M, RASTOGI S, GUPTA R C, et al. Therapy with cardiac contractility modulation electrical signals improves left ventricular function and remodeling in dogs with chronic heart failure[J]. J Am Coll Cardiol. 2007, 29;49(21):2120-2128.
[7]	GUPTA RC, MISHRA S, WANG M, et al. Cardiac contractility modulation electrical signals normalize activity, expression, and phosphorylation of the Na+-Ca2+ exchanger in heart failure[J]. J Card Fail, 2009, 15:48-56.
[8]	BUTTER C, RASTOGI S, MINDEN H H, et al. Cardiac contractility modulation electrical signals improve myocardial gene expression in patients with heart failure[J]. J Am Coll Cardiol, 2008, 51:1784-1789.
[9]	WINTER J, BRACK K E, NG G A. The acute inotropic effects of cardiac contractility modulation (CCM) are associated with action potential duration shortening and mediated by β1-adrenoceptor signaling[J]. J Mol Cell Cardiol, 2011, 51:252-262.
[10]	MORITA H, SUZUKI G, HADDAD W, et al. Long-term effects of non-excitatory cardiac contractility modulation electric signals on the progression of heart failure in dogs[J]. Eur J Heart Fail, 2004, 6:145-150.
[11]	YU C M, CHAN J Y, ZHANG Q, et al. Impact of cardiac contractility modulation on left ventricular global and regional function and remodeling[J]. JACC Cardiovasc Imaging, 2009, 12:1341-1049.
[12]	RASTOGI S, MISHRA S, ZACÀV, et al. Effects of chronic therapy with cardiac contractility modulation electrical signals on cytoskeletal proteins and matrix metalloproteinases in dogs with heart failure[J]. Cardiology, 2008, 110:230-237.
[13]	PAPPONE C, VICEDOMINI G, SALVATI A, et al. Electrical modulation of cardiac contractility:clinical aspects in congestive heart failure[J]. Heart Fail Rev, 2001, 6:55-60.
[14]	PAPPONE C, ROSANIO S, BURKHOFF D, et al. Cardiac contractility modulation by electric currents applied during the refractory period in patients with heart failure secondary to ischemic or idiopathic dilated cardiomyopathy[J]. Am J Cardiol, 2002, 90:1307-1013.
[15]	STIX G, BORGGREFE M, WOLPERT C, et al. Chronic electrical stimulation during the absolute refractory period of the myocardium improves severe heart failure[J]. Eur Heart J, 2004, 25:650-655.
[16]	PAPPONE C, AUGELLO G, ROSANIO S, et al. First human chronic experience with cardiac contractility modulation by nonexcitatory electrical currents for treating systolic heart failure:mid-term safety and efficacy results from a multicenter study[J]. J Cardiovasc Electrophysiol, 2004, 15:418-427.
[17]	NEELAGARU S B, SANCHEZ J E, LAU S K, et al. Nonexcitatory, cardiac contractility modulation electrical impulses:feasibility study for advanced heart failure in patients with normal QRS duration[J]. Heart Rhythm, 2006, 3:1140-1147.
[18]	BORGGREFE M M, LAWO T, BUTTER C, et al. Randomized, double blind study of non-excitatory, cardiac contractility modulation electrical impulses for symptomatic heart failure[J]. Eur Heart J, 2008, 29:1019-1028.
[19]	KADISH A, NADEMANEE K, VOLOSIN K, et al. A randomized controlled trial evaluating the safety and efficacy of cardiac contractility modulation in advanced heart failure[J]. Am Heart J, 2011, 161:329-337.
[20]	ABRAHAM W T, NADEMANEE K, VOLOSIN K, et al. Subgroup analysis of a randomized controlled trial evaluating the safety and efficacy of cardiac contractility modulation in advanced heart failure[J]. J Card Fail, 2011, 17:710-717.
[21]	BURKHOFF D. Does contractility modulation have a role in the treatment of heart failure?[J]. Curr Heart Fail Rep, 2011, 8:260-265.
[22]	LYON A R, SAMARA M A, FELDMAN D S. Cardiac contractility modulation therapy in advanced systolic heart failure[J]. Nat Rev Cardiol, 2013, 10:584-598.
[23]	KAHWASH R, BURKHOFF D, ABRAHAM W T. Cardiac contractility modulation in patients with advanced heart failure[J]. Expert Rev Cardiovasc Ther, 2013, 11:635-645.
[24]	BORGGREFE M, BURKHOFF D. Clinical effects of cardiac contractility modulation (CCM) as a treatment for chronic heart failure[J]. Eur J Heart Fail, 2012, 14:703-712.
[25]	ZHANG Q, CHAN Y S, LIANG Y J, et al. Comparison of left ventricular reverse remodeling induced by cardiac contractility modulation and cardiac resynchronization therapy in heart failure patients with different QRS durations[J]. Int J Cardiol, 2013, 167:889-893.
[26]	BUTTER C, MEYHÖFER J, SEIFERT M, et al. First use of cardiac contractility modulation (CCM) in a patient failing CRT therapy:clinical and technical aspects of combined therapies[J]. Eur J Heart Fail, 2007, 9:955-958.
[27]	NÄGELE H, BEHRENS S, EISERMANN C. Cardiac contractility modulation in non-responders to cardiac resynchronization therapy[J]. Europace, 2008, 10:1375-1380.
[28]	GOLIASCH G, KHORSAND A, SCHVTZ M, et al. The effect of device-based cardiac contractility modulation therapy on myocardial efficiency and oxidative metabolism in patients with heart failure[J]. Eur J Nucl Med Mol Imaging, 2012, 39:408-415.