Модуляция сердечной сократимости у пациентов с хронической сердечной недостаточностью и фибрилляцией предсердий
DOI: 10.26442/00403660.2020.09.000598
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Uskach T.M., Safiullina A.A., Sapel'nikov O.V., et al. Modulation of cardiac contractility in patients with chronic heart failure and atrial fibrillation. Therapeutic Archive. 2020; 92 (9): 8–14. DOI: 10.26442/00403660.2020.09.000598
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Материалы и методы. У 40 пациентов с ХСН и ФП до имплантации устройства МСС и через 2 и 6 мес наблюдения проводились следующие исследования: 12-канальная электрокардиограмма (ЭКГ), трансторакальная эхокардиография, тест 6-минутной ходьбы, определение уровня про-натрийуретического N-концевого пептида (NT-proBNP), суточное мониторирование ЭКГ, анкетирование по Миннесотскому опроснику качества жизни больных с ХСН (MHFLQ). Все пациенты до операции получали длительную оптимальную медикаментозную терапию ХСН.
Результаты. Полученные результаты свидетельствуют о статистически значимом положительном влиянии применения МСС у пациентов с ХСН и ФП на фракцию выброса левого желудочка, функциональный класс ХСН, а также уровни NT-proBNP независимо от этиологии ХСН.
Заключение. Применение МСС может являться перспективным в плане лечения сердечной недостаточности у пациентов с ХСН и ФП.
Ключевые слова: сердечная недостаточность, модуляция сердечной сократимости, фибрилляция предсердий, фракция выброса левого желудочка, узкий комплекс QRS.
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Aim. to evaluate the effectiveness of cardiac contractility modulation (MSS) in patients with chronic heart failure (CHF) and atrial fibrillation (AF).
Materials and methods. The following studies were performed in 40 patients with CHF and AF before implantation of the MSS device and after 2 and 6 months of follow-up: 12-channel ECG, transthoracic EchoCG, 6-minute walk test, determination of the level of Pro-natriuretic N-terminal peptide (NT-proBNP), daily ECG monitoring, and a questionnaire based on the Minnesota quality of life questionnaire for patients with CHF (MHFLQ). All patients received long-term optimal drug therapy for CHF before surgery.
Results. The results obtained indicate a statistically significant positive effect of the use of MSS in patients with CHF and AF on LV FV, the functional class of CHF, and levels of NT-proBNP regardless of the etiology of CHF.
Conclusion. The use of MSS may be promising for the treatment of heart failure in patients with CHF and AF.
Keywords: heart failure, modulation of heart contractility, atrial fibrillation, left ventricular ejection fraction, narrow QRS complex.
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16. Abi-Samra F, Gutterman D. Cardiac contractility modulation: a novel approach for the treatment of heart failure. Heart Fail Rev. 2016;21(6):645-60. doi: 10.1007/s10741-016-9571-6
17. Borggrefe MM, Lawo T, Butter C, et al. Randomized, double blind study of non-excitatory, cardiac contractility modulation electrical impulses for symptomatic heart failure. Eur Heart J. 2008;29(8):1019-28. doi: 10.1093/eurheartj/ehn020
18. 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. Am Heart J. 2011;161(2):329-37.e2. doi: 10.1016/j.ahj.2010.10.025
19. Abraham WT, 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 Cardiac Fail. 2011;17(9):710-7. doi: 0.1016/j.cardfail.2011.05.006
20. Schau T, Seifert M, Meyhofer J, et al. Long-term outcome of cardiac contractility modulation in patients with severe congestive heart failure. Europace. 2011;13(10):1436-44. doi: 10.1093/ europace/eur153
21. Kuschyk J, Roeger S, Schneider R, et al. Efficacy and survival in patients with cardiac contractility modulation: Long-term single center experience in 81 patients. Int J Cardiol. 2015;183:76-81. doi: 10.1016/
j.ijcard.2014.12.178
22. Kloppe A, Lawo T, Mijic D, et al. Longterm survival with Cardiac Contractility Modulation in patients with NYHA II or III symptoms and normal QRS duration. Int J Cardiol. 2016;209:291-5. doi: 10.1016/j.ijcard. 2016.02.001
23. Liu M, Fang F, Luo XX, et al. Improvement of long-term survival by cardiac contractility modulation in heart failure patients: A case-control study. Int J Cardiol. 2016;206:122-6. doi: 10.1016/j.ijcard.2016.01.071
24. Grigioni F, Carinci V, Boriani G, et al. Accelerated QRS widening as an independent predictor of cardiac death or of the need for heart transplantation in patients with congestive heart failure. J Heart Lung Transplant. 2002;21(8):899-902. PMID: 12163090.
25. Röger S, Michels J, Heggemann F, et al. Long term impact of cardiac contractility modulation on QRS duration. J Electrocardiol. 2014;47(6):936-40. doi: 10.1016/j.jelectrocard.2014.08.011
26. Nagele H, Behrens S, Eisermann C. Cardiac contractility modulation in non-responders to cardiac resynchronization therapy. Europace. 2008;10(12):1375-80. doi: 10.1093/europace/eun257
27. Kloppe A, Boesche L, Aweimer A, et al. Acute and short term safety and feasibility of the new OPTIMIZER SMART-system: Is it reasonable to avoid an atrial lead? EP Europace. 2018;20(Suppl. 1):i48.
doi: 10.1093/europace/euy015.128
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30. Stix G, Borggrefe M, Wolpert C, et al. Chronic electrical stimulation during the absolute refractory period of the myocardium improves severe heart failure. Eur Heart J. 2004;25(8):650-5. doi: 10.1016/j.ehj.2004.02.027
31. Abraham WT, Kuck KH, Goldsmith RL, et al. Randomized Controlled Trial to Evaluate the Safety and Efficacy of Cardiac Contractility Modulation. JACC Heart Fail. 2018;6(10):874-83. doi: 10.1016/j.jchf.2018.04.010
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1. Mosterd A, Hoes AW. Clinical epidemiology of heart failure. Heart. 2007;93(9):1137-46. doi: 10.1136/hrt. 2003.025270
2. Fomin IV, Belenkov YuN, Mareev VYu, et al. Prevalence of chronicheart failure in European part of Russian Federation – Data of AGECHF (Part II). Russian Heart Failure Journal. 2006;7(1):112-5 (In Russ.)
3. Zhirov IV, Romanova NV, Tereshchenko SN, Osmolovskaya YuF. Epidemiology and management of heart failure patients with atrial fibrillation. Kardiologiia. 2015;55(3):91-6 (In Russ.) doi: 10.18565/cardio.2015.3.91–96
4. Rasoul D, Ziaei F, Shan S, et al. 11 The Decennial Relationship between Heart Failure and Atrial Fibrillation – A Large Population Study. Heart. 2016;102(Suppl. 6):A7.2-A8. doi: 10.1136/heartjnl-2016-309890.11
5. Zafrir B, Lund LH, Laroche C, et al; Prognostic implications of atrial fibrillation in heart failure with reduced, mid-range, and preserved ejection fraction: a report from 14 964 patients in the European Society of Cardiology Heart Failure Long-Term Registry. Eur Heart J. 2018;39(48):4277-84. doi: 10.1093/eurheartj/ehy626
6. Pocock SJ, Ariti CA, McMurray JJV, et al; Meta-Analysis Global Group in Chronic Heart Failure. Predicting survival in heart failure: A risk score based on 39,372 patients from 30 studies. Eur Heart J. 2013;34(19):1404-13. doi: 10.1093/eurheartj/ehs337
7. Swedberg K, Olsson LG, Charlesworth A, et al. Prognostic relevance of atrial fibrillation in patients with chronic heart failure on long-term treatment with beta-blockers: results from COMET. Eur Heart J. 2005;26(13):1303-8. doi: 10.1093/eurheartj/ehi166
8. Tereshchenko SN, Zhirov IV, Romanova NV, et al. The first Russian registry of patients with chronic heart failure and atrial fibrillation (RIF-CHF): research design. Rational Pharmacotherapy in Cardiology. 2015;11(6):577-81 (In Russ.) doi: 10.20996/1819-6446-2015-11-6-577-581
9. Brignole M, Auricchio A, Baron-Esquivias G, et al. ESC guidelines on cardiac pacing and cardiac resynchronization therapy: the task force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Eur Heart J. 2013;34:2281-329. doi: 10.15829/1560-4071-2014-4-5-63
10. Lund LH, Jurga J, Edner M, et al. Prevalence, correlates, and prognostic significance of QRS prolongation in heart failure with reduced and preserved ejection fraction. Eur Heart J. 2013;34(7):529-39. doi: 10.1093/eurheartj/ehs305
11. Ponikowski P, Voors AA, Anker SD, et al. ESC Scientific Document Group. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37(27):2129-200. doi: 10.1093/eurheartj/ehw128
12. Cheng A, Landman SR, Stadler RW. Reasons for loss of cardiac resynchronization therapy pacing: insights from 32 844 patients. Circulation: Arrhythmia Electrophysiol. 2012; 5(5):884-8. doi: 10.1161/CIRCEP.112.973776
13. Kosztin A, Boros AM, Geller L, Merkely B. Cardiac resynchronisation therapy: current benefits and pitfalls. Kardiologia Polska. 2018;76(10):1420-5. doi: 10.5603/KP.a2018.0160
14. Ruschitzka F, Abraham WT, Singh JP, et al. EchoCRT Study Group. Cardiac-resynchronization therapy in heart failure with a narrow QRS complex. N Engl J Med. 2013;369(15):1395-405. doi: 10.1056/NEJMoa1306687
15. Kuck KH, Bordachar P, Borggrefe M, et al. New devices in heart failure: an European Heart Rhythm Association report: developed by the European Heart Rhythm Association; endorsed by the Heart Failure Association. Europace. 2014;16:109-28. doi: 10.1093/europace/eut311
16. Abi-Samra F, Gutterman D. Cardiac contractility modulation: a novel approach for the treatment of heart failure. Heart Fail Rev. 2016;21(6):645-60. doi: 10.1007/s10741-016-9571-6
17. Borggrefe MM, Lawo T, Butter C, et al. Randomized, double blind study of non-excitatory, cardiac contractility modulation electrical impulses for symptomatic heart failure. Eur Heart J. 2008;29(8):1019-28. doi: 10.1093/eurheartj/ehn020
18. 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. Am Heart J. 2011;161(2):329-37.e2. doi: 10.1016/j.ahj.2010.10.025
19. Abraham WT, 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 Cardiac Fail. 2011;17(9):710-7. doi: 0.1016/j.cardfail.2011.05.006
20. Schau T, Seifert M, Meyhofer J, et al. Long-term outcome of cardiac contractility modulation in patients with severe congestive heart failure. Europace. 2011;13(10):1436-44. doi: 10.1093/ europace/eur153
21. Kuschyk J, Roeger S, Schneider R, et al. Efficacy and survival in patients with cardiac contractility modulation: Long-term single center experience in 81 patients. Int J Cardiol. 2015;183:76-81. doi: 10.1016/
j.ijcard.2014.12.178
22. Kloppe A, Lawo T, Mijic D, et al. Longterm survival with Cardiac Contractility Modulation in patients with NYHA II or III symptoms and normal QRS duration. Int J Cardiol. 2016;209:291-5. doi: 10.1016/j.ijcard. 2016.02.001
23. Liu M, Fang F, Luo XX, et al. Improvement of long-term survival by cardiac contractility modulation in heart failure patients: A case-control study. Int J Cardiol. 2016;206:122-6. doi: 10.1016/j.ijcard.2016.01.071
24. Grigioni F, Carinci V, Boriani G, et al. Accelerated QRS widening as an independent predictor of cardiac death or of the need for heart transplantation in patients with congestive heart failure. J Heart Lung Transplant. 2002;21(8):899-902. PMID: 12163090.
25. Röger S, Michels J, Heggemann F, et al. Long term impact of cardiac contractility modulation on QRS duration. J Electrocardiol. 2014;47(6):936-40. doi: 10.1016/j.jelectrocard.2014.08.011
26. Nagele H, Behrens S, Eisermann C. Cardiac contractility modulation in non-responders to cardiac resynchronization therapy. Europace. 2008;10(12):1375-80. doi: 10.1093/europace/eun257
27. Kloppe A, Boesche L, Aweimer A, et al. Acute and short term safety and feasibility of the new OPTIMIZER SMART-system: Is it reasonable to avoid an atrial lead? EP Europace. 2018;20(Suppl. 1):i48.
doi: 10.1093/europace/euy015.128
28. Revishvili ASh, Artyukhina EA, Amiraslanov AYu, et al. The first experience of treatment of patients with chronic heart failure using cardiac contractility modulation device. Journal of Arrhythmology. 2017;90:12-8 (In Russ.)
29. Seferovic PM, Ponikowski P, Anker SD, et al. Clinical practice update on heart failure 2019: pharmacotherapy, procedures, devices and patient management. An expert consensus meeting report of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2019;21(10):1169-86. doi: 10.1002/ejhf.1531
30. Stix G, Borggrefe M, Wolpert C, et al. Chronic electrical stimulation during the absolute refractory period of the myocardium improves severe heart failure. Eur Heart J. 2004;25(8):650-5. doi: 10.1016/j.ehj.2004.02.027
31. Abraham WT, Kuck KH, Goldsmith RL, et al. Randomized Controlled Trial to Evaluate the Safety and Efficacy of Cardiac Contractility Modulation. JACC Heart Fail. 2018;6(10):874-83. doi: 10.1016/j.jchf.2018.04.010
1 ФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава России, Москва, Россия;
2 ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия;
3 ГБУЗ «Городская клиническая больница им. И.В. Давыдовского» Департамента здравоохранения г. Москвы, Москва, Россия;
4 ГБУЗ «Городская поликлиника №191» Департамента здравоохранения г. Москвы, Москва, Россия
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T.M. Uskach1,2, A.A. Safiullina1, O.V. Sapel'nikov1, V.A. Amanatova1, O.A. Nikolaeva3, I.R. Grishin1, B.M. Nazarov4, S.N. Tereshchenko1,2
1 National Medical Research Center for Cardiology, Moscow, Russia;
2 Russian Medical Academy of Continuous Professional Education, Moscow, Russia;
3 Davydovsky Сity Clinical Hospital, Moscow, Russia;
4 City Polyclinic №191, Moscow, Russia