vestarВестник аритмологииJournal of Arrhythmology1561-86412658-7327НАО «Инкарт»10.35336/VA-2022-1-03vestar-1051Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL ARTICLESОтдаленные результаты хирургического лечения пациентов с хронической сердечной недостаточностью с помощью имплантации кардиомодулирующих устройствLong-term results of cardiac contractility modulation in patients with chronic heart failurehttps://orcid.org/0000-0002-3405-1063АмираслановА. Ю.AmiraslanovA. Yu.

Москва, Большая Серпуховская ул., 27

Moscow, 27 Bolshaya Serpukhovskaya str.

anar_amiraslanov@list.ruhttps://orcid.org/0000-0003-3126-7106ВасковскийВ. А.VaskovskiyV. A.

Москва, Большая Серпуховская ул., 27

Moscow, 27 Bolshaya Serpukhovskaya str.

https://orcid.org/0000-0001-7065-0250АртюхинаЕ. А.ArtyukhinaE. A.

Москва, Большая Серпуховская ул., 27

Moscow, 27 Bolshaya Serpukhovskaya str.

https://orcid.org/0000-0003-1791-9163РевишвилиА. Ш.RevishviliA. Sh.

Москва, Большая Серпуховская ул., 27

Moscow, 27 Bolshaya Serpukhovskaya str.

ФГБУ «НМИЦ хирургии им А. В. Вишневского» Минздрава РоссииРоссияA.V. Vishnevsky National Medical Research Center of Surgery of the Ministry of Health of the Russian FederationRussian Federation2022280320222911723Copyright © Амирасланов А.Ю., Васковский В.А., Артюхина Е.А., Ревишвили А.Ш., 20222022Амирасланов А.Ю., Васковский В.А., Артюхина Е.А., Ревишвили А.Ш.Amiraslanov A.Y., Vaskovskiy V.A., Artyukhina E.A., Revishvili A.S.This work is licensed under a Creative Commons Attribution 4.0 License.https://vestar.elpub.ru/jour/article/view/1051Цель

Цель. Оценить общую эффективность кардиомодулирующей терапии и сравнить полученные отдаленные результаты у пациентов с хронической сердечной недостаточностью (ХСН) различной этиологии.

Материал и методы исследования. 61 пациенту с ХСН II-III функционального класса (ФК) по NYHA, фракцией выброса левого желудочка (ФВЛЖ) 20-40% и шириной комплекса QRS˂130 мс имплантированы устройства для модуляции сердечной сократимости (МСС). Распределение в зависимости от этиологии ХСН следующее: ишемическая кардиомиопатия (ИКМП) - 41 пациент, неишемическая кардиомиопатия (НКМП) - 20 пациентов. Всем пациентам проводилась трансторакальная эхокардиография, тест 6-минутной ходьбы (ТШХ), анкетирование по Миннесотскому опроснику качества жизни (КЖ) больных с ХСН (MHFLQ).

Результаты

Результаты. Срок наблюдения всех пациентов составил 25 месяцев. У 54 пациентов с МСС терапией выявлено значимое улучшение ФВЛЖ по Simpson c 32,2% до 37,6% (р=0,026), снижение конечно-систолического объема ЛЖ с 150 до 137 мл (р=0,034), конечно-диастолического объема ЛЖ с 220 до 201 мл (р=0,044), уменьшение ФК ХСН по NYHA более чем на 1 класс у 29 (53,7%) пациентов (р=0,015), увеличение ТШХ с 265 до 343 м (р=0,029), а также улучшение КЖ согласно опроснику MHFLQ с 46,1 до 35,8 баллов (р=0,042). НКМП у пациентов с ХСН была сопряжена со значимым улучшением КЖ (с исходных 42,7 до 30,3 баллов, р=0,029), и значимо более частым снижением ФК ХСН >1 (83,3% и 47,2%, p=0,012) по сравнению с ИКМП.

Заключение

Заключение. Устройства для МСС эффективны при лечении пациентов с ХСН II-III ФК по NYHA, ФВЛЖ 20-40%, шириной комплекса QRS˂130 мс. Наличие НКМП ассоциировано с лучшей динамикой снижения ФК ХСН и улучшением КЖ пациентов. 

Aim

Aim. Evaluate the overall effectiveness of cardiac contractility modulation (CCM) therapy in patients with chronic heart failure of various etiology.

Methods

Methods. The study included 61 patients with chronic heart failure (NYHA class II-III), ejection fraction 20-40% and narrow QRS <130 ms, who were implanted the CCM devices. Depending on the etiology of heart failure, ischemic cardiomyopathy prevailed (41 patients). All patients were performed echocardiography, 6-min walk test and Minnesota Living with Heart Failure questionnaire (MHFLQ). Results. The observation period was 25 months. All 54 patients significantly improved left ventricular ejection fraction from 32.2% to 37.6% (р=0.026) and volume parameters (left ventricle end systolic volume from 150 to 137 ml (р=0.034), left ventricle end diastolic volume from 220 to 201 ml (р=0.044), reduced the heart failure NYHA class >1 in 29 (53.7%) patients (р=0.015), increased 6-min walk test from 265 to 343 m (р=0.029), and the MHFLQ improved from 46.1 to 35.8 (р=0.042). Non-ischemic cardiomyopathy was associated with significant improvement in MHFLQ (from 42.7 to 30.3, р=0.029) and lowering the heart failure NYHA class>1 (83.3%, vs 47.2%, p=0.012) compared to ischemic group. Conclusion. CCM is safe and effective in patients with chronic heart failure NYHA class II-III, ejection fraction 20- 40% and narrow QRS˂130 ms, who were implanted the CCM devices. Depending on the etiology of heart failure, ischemic cardiomyopathy prevailed (41 patients). All patients were performed echocardiography, 6-min walk test and Minnesota Living with Heart Failure questionnaire (MHFLQ).

Results

Results. The observation period was 25 months. All 54 patients significantly improved left ventricular ejection fraction from 32.2% to 37.6% (р=0.026) and volume parameters (left ventricle end systolic volume from 150 to 137 ml (р=0.034), left ventricle end diastolic volume from 220 to 201 ml (р=0.044), reduced the heart failure NYHA class >1 in 29 (53.7%) patients (р=0.015), increased 6-min walk test from 265 to 343 m (р=0.029), and the MHFLQ improved from 46.1 to 35.8 (р=0.042). Non-ischemic cardiomyopathy was associated with significant improvement in MHFLQ (from 42.7 to 30.3, р=0.029) and lowering the heart failure NYHA class>1 (83.3%, vs 47.2%, p=0.012) compared to ischemic group.

Conclusion

Conclusion. CCM is safe and effective in patients with chronic heart failure NYHA class II-III, ejection fraction 20- 40% and narrow QRS˂130 ms. Non-ischemic etiology of cardiomyopathy was associated with significant improvement in MHFLQ and lowering the heart failure class. 

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The authors declare that there are no conflicts of interest present.