Cardiac contractility modulation to enhance optimized medical therapy and improve cardiac remodeling in advanced heart failure: a case report

作者：Lina Feng, Lina Su, Ren Jingyi · 发表于：Frontiers in Cardiovascular Medicine · 年份：2025 · DOI：10.3389/fcvm.2025.1577680 · 被引用次数：4 · 研究领域：Heart Failure Treatment and Management、Cardiac pacing and defibrillation studies、Cardiovascular Function and Risk Factors

Background: Guideline-directed medical therapy (GDMT) for heart failure (HF) with reduced ejection fraction (HFrEF) has been demonstrated to significantly reduce morbidity and mortality. However, many patients, especially those with advanced HFrEF, are unable to tolerate optimal GDMT due to hypotension. Cardiac contractility modulation (CCM) is a novel therapeutic approach that enhances myocardial contractility and reverses cardiac remodeling, thereby improving cardiac function and quality of life in patients with HFrEF. However, whether CCM can bridge the hemodynamic vulnerability phase to facilitate GDMT optimization and improve patient prognosis remains unclear. Case presentation: YHA functional class III) had recurrent hospitalizations for HF over the past 4 years. Due to hypotension (systolic blood pressure ≤90 mmHg), the patient was unable to tolerate full-dose GDMT, with sacubitril-valsartan limited to 25 mg twice daily, metoprolol succinate to 23.75 mg once daily, and spironolactone to 20 mg once daily. After a comprehensive evaluation, a CCM device was implanted as the most effective and evidence-based option. Postoperatively, the patient's blood pressure gradually improved, allowing initiation of the four major therapeutic drug classes, which were uptitrated to the maximum tolerated doses. With regular follow-up for 12 months, the patient showed dramatic improvements in exercise capacity and quality of life. More surprisingly, there was significant improvement in ca...