The effect of device-based cardiac contractility modulation therapy on myocardial efficiency and oxidative metabolism in patients with heart failure

• Published in: European journal of nuclear medicine and molecular imaging Vol. 39; no. 3; pp. 408 - 415
• Main Authors: Goliasch, Georg, Khorsand, Aliasghar, Schütz, Matthias, Karanikas, Georgios, Khazen, Cesar, Sochor, Heinz, Schmidinger, Herwig, Wolzt, Michael, Graf, Senta
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01-03-2012; Springer Nature B.V
• Subjects: Acetates; Aged; Carbon Radioisotopes; Cardiology; Energy Metabolism; Female; Fetuses; Heart; Heart diseases; Heart failure; Heart Failure - diagnostic imaging; Heart Failure - metabolism; Heart Failure - physiopathology; Heart Failure - therapy; Heart-Assist Devices; Humans; Imaging; Male; Medical equipment; Medical treatment; Medicine; Medicine & Public Health; Middle Aged; Muscle contraction; Myocardial Contraction; Myocardium - metabolism; Nuclear Medicine; Oncology; Original Article; Orthopedics; Oxidation-Reduction; Oxidative metabolism; Oxidative stress; Oxygen - metabolism; Oxygen consumption; Positron emission tomography; Radiology; Stress; Time Factors; Tomography; Treatment Outcome; Heart failure; Device therapy; Cardiac contractility modulation; PET
• ISSN: 1619-7070; 1619-7089
• DOI: 10.1007/s00259-011-1977-8

Purpose
Cardiac contractility modulation (CCM) is a device-based therapy that involves delivery of nonexcitatory electrical signals resulting in improved ventricular function and a reversal of maladaptive cardiac fetal gene programmes. Our aim was to evaluate whether acute application of CCM leads to an increase in myocardial oxygen consumption (MVO
2
) in patients with chronic heart failure using
11
C-acetate positron emission tomography (PET).
Methods
We prospectively enrolled 21 patients with severe heart failure.
11
C-acetate PET was performed before and after activation of the CCM device. In 12 patients an additional stress study with dobutamine was performed.
Results
Under resting conditions, the values of myocardial blood flow (MBF), MVO
2
and work metabolic index (WMI, reflecting myocardial efficiency) with the CCM device activated did not differ significantly from the values with the device deactivated. MBF was 0.81 ± 0.18 ml min
−1
 g
−1
with the device off and 0.80 ± 0.15 ml min
−1
 g
−1
with the device on (
p
 = 0.818), MVO
2
was 6.81 ± 1.69 ml/min/100 g with the device off and 7.15 ± 1.62 ml/min/100 g with the device on (
p
 = 0.241) and WMI was 4.94 ± 1.14 mmHg ml/m
2
with the device off and 5.21 ± 1.36 mmHg ml/m
2
with the device on (
p
 = 0.344). Under dobutamine stress, the values of MBF, MVO
2
and WMI with the CCM device activated did not differ from the values with the device deactivated, but were significantly increased compared with the values obtained under resting conditions.
Conclusion
These results indicate that CCM does not induce increased MVO
2
, even under stress conditions.