Impact Of Cardiac Contractility Optimizer On Echocardiographic Parameters In Chronic Heart Failure

Background Cardiac contractility modulation (Optimizer) is an emerging therapy for management of chronic heart failure with reduced ejection fraction (HFrEF) with improvement of functionality and alleviations of symptoms. Here we describe an improvement in echocardiography parameters after placement of the optimizer. Methods Six patients with persistent HFrEF and NYHA class 3 or worse symptoms despite maximal goal directed medical therapy (GDMT) for 3 months, underwent optimizer placement. Echocardiograms were reviewed before and after placement of the optimizer. Parameters were analyzed using the paired t-test. Results All patients noted symptomatic improvement and tolerance to continued GDMT. No adverse events were noted during the post-implantation period. Follow up echocardiogram was done in mean 135 days post optimizer placement (range 43 to 245 days). Mean interventricular septum thickness increased from 0.9 cm to 1.02 cm after optimizer placement. Average end-diastolic volume (EDV) decreased from 170 ml to 146.2 ml, and average end-systolic volume (ESV) decreased from 104.2 to 91.6ml. Mean left ventricular ejection fraction (LVEF) improved from 34.6 % to 38.1%. Similarly, there was an increase in tricuspid annular plane systolic excursion (TAPSE) from 18 mm to 21.6mm after implantation. This is an ongoing study with continued follow-up and enrollment. Conclusion This study demonstrates a trend towards improvement in echocardiographic parameters, in particular ejection fraction, TAPSE and reduction in EDV and ESV indication improved myocardial contractility and left ventricular dimensions. Cardiac contractility modulation (Optimizer) is an emerging therapy for management of chronic heart failure with reduced ejection fraction (HFrEF) with improvement of functionality and alleviations of symptoms. Here we describe an improvement in echocardiography parameters after placement of the optimizer. Six patients with persistent HFrEF and NYHA class 3 or worse symptoms despite maximal goal directed medical therapy (GDMT) for 3 months, underwent optimizer placement. Echocardiograms were reviewed before and after placement of the optimizer. Parameters were analyzed using the paired t-test. All patients noted symptomatic improvement and tolerance to continued GDMT. No adverse events were noted during the post-implantation period. Follow up echocardiogram was done in mean 135 days post optimizer placement (range 43 to 245 days). Mean interventricular septum thickness increased from 0.9 cm to 1.02 cm after optimizer placement. Average end-diastolic volume (EDV) decreased from 170 ml to 146.2 ml, and average end-systolic volume (ESV) decreased from 104.2 to 91.6ml. Mean left ventricular ejection fraction (LVEF) improved from 34.6 % to 38.1%. Similarly, there was an increase in tricuspid annular plane systolic excursion (TAPSE) from 18 mm to 21.6mm after implantation. This is an ongoing study with continued follow-up and enrollment. This study demonstrates a trend towards improvement in echocardiographic parameters, in particular ejection fraction, TAPSE and reduction in EDV and ESV indication improved myocardial contractility and left ventricular dimensions.