Associazione Nazionale Medici Cardiologi Ospedalieri



Global longitudinal strain as a predictor of response to cardiac contractility modulation in patients with heart failure: a case series

Matteucci Andrea Roma (Roma) – Sfn | Pignalberi Carlo Roma (Roma) – Sfn | Pandozi Claudio Roma (Roma) – Sfn | Magris Barbara Roma (Roma) – Sfn | Meo Antonella Roma (Roma) – Sfn | Schiaffini Giammarco Roma (Roma) – Sfn | Di Fusco Stefania Angela Roma (Roma) – Sfn | Cianfrocca Cinzia Roma (Roma) – Sfn | Aquilani Stefano Roma (Roma) – Sfn | Colivicchi Furio Roma (Roma) – Sfn

BACKGROUND: Cardiac contractility modulation (CCM) in heart failure (HF) patients with reduced ejection fraction (HFrEF) is an innovative therapy which may contribute to increased exercise capacity and quality of life and reduced hospitalizations. With speckle-tracking echocardiography and global longitudinal strain (GLS), changes in myocardial function can be detected with greater sensitivity than conventional approaches for measuring diastolic and systolic function, including left ventricular ejection fraction. We aim to analyze the usefulness of GLS in detecting improvement in systolic function and response to CCM treatment.

METHODS: We studied 5 patients with CCM referred to our outpatient cardiology clinic. All patients underwent complete echocardiography with evaluation of GLS and ejection fraction. Follow-ups were performed at 1, 3, and 6 months. 

RESULTS: All patients were men (mean age 65.3±15.7 yrs). Mean baseline ejection fraction was 37.1±9.3%, mean GLS was 7.7±3.1%, and patients had mild-to-moderate left ventricular enlargement (mean indexed telediastolic volumes 101.4±8.7 ml/m2). Follow-up performed at the first month showed values similar to baseline values. Between the third and sixth months, a non-significant improvement in ejection fraction and GLS was recorded (EF 40.75±9.6% p=0.51; GLS 8.9±4.2 p=0.62). Indexed telediastolic volumes were reduced (101.4±9.3 ml/m2 vs 89.5±7.4 ml/m2 p=0.05).

CONCLUSIONS: CCM therapy seems to be useful in achieving volumetric remodeling in patients with HFrEF. GLS assessment may be useful in detecting improvement in systolic function. Further studies with larger samples and longer follow-up are needed to confirm these results.