Associazione Nazionale Medici Cardiologi Ospedalieri



Clinical Benefits of Advanced Algorithms in Heart Failure Management in Patients Undergoing Cardiac Contractility Modulation Device Implantation

Floris Roberto Sardegna(SU) – Ospedale Nostra Signora di Bonaria | Demontis Maria Valeria San Gavino Monreale(SU) – Ospedale Nostra Signora di Bonaria | Orru Fabio San Gavino Monreale(SU) – Ospedale Nostra Signora di Bonaria

INTRODUCTION: A 71-year-old man, diagnosed with primary dilated cardiomyopathy and severe left ventricular dysfunction (LVDTD 60 mm, LVEF 20%), exhibited normal right ventricular function (RVDTD 36 mm, TAPSE 21 mm, RV S’ TDI 11 cm/s), and moderate mitral regurgitation. In early 2019, he was hospitalized for heart failure and underwent the implantation of a biventricular defibrillator for primary prevention, activating a multiparametric algorithm for heart failure management. At discharge, maximal pharmacological therapy was confirmed.

Since September 2022, the heart failure synthetic index exceeded the critical threshold, reaching a value of 17, triggering a remote monitoring alert necessitating an increase in diuretic therapy. Despite a few months of clinical stability, in December 2022, he reported a progressive reduction in functional capacity, confirmed by an increase in the heart failure index.

DIAGNOSIS AND MANAGEMENT: Due to the onset of NYHA class III symptoms in February 2023, the patient was hospitalized. An echocardiogram revealed a continuous decline in right ventricular function (TAPSE 12 mm, RV S’ TDI 6 m/s). He underwent four biweekly infusions of Levosimendan, resulting in a transient clinical improvement. In March 2023, a device for modulating cardiac contractility was implanted without acute complications (Fig.1).

Two months post-implantation, a progressive improvement in clinical conditions was observed, accompanied by a gradual decline in the heart failure index returning to baseline values (Fig.2). The echocardiogram showed stable left systolic function and a significant improvement in right ventricular functional indices (Fig.3). Since May 2023, the patient has not required Levosimendan infusion, maintaining a stable NYHA class II.

CONCLUSION: Cardiac contractility modulation proves to be an effective method in managing heart failure, reducing symptoms, and preventing hospitalizations. Improved patient management is evident with reduced volumes and enhanced contractile capacity of the right ventricle. The use of advanced algorithms integrated with defibrillation devices allows for the assessment of the method ‘s efficacy even remotely