Zusammenfassung
Die Herzinsuffizienz stellt eine der größten medizinischen Herausforderungen in den nächsten Jahren dar, mit steigenden Fallzahlen infolge der Alterung der Gesellschaft. Sie geht mit schlechter Prognose und eingeschränkter Lebensqualität einher – trotz ständiger Verbesserung der medikamentösen Therapie, die zu einer stetigen Abnahme der Sterblichkeit und Zunahme der Lebensqualität geführt hat. Für therapierefraktäre Patienten mit eingeschränkter linksventrikulärer (LV-) Funktion, Linksschenkelblock und verbreitertem QRS-Komplex (≥ 130 ms) ist die kardiale Resynchronisationstherapie (CRT) der Goldstandard in Ergänzung zur medikamentösen Therapie. Darüber hinaus sind andere Verfahren wie die Vagusstimulation in der klinischen Prüfung, die aber noch keine generelle Therapieempfehlung haben. Insgesamt repräsentieren CRT-Patienten jedoch nur ein Drittel aller Patienten mit Herzinsuffizienz, und darüber hinaus sind 25 % der CRT-Patienten „Non-Responder“, die nicht von der CRT profitieren.
Bei Patienten mit Herzinsuffizienz, einer linksventrikulären Ejektionsfraktion (LVEF) zwischen 25 und 45 % und einer QRS-Dauer < 130 ms, die nicht für eine CRT geeignet sind, stellt heutzutage die kardiale Kontraktilitätsmodulation (CCM) eine Therapieoption dar, die sich in mehreren randomisierten Studien als effektiv und sicher herausgestellt hat. Sie verringert die Häufigkeit von Krankenhausaufenthalten infolge der Herzinsuffizienz und verbessert deren Symptome, die funktionelle Kapazität und die Lebensqualität. Das Ziel dieser Arbeit ist es, die Wirkmechanismen, die Studienlage, die derzeitigen Indikationen und die neueren Entwicklungen der CCM-Therapie zur Behandlung von Patienten mit chronischer Herzinsuffizienz darzustellen.
Abstract
Heart failure (HF) will be one of the biggest medical challenges in the coming years, with increasing prevalence in an aging society. It is associated with a poor prognosis and impaired quality of life—despite steadily improving medical therapy which has resulted in a steady decrease in mortality and an increase in quality of life. In medically refractory patients with impaired left ventricular (LV) function, left bundle branch block and wide QRS complex (≥130 ms) cardiac resynchronization therapy (CRT) in addition to medical therapy has become the gold standard. Additionally, other therapeutic modalities such as vagal stimulation are being clinically tested but as yet have no general therapeutic recommendation. Overall, CRT patients represent only one-third of all HF patients and about 25% are “non-responders” who do not benefit from CRT.
In HF patients with an LVEF between 25 and 45% and a QRS duration <130 ms who are not suitable for CRT, cardiac contractility modulation (CCM) is currently a therapeutic option that has been shown in several randomized trials to be efficacious and safe. It reduces the frequency of HF hospitalizations and improves HF symptoms, functional capacity, and quality of life. The goal of this article is to present mechanisms of action, major clinical studies, current indications, and recent developments of CCM for the treatment of patients with chronic HF.
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K.-H. Kuck, A. Ujeyl, J. Vogler und R.R. Tilz geben an, dass kein Interessenkonflikt besteht.
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Kuck, KH., Ujeyl, A., Vogler, J. et al. Kardiale Kontraktilitätsmodulation. Herz 46, 533–540 (2021). https://doi.org/10.1007/s00059-021-05071-w
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DOI: https://doi.org/10.1007/s00059-021-05071-w