P3374Sustained improvements to ventricular function due to asymptomatic diaphragmatic stimulation

Abstract

right heart chambers due to significant decreasing of the HR. 6MWT showed that pts of the 2nd gr were able to walk 121,3±17,6 meters more than pts of the 1st gr.Estimating results of SF-36 it was found that pts of 2nd group had significant improvement at such scales as RPF, GH, Vitality, RE and MH comparing to pts of the 1st gr. Conclusion: 6 MWT confirmed efficacy of ivabradin in pts with CCP and RHF. Early prescription of ivabradine in this cohort of pts prevents worsening of RHFimproving the structure-functional data of the right heart chambers, which has a positive influence on life quality of these pts. P3372 | BEDSIDEIs the administration of mineralocorticoid receptor antagonist required in asymptomatic AHA/ACC stage B heart failure patients?T. Okumura, A. Sawamura, Y. Sugiura, H. Hiraiwa, T. Kondo, S. Aoki, N. Watanabe, N. Kano, K. Fukaya, R. Morimoto, Y.K. Bando, T. Murohara. Nagoya University Graduate School of Medicine, Department of Cardiology, Nagoya, Japan Background: Cardiac reverse remodeling (CRR) is considered as a surrogate marker for favorable prognosis of non-ischemic dilated cardiomyopathy (NIDCM). Based on the results of large clinical trials, the current guidelines recommended the administration of mineralocorticoid receptor antagonist (MRA) to reduce mortality and HF hospitalization in all symptomatic heart failure (HF) patients with reduced ejection fraction despite treatment with ACE inhibitors/ARB and beta-blockers. However, the efficacy of the MRA for asymptomatic HF patients (AHA/ACC stage B) has not been established. Purpose: The purpose of this study was 1) to investigate the association between MRA and CRR and 2) the prognostic value of additional MRA administration in asymptomatic NIDCM patients. Methods: We enrolled 122 NIDCM patients classified AHA/ACC stage B HF in this retrospective cohort study. NIDCM was defined by the presence of left ventricular ejection fraction <50% on echocardiography and a dilated LV cavity, in the absence of coronary heart disease, valvular heart disease, or secondary cardiac muscle disease caused by any known systemic condition. All patients were divided into two groups; with-MRA group and without-MRA group. CRR was defined as an absolute increase in left ventricular ejection fraction ≥10% accompanied by a decrease in left ventricular end-diastolic diameter >10% as assessed by echocardiography at 12 months. The cardiac event was defined as composite outcome including cardiac-related death, ICD/CRTD implantation and unplanned hospitalization for worsening HF within 12 months. Results: As for baseline characteristics, the mean of left ventricular ejection fraction and end-diastolic diameter was 33.2% and 62.5 mm, respectively. The administration rate of ACE inhibitors/ARBs and was 84% and 87%. Sixty-three (52%) patients were treated with MRA. The rate of CRR was significantly higher in patients treated with MRA than in patients without MRA (52% vs 29%, p=0.033; Figure A). In Kaplan-Meier survival analysis, the cardiac event-free rates were comparable ...

Synchronized Diaphragmatic Stimulation for Heart Failure With a Reduced Left Ventricular Ejection Fraction Using the VisONE System: A First-in-Patient Study With Extended Population

“…Beeler et al., 4 using a cross-over trial design (3-week treatment periods) and a modified CRT device on chronic HFrEF patients, found that SDS improved NYHA class, dyspnea, exercise capacity, and LVEF when SDS was optimized within the cardiac cycle. Continued SDS therapy for a year on these patients, 5 suggested that stimulation thresholds were stable without reported patient symptoms from diaphragmatic stimulation.…”

“…Synchronized diaphragmatic stimulation (SDS) is a recent HF therapy which stimulates the diaphragm in a manner imperceptible to the patient 2 and at a specific timepoint in each cardiac cycle, thereby modulating intrathoracic pressure and pericardial restraint to increase systemic venous return and improve cardiac performance. 3 , 4 , 5 , 6 Previous studies used modified CRT devices with the stimulating lead attached to the superior left hemisphere of the diaphragm to deliver diaphragmatic stimulation synchronized to biventricular pacing. 3 , 4 , 5 In this manner, Beeler et al., using a small, randomized cross-over trial design, 4 found that 3 ​weeks of diaphragmatic stimulation improved dyspnea, functional capacity, and left ventricular ejection fraction (LVEF), and these improvements may have continued for up to 1 ​year 5 without adverse events related to diaphragmatic function.…”

“… 3 , 4 , 5 , 6 Previous studies used modified CRT devices with the stimulating lead attached to the superior left hemisphere of the diaphragm to deliver diaphragmatic stimulation synchronized to biventricular pacing. 3 , 4 , 5 In this manner, Beeler et al., using a small, randomized cross-over trial design, 4 found that 3 ​weeks of diaphragmatic stimulation improved dyspnea, functional capacity, and left ventricular ejection fraction (LVEF), and these improvements may have continued for up to 1 ​year 5 without adverse events related to diaphragmatic function. A case report 6 of a dedicated SDS system (VisONE) successfully implanted using a minimally invasive abdominal laparoscopic approach with the stimulating lead attached to the inferior left hemisphere of the diaphragm demonstrated enhanced quality of life, exercise tolerance, and cardiac function.…”