Modulazione della contrattilità cardiaca nello scompenso cardiaco a frazione di eiezione ridotta: revisione critica delle evidenze ed aspetti decisionali pratici

This critical review illustrates the pathophysiological aspects and available scientific evidence about cardiac contractility modulation therapy. A useful algorithm dealing with the essential decisional knots to consider for device implantation in patients with heart failure in NYHA class >II and ejection fraction ≤45% is presented. The present review paves the way for the development of an Italian registry aiming at analyzing the characteristics of implanted patients based on a multiparametric approach, including cardiac bio-markers, to identify clinical profiles and predictors of response to therapy. The Answers and Questions section provides useful insights into pathophysiology, technical specifications, clinically relevant scenarios and future perspectives.