{"id":"b26440917450","type":"article","url":"https://hartvaat.nl/2026/08/18/c-mic-apparaat-vermindert-hartfalen-ernst-onafhankelijk-van-gdmt-aanpassingen-c-/","title":"C-MIC-apparaat vermindert hartfalen-ernst onafhankelijk van GDMT-aanpassingen — C-MIC II","title_en":"Differential Rates of Guideline-Directed Medical Therapy Modification in C-MIC and Control Patients: Results from the C-MIC II Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"ESC heart failure","doi":"10.1093/eschf/xvag220","source_url":"https://doi.org/10.1093/eschf/xvag220","authors":["Marat Fudim","Tamara Kovacevic-Preradovic","Dragana N Kosevic","Sasko Jovev","Nermir Granov","Tanja Popov","Igor Rudez","Petar Vukovic","Velibor Ristic","Annette Holtdirk","Miodrag Peric","Faouzi Kallel","Javed Butler","J Eduardo Rame","Stefan D Anker","Marija Zdravkovic"],"significance":5,"published":"2026-08-25","source_date":"2026-08-18","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfref-hartfalen-met-verminderde-ejectie/","https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/"],"congress":"","summary_en":"A secondary analysis of the C-MIC II trial evaluated whether the benefits of C-MIC device therapy in HFrEF patients were independent of background guideline-directed medical therapy (GDMT) adjustments. While GDMT intensity slightly increased in the control group—likely reflecting clinical deterioration—it decreased in the C-MIC group. Despite this, C-MIC therapy consistently improved left ventricular ejection fraction, patient-reported outcomes, and exercise capacity regardless of baseline SGLT2 inhibitor use. These findings indicate that the device provides clinical benefits independent of pharmacological intensification, supporting its role as an effective add-on strategy in HFrEF management.","created":"2026-08-19T01:01:19Z","updated":"2026-08-19T01:01:19Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"In een secundaire analyse van de C-MIC II-proef onderzochten onderzoekers of de voordelen van C-MIC-therapie bij patiënten met HFrEF onafhankelijk waren van aanpassingen in de richtlijn-gebaseerde medicatie. Hoewel de medicatie-intensiteit in de controlegroep licht toenam—waarschijnlijk door verslechtering van het hartfalen—daalde deze in de C-MIC-groep. Desalniettemin toonde de C-MIC-therapie consistente verbeteringen in de uitkomst van het hart (LVEF), de kwaliteit van leven (KCCQ-OSS) en de loopafstand, ongeacht het gebruik van SGLT2-remmers. Deze bevindingen suggereren dat het apparaat zelfstandig bijdraagt aan klinische verbetering, wat belangrijk is voor de keuze van add-on therapieën bij HFrEF.","abstract_original":"BACKGROUND: In the C-MIC II trial, C-MIC therapy improved outcomes in patients with heart failure (HF) with reduced ejection fraction (HFrEF). We evaluated whether differences in background HF medication adjustments influenced the observed benefits. METHODS: Ambulatory patients with chronic non-ischemic HFrEF receiving guideline-directed medical therapy (GDMT) were enrolled. The primary outcome was change in GDMT and diuretic intensity over 6 months. Treatment effects on left ventricular ejection fraction (LVEF), Kansas City Cardiomyopathy Questionnaire Overall Summary Score (KCCQ-OSS), and 6-minute walk distance (6MWD) were assessed by baseline sodium-glucose cotransporter-2 inhibitor (SGLT2i) use for consistency. RESULTS: Among 65 patients, 25 (39%) had GDMT adjustments (C-MIC device: 44%; control 33%; p= 0.390). GDMT intensity increased in controls (Δ +0.36) but decreased (Δ -0.16; p= 0.100) in C-MIC group. Diuretic intensity decreased in C-MIC group (Δ -0.10) but increased in controls (Δ +0.12; p= 0.200). When stratified by baseline SGLT2i use, C-MIC therapy induced consistent improvements in LVEF (SGLT2i: +6% [95% CI 3-9; p<0.001] vs. without SGLT2i: +4% [95% CI 2-7; p=0.003]), KCCQ-OSS (SGLT2i: +42 points [95% CI 26-58; p<0.001] vs. without SGLT2i: +40 [95% CI 28-51; p<0.001]) and 6MWD (SGLT2i: +150 meters [95% CI 88-212; p<0.001] vs. without SGLT2i: +141 meters (95% CI 63-219; p<0.001]). CONCLUSION: Medication intensity decreased in C-MIC-treated patients but increased in controls, driven primarily by escalation of diuretics, likely reflecting worsening HF. Consistent improvements in LVEF, 6MWD and KCCQ-OSS across SGLT2i subgroups suggest that the observed benefits are independent of background pharmacologic intensification."}