Search Results (254)

Left ventricular (LV) extracellular volume fraction (ECV) quantified by cardiac computed tomography (CT) reflects diffuse myocardial fibrosis. In patients with atrial fibrillation (AF) and reduced LV ejection fraction (LVEF), distinguishing tachycardia-induced cardiomyopathy from underlying myocardial disease remains challenging. The prognostic value of ECV for predicting reverse remodeling (RR) after catheter ablation for AF remains uncertain. We retrospectively analyzed 102 patients with LVEF ≤ 50% on echocardiography who underwent cardiac CT before AF ablation between May 2015 and April 2025. RR was defined as a ≥15% reduction in LV end-systolic volume with recovery of LVEF > 50%, or an absolute increase in LVEF of ≥15%. RR occurred in 49 patients (48%). ECV was significantly lower in patients with RR than in those without (31.2 ± 3.5% vs. 37.6 ± 7.8%, p < 0.001). Receiver operating characteristic analysis identified an optimal cutoff of 34.8% (area under the curve 0.77; sensitivity 88%; specificity 62%, p < 0.001). In multivariable logistic regression analysis, lower ECV remained independently associated with RR (odds ratio 0.84; 95% confidence interval 0.75–0.95; p = 0.006). CT-derived ECV was associated with RR after AF ablation in patients with reduced LVEF and may provide additional information for clinical decision-making. Full article

Background/Objectives: Invasive mapping studies have shown that one-third of patients with an electrocardiographic pattern of LBBB have intact left bundle branch block conduction and therefore do not actually have a substrate for resynchronization. We aimed to evaluate the activation pattern among responders and non-responders to CRT in a relatively large patient cohort using noninvasive electrocardiographic imaging (ECGi). Methods: A cohort of 185 patients who underwent CRT implantation were enrolled. ECGi was performed at the same hospitalization during intrinsic rhythm. The earliest and the latest left ventricular (LV) activation sites were analyzed according to the 17-segment American Heart Association model. The echocardiographic response to CRT was defined as a reduction of ≥15% in LV end-systolic volume, and clinical response as an improvement of at least one New York Heart Association class at 12 months from the baseline. Results: The earliest activation in the middle inferoseptal LV segment (No.9) was significantly more prevalent among non-responders. A breakthrough in the remaining septal segments (No.2, 3, 8, or 14) was an independent predictor of both clinical (odds ratio (OR) 3.1 [95% confidence interval (CI): 1.2–8.1], p = 0.021) and echocardiographic (OR 5.1 [95% CI: 2.2–11.8], p < 0.001) responses to CRT. Other independent predictors of echocardiographic and clinical response to CRT in this study were LV pacing site in the lateral wall and QLV interval. Conclusions: The earliest endocardial activation site in segments 2, 3, 8, or 14 of the LV is an independent intrinsic activation marker associated with CRT response, complementary to intraoperative factors. Full article

Introduction: Gestational physiology is characterized by an expansion of plasma volume and an elevation in cardiac output. Given the scarcity of existing data on pregnancy-related left atrial (LA) volumetric and functional features, this study aims to define LA volumes, volume-based functional properties and strains in healthy subjects during mid-term pregnancy. Methods: The present study comprised 19 healthy women in mid-term pregnancy (mean age: 30.5 ± 2.7 years, weight: 81.7 ± 14.0 kg, height: 166.9 ± 5.7 cm) without any symptoms, known diseases or other conditions, which could affect the results. Their results were compared to those of 43 healthy non-pregnant women (mean age: 28.6 ± 4.9 years, weight: 59.9 ± 8.5 kg, height: 167.8 ± 7.6 cm). All participants underwent comprehensive two-dimensional Doppler echocardiography with three-dimensional speckle-tracking echocardiography (3DSTE). Results: Thicker interventricular septum, increased left ventricular ejection fraction and impaired early and late transmitral flow velocities could be detected in healthy pregnant subjects as compared to those of non-pregnant individuals. End-systolic maximum LA volume was increased with elevated stroke volume and emptying fraction. While early diastolic LA volume was preserved with elevated stroke volume and emptying fraction, late diastolic LA volume, stroke volume and emptying fraction remained unchanged. However, indexed LA volumes did not differ between the groups. Among end-systolic peak global LA strains, only LA longitudinal strain (LS) was increased, while all others remained unchanged. Among regional strains, basal, midatrial and superior LA circumferential strain (CS) and LA-LS were increased except for basal LA-CS, which was impaired. Among late diastolic LA strains at atrial contraction, none of them showed any significant changes in healthy pregnant subjects compared with those of non-pregnant women. Conclusions: With a detailed 3DSTE study, elevated end-systolic LA volume and preserved diastolic LA volumes, together with enhanced end-systolic LA reservoir and early diastolic LA conduit functional properties, could be detected with features of preserved late diastolic booster pump function in healthy women during mid-term pregnancy (second trimester). When comparing indexed LA volumes, no significant difference could be confirmed between the pregnant and non-pregnant groups. This suggests that the increased end-systolic LA volume may be an adaptation to increased body weight. Full article

Introduction. Pregnancy is characterized by a significant expansion of plasma volume and an increase in cardiac output, necessitating structural and functional adaptations of the cardiac chambers, including the right atrium (RA). To evaluate these changes, three-dimensional (3D) speckle-tracking echocardiography (STE) was used as a validated and sophisticated modality for the concurrent assessment of RA volumetric and functional alterations. This study aimed to characterize RA volumes, volume-based functional indices, and strain parameters in healthy women during mid-gestation, compared with a cohort of non-pregnant controls. Methods. This retrospective cohort analysis included 20 healthy, asymptomatic women in their second trimester (mean age: 29.9 ± 3.0 years; weight: 81.2 ± 14.2 kg; height: 166.9 ± 5.8 cm; body surface area [BSA]: 1.95 ± 0.17 m²). The control group consisted of 30 age-matched healthy non-pregnant women (mean age: 29.9 ± 4.1 years; weight: 58.7 ± 6.5 kg; height: 166.0 ± 5.4 cm; BSA: 1.68 ± 0.11 m²). All subjects underwent comprehensive two-dimensional Doppler echocardiography and 3DSTE. Results. Early and late diastolic RA volumes were significantly reduced, despite preserved end-systolic RA volume. Pregnant subjects exhibited reduced active RA stroke volume and increased passive RA emptying fraction, while all other parameters remained comparable between the groups. No significant differences were observed between groups in end-systolic peak RA global or mean segmental strains, nor in RA strains measured during atrial contraction. However, end-systolic peak regional RA strain analysis revealed decreased basal RA circumferential strain (CS) and increased superior RA-CS in pregnant participants compared with controls. Furthermore, during late diastole (at atrial contraction), superior RA-CS, RA-3D strain, and RA-area strain were significantly higher in healthy pregnant subjects than in controls. Conclusions. Substantial regional changes in RA function were detected by 3DSTE, likely reflecting adaptation to pregnancy-induced plasma volume expansion, and resulting in significant RA volumetric changes. Full article

Aging is a significant risk factor for cardiovascular diseases. The prevalence of heart failure increases with age, making it a leading cause of morbidity and mortality. We investigated age-associated changes in expression of Nuclear Factor (Erythroid-derived 2)-Like 2 (NFE2L2 or NRF2) in the myocardium of humans, rhesus monkeys, Fischer rats, and C57BL/6 mice. NRF2 is a transcription factor that orchestrates the expression of genes involved in antioxidant and detoxification responses. Analyses of RNA-seq data from the Genotype-Tissue Expression (GTEx) project, which contains left ventricular samples from 294 male donors, revealed a trend of age-associated declines in NRF2 transcripts and several of its downstream genes (SOD1, SOD2, CAT, GCLM, and AKR1B). Age-dependent decreases in NRF2 protein expression were observed in the myocardium of Rhesus monkeys and Fischer rats. To determine whether NRF2 loss contributes to myocardial aging, we evaluated cardiac function of NRF2 knockout mice (KO) at 19 and 24 months of age. At 19 months, the NRF2 KO mice exhibited diastolic dysfunction, characterized by an increased end-diastolic volume (EDV) and end-systolic volume (ESV), accompanied by a reduced ejection fraction (EF) and fractional shortening (FS), indicative of early onset of heart failure. The NRF2 KO mice displayed premature aging phenotypes and had reduced lifespans. Our findings support the trend of NRF2 signaling decline with age, and that loss of NRF2 accelerates the maladaptive cardiac remodeling and functional deterioration associated with aging. Full article

Background: Myocardial fibrosis plays a key role in adverse remodeling after ST-segment-elevated myocardial infarction (STEMI). The effect of sodium–glucose cotransporter 2 inhibitors (SGLT2is) on myocardial fibrosis deposition among patients with STEMI undergoing primary percutaneous coronary intervention (pPCI) is unclear. Objectives: To assess the effects of SGLT2is on myocardial fibrosis among patients with STEMI undergoing pPCI. Methods: Patients with STEMI undergoing pPCI with left ventricular ejection fraction ≤ 50% were randomized to dapagliflozin 10 mg or placebo. The primary endpoint was cardiac magnetic resonance (CMR)-derived 6-month changes in remote myocardium extracellular volume (ECV) fraction from baseline. Secondary endpoints included changes in CMR-derived myocardial volumes, change in serum fibrosis biomarker levels, and adverse events. Multivariable adjustment for infarction location and diabetes status was performed as sensitivity. The study was halted prematurely due to slow recruitment. Results: Fifty-two patients underwent randomization between May 2021 and April 2024 and completed follow-up. At 6 months, dapagliflozin resulted in a non-significant reduction in ECV change compared to placebo (−0.39 [4.7] vs. 1.43 [5.7]; difference: −1.82 [−4.86; 1.23]; p-value = 0.235) while also leding to a higher degree of reduction in N-terminal pro-peptide of type III collagen (−177.0 pg/mL [416.1] vs. 3.6 pg/mL [553.8]; p-value = 0.208). No significant differences in other biomarkers or adverse events were noted in the main analysis. After adjustment, dapagliflozin was associated with increased reduction in left ventricular end-systolic volume (−4.02 mL [7.4] vs. 0.10 mL [10.1]; difference: −4.92 [−9.8; −0.1]; p-value = 0.047). Conclusions: In STEMI patients undergoing pPCI, dapagliflozin did not result in a significant reduction in ECV or biomarkers of fibrosis at 6 months. Full article

Objective: This study assessed the blood-pressure effects of various exercise regimens in middle-aged and older adults with type 2 diabetes, considering baseline levels, to clarify dose–response relationships for personalized exercise guidance. Methods: We conducted a dose–response network meta-analysis. Systematic searches were performed in Web of Science, EMBASE, PubMed and Cochrane Library. Baseline blood pressure was modelled as an explanatory variable via meta-regression. Thirty-six eligible RCTs of physical-activity interventions in older adults with type 2 diabetes reporting blood-pressure outcomes were included. Results: In stage 1–2 hypertension, mind–body activities were associated with the greatest systolic blood-pressure reduction and appear to be the most effective intervention based on available evidence. For diastolic blood pressure, combined aerobic-resistance training was effective in stage 1 hypertension. Dose–response analysis indicated that clinically meaningful reductions occur at modest volumes (668 and 657 MET-min/week for systolic and diastolic pressures, respectively), aligning with the lower end of international activity guidelines. Conclusions: Individualized exercise prescription based on baseline blood pressure may offer a useful non-pharmacological strategy for hypertension management in older adults with type 2 diabetes. By quantifying the required activity dose, this work provides an evidence base for integrating structured exercise into precision care for this high-risk population. Full article

Background: Adverse left ventricular remodeling (ALVR) remains an important complication after ST-segment elevation myocardial infarction (STEMI) despite timely reperfusion therapy. Early circulating biomarkers reflecting thromboinflammatory and eicosanoid-related pathways may improve identification of patients at risk of unfavorable remodeling. Objectives: To investigate whether platelet count, 20-hydroxyeicosatetraenoic acid (20-HETE), 15(S)-hydroxyeicosatetraenoic acid [15(S)-HETE], and NETosis activity measured on the morning after reperfusion therapy are associated with serial cardiac magnetic resonance (CMR)-defined ALVR after first STEMI. Methods: In this prospective single-center study, 93 patients with first STEMI treated with reperfusion therapy, including primary percutaneous coronary intervention (PCI) in 87 patients and thrombolysis followed by PCI underwent baseline CMR at a median of 4 days after PCI and repeat CMR at 6 months. ALVR was defined as a ≥12% increase in both left ventricular end-diastolic volume and left ventricular end-systolic volume at follow-up. Fasting blood samples obtained on the morning after PCI were used to measure platelet count, 20-HETE, 15(S)-HETE, and NETosis activity. Univariable and multivariable logistic regression and receiver operating characteristic analyses were performed. A secondary exploratory analysis evaluated predictors of absolute improvement in left ventricular ejection fraction (LVEF) of ≥10%. Results: ALVR occurred in 19 of 93 patients (20.4%). Patients with ALVR had lower platelet count and lower 20-HETE levels at baseline. In the multivariable model, lower platelet count (OR 0.981, 95% CI 0.965–0.996; p = 0.015) and lower 20-HETE (OR 0.985, 95% CI 0.970–1.000; p = 0.047) were independently associated with ALVR, whereas urea was not significant. In receiver operating characteristic analysis, 20-HETE showed the highest discriminatory ability for ALVR (AUC 0.713, 95% CI 0.594–0.833; p < 0.001), followed by platelet count (AUC 0.670, 95% CI 0.546–0.794; p = 0.007). By contrast, 15(S)-HETE and NETosis activity were not significant discriminators in the primary analyses. Overall LV function improved during follow-up, with LVEF increasing from 49.0% to 56.0% (p < 0.001). In secondary exploratory analysis, higher HDL was independently associated with LVEF improvement of ≥10% (OR 7.84, 95% CI 1.26–48.99; p = 0.028). Conclusions: Lower platelet count and lower 20-HETE measured on the morning after PCI were independently associated with subsequent CMR-defined ALVR after first STEMI. Platelet count may serve as a simple, clinically accessible marker of risk, while 20-HETE suggests a potential role of eicosanoid-related pathways in remodeling process. Full article

Background: Guideline-directed medical therapy (GDMT) is recommended after acute myocardial infarction (AMI), particularly in patients with left ventricular systolic dysfunction, yet real-world implementation remains suboptimal. Whether greater early GDMT intensity is associated with post-infarction ventricular remodeling has not been fully established. We aimed to quantify the guideline-to-practice gap and evaluate the association between GDMT intensity, cardiac remodeling, and clinical outcomes after AMI. Methods: In this single-center retrospective cohort study, 186 consecutive patients hospitalized for AMI who underwent successful percutaneous coronary intervention and had baseline plus follow-up transthoracic echocardiography were included. GDMT intensity was defined as the number of prescribed foundational therapy classes at discharge (renin–angiotensin system inhibitors, beta-blockers, mineralocorticoid receptor antagonists, and sodium–glucose cotransporter 2 inhibitors; range 0–4). The primary endpoint was change in left ventricular end-diastolic diameter (ΔLVEDD). Secondary endpoints included changes in left ventricular ejection fraction, left ventricular end-diastolic volume, left ventricular mass, and heart failure rehospitalization. Multivariable models adjusted for relevant clinical covariates were applied. Results: Only 18.8% of the overall cohort and 26.2% of patients with baseline left ventricular ejection fraction ≤ 40% received all four GDMT pillars. A graded association was observed between higher GDMT intensity and more favorable remodeling. In adjusted analyses, each additional GDMT pillar was associated with a greater reduction in LVEDD (β = 0.120 cm, p = 0.004). In the prespecified reduced-ejection-fraction subgroup, the association was stronger (β = 0.204 cm, p < 0.001). Higher GDMT intensity was also associated with lower odds of heart failure rehospitalization (odds ratio 0.384, 95% CI 0.195–0.754; p = 0.006). Conclusions: In this real-world post-AMI cohort, broader implementation of foundational GDMT at discharge was associated with more favorable early ventricular reverse remodeling and lower odds of heart failure rehospitalization. These findings highlight a persistent implementation gap and support prospective studies evaluating rapid comprehensive GDMT initiation after AMI. Full article

Introduction. Left ventricular (LV) function can be characterized by numerous parameters, the most well-known being the ejection fraction (EF), derived from LV end-systolic and end-diastolic volumes (ESV and EDV, respectively) throughout the cardiac cycle. M-mode echocardiography (MME-)-based determination of the longitudinal displacement of the mitral annulus (MA plane systolic excursion, MAPSE) remains a simpler and more practical parameter for assessing LV function in daily clinical routine. Although the relationships between MAPSE, LV deformation and LV rotational mechanics are well-established in healthy individuals, it remains unclear whether MAPSE also correlates with LV volumes themselves. To address this, the associations between LV-ESV and LV-EDV and MAPSE in a healthy cohort were investigated, exploring how these variables relate across average, sub-average, and above-average ranges. Methods. The present cohort study enrolled 115 healthy adult volunteers (mean age: 35.3 ± 12.1 years; 68 men). Complete two-dimensional (2D) Doppler echocardiography with MAPSE assessment and 3DSTE-derived measurement of LV volumes was performed in all cases. Results. Both end-diastolic and end-systolic LV diameters and volumes tended to be higher in individuals with lower- or higher-than-average MAPSE compared to those with average MAPSE. These differences reached statistical significance for 2D echocardiography-derived LV end-systolic diameter and volume, as well as for 3DSTE-derived LV-EDV and LV-ESV. MAPSE remained consistent regardless of the degree of LV-EDV and LV-ESV. No significant correlations were observed between MAPSE and LV-EDV or LV-ESV. Conclusions. LV longitudinal shortening, as represented by MAPSE, is not associated with 3DSTE-derived LV volumes in healthy adults. However, the observed lack of association may not necessarily reflect true physiological independence, but could instead result from limited statistical power, measurement variability, or model misspecification. Full article

Background. Physiological remodeling resulting from chronic exercise-induced volume and pressure overload is a well-recognized characteristic of the athlete’s heart. This study aimed to explore potential changes in three-dimensional speckle-tracking echocardiography-derived aortic valve annular (AVA) dimensions and dynamics in elite athletes engaged in high-dynamic sports with varying degrees of static components. Furthermore, we sought to determine whether these parameters differ depending on the magnitude of the sport’s dynamic component. Methods. The athlete cohort included 56 individuals and was divided into three groups based on the static component of their sport: C. I. (high dynamic/low static) consisted of 13 elite athletes (mean age: 22.7 ± 3.8 years, 5 males), C. II. (high dynamic/moderate static) consisted of 18 elite athletes (mean age: 23.0 ± 4.6 years, 6 males) and C. III. (high dynamic/high static) consisted of 25 elite athletes (mean age: 21.7 ± 4.5 years, 9 males). Data of athletes were compared with those of 38 age- and sex-matched healthy non-athletic individuals (mean age: 23.8 ± 2.5 years, 14 males). Results. AVA dimensions did not differ significantly between athletes and controls nor among the athlete subgroups. AVA plane systolic excursion (AAPSE) was increased in all athletes compared with controls (1.31 ± 0.30 cm vs. 1.18 ± 0.36 cm, p < 0.05). All athletes showed a significantly larger proportion of individuals showing larger end-diastolic AVA than end-systolic AVA (55% vs. 24%, p < 0.05). All athletes demonstrated reduced basal LV-RS (26.5 ± 13.9% vs. 31.5 ± 13.2%, p < 0.05) and increased basal LV-LS (−21.4 ± 4.4 vs. 19.9 ± 4.2%, p < 0.05) compared with controls. This pattern of findings was consistent across all athlete subgroups. Conclusions. Although AVA is not dilated in elite athletes practicing dynamic sports, its spatial displacement, as represented by AAPSE, together with increased basal LV-LS and a higher proportion of larger end-diastolic AVA, is augmented, while basal LV-RS is reduced. These findings suggest a functional shift from radial contraction toward enhanced longitudinal dynamics. All these findings appear to be independent of the static component of dynamic sports. Full article

Background/Objectives: Gated cardiac positron emission tomography (PET) synchronizes PET data to the cardiac cycle based on an electrocardiogram (ECG) signal, providing left ventricular (LV) functional and geometrical parameters. Nevertheless, image artifacts, due to cardiac-, breathing-, and/or patient-motion occurring during image acquisition, undermine the reliability and clinical utility of these parameters. This study aims to elucidate the effect of two motion correction (MC) tools, CardioFreeze (CF) and a data-driven motion correction (DDMC) prototype, on LV functional and geometrical parameters. Methods: ECG-gated rest/stress [¹³N]NH₃ PET/CT scans from forty patients with myocardial ischemia and thirty-nine patients with normal myocardial perfusion were included. The following four reconstructions were performed for each patient scan: without motion correction (NMC), with CF, DDMC, and DDMC & CF. Images were processed with Cedars-Sinai QPET software. Results: End-diastolic volume (EDV) in rest and stress increased significantly using DDMC. End-systolic volume (ESV) increased significantly, while LV ejection fraction (LVEF) decreased significantly using any MC tool, regardless of the phase. Shape index end-systole (SI ES) and shape-index end-diastole (SI ED) increased significantly when using MC, except for SI ED in rest, where DDMC did not cause any difference. Eccentricity index end-systole (ECC ES) in rest and stress increased significantly in patients with normal myocardial perfusion, while it did not differ in ischemic patients after applying MC. Conclusions: MC tools significantly increase ESV values and decrease EF values. The highest effect is observed with the combined use of DDMC & CF. Image quality is greatly improved when using MC, regardless of the method, particularly in patients with the highest myocardial displacement. Full article

Background/Objectives: Early diagnosis of hypertension (HTN) is critical, but most screening models do not simultaneously distinguish phenotypes based on systolic or diastolic patterns. We developed and temporally validated a multinomial model to predict normotension and three phenotypes of undiagnosed hypertension in Peru. Methods: We used ENDES 2017–2019 for development (final analytic n = 62,091) and ENDES 2021–2024 for temporal validation (final analytic n = 77,372), excluding 2020 due to COVID-19 disruptions. We included adults aged ≥18 years without self-reported HTN. The outcome was classified as normotension, isolated diastolic hypertension (IDH), isolated systolic hypertension (ISH), or systolic–diastolic hypertension (SDH). Eight nonlaboratory predictors were used: age, BMI, sex, residential altitude, smoking, alcohol consumption, vegetable intake, and fruit intake. Results: The model achieved an AUC of 0.789 (95% CI: 0.783–0.795) in training and 0.776 (95% CI: 0.770–0.781) in temporal validation. The prevalence of undiagnosed hypertension was 11.6% in the training set and 12.6% in the validation set. At a prespecified cutoff of 0.1004, sensitivity and specificity were 79.0% and 63.2% in training and 78.7% and 60.9% in validation, respectively (NPV 95.8% and 95.2%). Decision curve and clinical impact analyses suggested a positive net benefit and plausible referral volumes across a range of thresholds. Conclusions: This model could help prioritize confirmatory blood pressure measurements in resource-limited settings. Full article

Mitral valve prolapse represents the most common cause of primary mitral regurgitation in Western countries and has traditionally been viewed as a disorder driven by valvular incompetence and chronic volume overload. Within this paradigm, left ventricular enlargement was expected to correlate with regurgitant severity. However, patients with myxomatous bileaflet prolapse often exhibit left ventricular dilatation disproportionate to the degree of regurgitation, leading to the hypothesis of an intrinsic myocardial disease process. Cardiovascular magnetic resonance imaging has challenged this concept through the identification of doming volume, a previously unrecognized systolic blood compartment located between the mitral annular plane and the ventricular surface of prolapsing leaflets. This volume is mechanically coupled to ventricular contraction and contributes to total ventricular volume load independently of transvalvular regurgitation. Recognition of doming volume provides a physiological explanation for excessive ventricular remodeling observed in bileaflet prolapse and Barlow disease. Doming volume has important implications for imaging assessment. Its common exclusion from echocardiographic volumetric measurements may result in underestimation of left ventricular end-systolic volume, overestimation of ejection fraction, and underestimation of regurgitant burden, contributing to discordance between echocardiographic and cardiovascular magnetic resonance-derived measurements. Cardiovascular magnetic resonance enables comprehensive assessment, allowing accurate quantification of ventricular volumes, mitral regurgitation severity, doming volume, and myocardial tissue characteristics. Integration of doming volume into the evaluation of mitral valve prolapse improves physiological consistency between imaging findings and ventricular remodeling. However, further evidence is required before doming volume assessment can be incorporated into operative clinical indications or decision-making thresholds. Full article

Background/Objectives: Heart failure (HF) is associated with substantial morbidity, impaired quality of life (QOL), and reduced functional capacity. In selected patients with symptomatic HF despite Optimal Medical Therapy (OMT), Cardiac Contractility Modulation (CCM) may be a therapeutic option. Identifying patients most likely to benefit from CCM remains an unmet need. The Predict-CCM study aims to evaluate long-term clinical and objective outcomes after CCM therapy and to assess the predictive value of pre-implant low-dose dobutamine stress echocardiography (LDDSE). Methods and Results: Predict-CCM is an independent, non-profit, multicenter, observational cohort study conducted in Italy, with both retrospective and prospective enrollment. The primary endpoint is the proportion of subjects with a clinical response to CCM at 12 months, defined as a ≥1-class reduction in NYHA class. Secondary clinical endpoints include reductions in HF-related hospitalizations, changes in QOL assessed by the Minnesota Living with Heart Failure Questionnaire (MLHFQ), and changes in NT-proBNP levels from baseline to follow-up. Outcomes will be evaluated in the overall cohort and in two subcohorts stratified by pre-implant LDDSE response: (1) reduction in left ventricular end systolic volume (LVESV) ≥ 15% (DeltaLVESV ≥ 15%); and (2) reduction in LVESV < 15% (DeltaLVESV < 15%). Assuming a 70% clinical response rate at 12 months, the estimated sample size is 120 patients. The study was approved by the Ethics Committee in March 2025. Enrollment will continue for 2 years, with a 12-month follow-up period after implant for each subject. Conclusions: This study may provide new criteria for patient selection and outcome assessment in CCM therapy. Left ventricular contractile reserve assessed by stress echocardiography may be a promising predictor of response. Full article