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Published on: June 12, 2021
Cardiac shock wave therapy and myocardial perfusion in severe coronary artery disease
M Kaller1, L Faber2, N Bogunovic2
1Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center North Rhine-Westphalia, University Hospital of the Ruhr-University Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany.
Insights
Cardiac shock wave therapy (CSWT) improves localized heart perfusion and angina symptoms in end-stage coronary artery disease (CAD) patients. This noninvasive treatment offers a potential option for those with refractory symptoms.
Area of Science:
- Cardiology
- Noninvasive Therapeutics
- Medical Imaging
Background:
- Ultrasound-guided cardiac shock wave therapy (CSWT) is a noninvasive treatment for chronic-refractory angina.
- Previous trials indicate CSWT improves angina symptoms, cardiac function, and quality of life.
- Absolute myocardial perfusion measurements before and after CSWT have not been extensively studied.
Purpose of the Study:
- To assess the impact of CSWT on absolute myocardial perfusion in patients with chronic-refractory angina.
- To evaluate changes in regional and global left-ventricular myocardial perfusion and coronary resistance post-CSWT.
- To correlate perfusion improvements with clinical outcomes and angina class.
Main Methods:
- A total of 21 patients with CCS III angina and coronary artery disease (CAD) were included.
- Nitrogen-13 ammonia positron emission tomography (N-13 NH3 PET) scans were performed under adenosine before and after CSWT.
- Absolute myocardial perfusion and minimal coronary resistance were measured in treated and remote segments.
Main Results:
- CSWT was well-tolerated by all patients.
- Global left-ventricular myocardial perfusion and minimal coronary resistance did not significantly change.
- Treated segments showed a significant improvement in perfusion (11%) and resistance (15%).
- Patients with improved target perfusion (≥5%) demonstrated a higher rate of CCS class improvement (77%).
Conclusions:
- Standard CSWT can enhance myocardial perfusion in the treated area and alleviate clinical symptoms of CAD.
- The therapy does not affect global myocardial perfusion.
- CSWT is a safe, noninvasive option for end-stage CAD patients with refractory angina.
Background:
Ultrasound guided cardiac shock wave therapy (CSWT) is a noninvasive therapeutic option in the treatment of chronic-refractory angina. Clinical trials have shown that CSWT reduces angina symptoms, improves regional systolic function, LV ejection fraction, myocardial perfusion and quality of life parameters. Absolute measurements of myocardial perfusion before and after CSWT have not been performed so far.
Methods And Results:
We studied a total of 21 CCS III patients with history of CAD and multiple interventions who suffered from disabling angina despite individually optimized medical therapy. An N-13 NH3 PET perfusion scan under adenosine was performed before and after CSWT treatment. CSWT was well tolerated in all patients. Absolute perfusion under adenosine of the global left-ventricular myocardium did not change under therapy or minimal coronary resistance. The treated segments, however, showed in terms of both perfusion and resistance a mild but significant improvement, by 11 and 15 %, respectively, whereas no change could be observed in the remote segments. Considering a threshold of increased perfusion of 5 %, 10 (77 %) out of 13 patients with a better target perfusion improved in their CCS class, whereas 3 (43 %) out of 7 patients without improved target perfusion improved in their CCS class too.
Conclusion:
Standard CSWT has the potential to improve myocardial perfusion of the therapy zone and clinical CAD symptomatology without affecting global myocardial perfusion. As a noninvasive and well tolerated therapeutic option, these data suggest the use of CSWT in patients with end-stage CAD.
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