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Transthoracic Speckle Tracking Echocardiography for the Quantitative Assessment of Left Ventricular Myocardial Deformation
Published on: October 20, 2016
Cardiac shock wave therapy improves myocardial perfusion and preserves left ventricular mechanics in patients with
Anderson S Duque1, Conrado L Ceccon1, Wilson Mathias1,2
1Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil.
Insights
Cardiac shockwave therapy (CSWT) improved quality of life and angina symptoms in patients with refractory angina (RA). The treatment enhanced myocardial perfusion in treated segments without negatively impacting left ventricular mechanics.
Area of Science:
- Cardiology
- Medical Devices
- Regenerative Medicine
Background:
- Chronic coronary disease and refractory angina (RA) present significant challenges in patient management.
- Cardiac shockwave therapy (CSWT) is an emerging treatment modality for RA.
- The study investigates the impact of CSWT on myocardial perfusion and mechanics in RA patients.
Purpose of the Study:
- To evaluate the effects of CSWT on left ventricular myocardial perfusion.
- To assess changes in left ventricular mechanics following CSWT.
- To determine the impact of CSWT on clinical outcomes and quality of life in patients with RA.
Main Methods:
- Prospective study of 19 patients undergoing CSWT.
- Left ventricular mechanics assessed by speckle tracking echocardiography (STE).
- Myocardial perfusion evaluated by single-photon emission computed tomography (SPECT) using Technetium-99m Sestamibi.
- Clinical status assessed using Canadian Cardiac Society (CCS), New York Heart Association (NYHA) classifications, and Seattle Angina Questionnaire (SAQ).
Main Results:
- CSWT was safe with no major side effects.
- Significant reduction in CCS (94.7% to 15.8%) and NYHA (68.4% to 36.8%) classifications.
- Improved quality of life reported via SAQ (38.5% increase).
- No significant change in global summed stress score (SSS), but reduction in SSS for treated ischemic segments (P=0.024).
- Global longitudinal strain remained unchanged.
Conclusions:
- CSWT is a safe and effective treatment for refractory angina.
- CSWT improves quality of life and clinical symptoms in RA patients.
- The therapy enhances myocardial perfusion in treated areas while preserving left ventricular mechanics.
Background:
Cardiac shockwave therapy (CSWT) is a new potential option for the treatment of patients with chronic coronary disease and refractory angina (RA). We aimed to study the effects of CSWT on left ventricular myocardial perfusion and mechanics in patients with RA.
Method:
We prospectively studied 19 patients who underwent CSWT. Left ventricular mechanics were evaluated by speckle tracking echocardiography (STE), and myocardial perfusion by single-photon emission computed tomography, using stress/rest-Technetium-99 m Sestamibi, for determination of summed stress score (SSS). Canadian Cardiac Society (CCS), New York Heart Association (NYHA), and quality of life by Seattle Angina Questionnaire (SAQ) were assessed at baseline and 6 months after therapy.
Results:
CSWT therapy was applied without major side effects. At baseline, 18 patients (94.7%) had CCS class III or IV, and after CSWT there was reduction to 3 (15.8%), P = .0001, associated with improvement in SAQ (38.5%; P < .001). Thirteen (68.4%) had class NYHA III or IV before treatment, with significant reduction to 7 (36.8%); P = .014. No change was observed in the global SSS from baseline to 6-month follow-up (15.33 ± 8.60 vs 16.60 ± 8.06; P = .157). However, there was a significant reduction in the average SSS of the treated ischemic segments (2.1 ± 0.87 pre vs 1.6 ± 1.19 post CSWT; P = .024). Global longitudinal strain by STE remained unaltered (-13.03 ± 8.96 pre vs -15.88 ± 3.43 6-month post CSWT; P = .256).
Conclusion:
CSWT is a safe procedure for the treatment of patients with RA that results in better quality of life, improvement in myocardial perfusion of the treated segments with preservation of left ventricular mechanics.
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