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. 2015 Jan-Feb;16(1):6-11.
doi: 10.1016/j.carrev.2014.10.011. Epub 2014 Nov 10.

The beneficial effect of extracorporeal shockwave myocardial revascularization in patients with refractory angina

Gianluca Alunni  1 , Sebastiano Marra  2 , Ilaria Meynet  2 , Maurizio D'amico  2 , Pelloni Elisa  2 , Annalaura Fanelli  2 , Stefano Molinaro  2 , Paolo Garrone  2 , Armando Deberardinis  3 , Mario Campana  3 , Amir Lerman  4
Affiliations

The beneficial effect of extracorporeal shockwave myocardial revascularization in patients with refractory angina

Gianluca Alunni et al. Cardiovasc Revasc Med. 2015 Jan-Feb.

Abstract

Objectives: The incidence of patients with refractory angina (RA) is increasing. Medical therapy for RA is limited and prognosis is poor. Experimental data suggest that the use of Extracorporeal shockwave myocardial revascularization (ESMR) may contribute to angiogenesis and improve symptoms of angina in patients with RA. Purpose of our study is to determine the efficacy of cardiac shock wave therapy (ESMR) in the management of patients with nonrevascolarized coronary artery disease (CAD).

Methods: We performed a prospective cohort study to examine the efficacy of ESMR applcation in patients with RA despite optimal medical therapy, not suitable for further PCI or CABG. Characteristics such as angina class scores (CCS class score), nitroglycerin consumption and hospitalization rate among cases (patients with RA who received ESMR) and controls (patients with RA who did not receive ESMR) were compared at baseline and 6 months after ESMR therapy. In patients receiveing d ESMR the effect of on cardiac perfusion was assessed.

Results: There were 43 patients in the case group and 29 patients in the control group. The mean age of the patients was 70 ± 9.5 years in the case group and 71 ± 5.3 years in the control group. Other characteristics (diabetes, coronary artery bypass graft, percutaneus coronary intervention, baseline CCS class score) were similar in both groups. There was a significant improvement in CCS class score (1.33 ± 0.57 in cases and 1.92 ± 0.69 in controls; p = 0.0002), nitroglycerin consumption (20% in case cases, and 44.8% in controls; P < 0.03) and hospitalization rate significantly reduced (13.9% in case cases, and 37.9% in controls; P < 0.03). The patients who received ESMR, there was a significantly improvement in myocardial perfusion after 6 months with a 33% relative reduction of summed stress score (SSS) (p = 0.002).

Conclusion: This case control study demonstrates the beneficial effect of ESMR therapy on cardiac symptoms, myocardial perfusion and reduced hospitalization in patients with refractory angina. Ther current study supports a role for ESMR as a non-invasive therapuetic option for patients with RA.

Keywords: Echocardiography; Refractory angina; Shock wave therapy.

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Figures

Fig. 1
Fig. 1
Clinical outcome CCS Class Score of the two study groups at 6 months follow up.
Fig. 2
Fig. 2
Clinical outcome nitrates up-take of the two study groups at 6 months follow up.
Fig. 3
Fig. 3
Clinical outcome hospitalization of the two study groups at 6 months follow up.
Fig. 4
Fig. 4
Evaluation myocardial perfusion by SPECT before and after the treatment.
Fig. 5
Fig. 5
Evaluation myocardial perfusion by SPECT (Summed Rest Score) before and after the treatment to single patients.
Fig. 6
Fig. 6
Evaluation myocardial perfusion by SPECT (Summed Stress Score) before and after the treatment to single patients.
See this image and copyright information in PMC

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