BackgroundCardiac shockwave therapy (CSWT) might improve symptoms and decrease ischaemia burden by stimulating collateral growth in chronic ischaemic myocardium. This prospective study was performed to evaluate the feasibility and safety of CSWT.MethodsWe included 33 patients (mean age 70 ± 7 years, mean left ventricular ejection fraction 55 ± 12 %) with end-stage coronary artery disease, chronic angina pectoris and reversible ischaemia on myocardial scintigraphy. CSWT was applied to the ischaemic zones (3–7 spots/session, 100 impulses/spot, 0.09 mJ/mm2) in an echocardiography-guided and ECG-triggered fashion. The protocol included a total of 9 treatment sessions (3 treatment sessions within 1 week at baseline, and after 1 and 2 months). Clinical assessment was performed using exercise testing, angina score (CCS class), nitrate use, myocardial scintigraphy, and cardiac magnetic resonance (CMR) 1 and 4 months after the last treatment session.ResultsOne and 4 months after CSWT, sublingual nitrate use decreased from 10/week to 2/week (p < 0.01) and the angina symptoms diminished from CCS class III to CCS class II (p < 0.01). This clinical improvement was accompanied by an improved myocardial uptake on stress myocardial scintigraphy (54.2 ± 7.7 % to 56.4 ± 9.4 %, p = 0.016) and by increased exercise tolerance at 4-month follow-up (from 7.4 ± 2.8 to 8.8 ± 3.6 min p = 0.015). No clinically relevant side effects were observed.ConclusionCSWT improved symptoms and reduced ischaemia burden in patients with end-stage coronary artery disease without relevant side effects. The study provides a solid basis for a randomised multicentre trial to establish CSWT as a new treatment option in end-stage coronary artery disease.

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Three patients presented with swelling of the leg after surgical removal of the greater saphenous vein (GSV): two of them after stripping of the GSV for varicosity, and one after harvesting the GSV for coronary artery bypass graft (CABG) surgery. Lymphoscintigraphic examination of the affected leg revealed impaired lymphatic drainage. Two of the subjects showed an impaired lymphatic drainage in both legs, suggesting a pre-existing dysplastic lymphatic system. We discuss and review the cause of lymphedema after venous surgery.

Objective: The values used to define white-coat and masked blood pressure (BP) effects are usually arbitrary. This study aimed at investigating the accuracy of various thresholds based on the differences (DBP) between office BP (OBP) and 24h-ambulatory BP monitoring (ABPM) to identify white-coat (WCH) and masked (MH) hypertension, which are phenotypes assumed to carry adverse prognosis. Design and method: This cross-sectional study included 11,350 [Derivation cohort; 45% men, mean age = 55.1 ± 14.1 years, OBP = 132.1 ± 17.6/83.9 ± 12.5 mmHg, ABPM = 121.6 ± 11.4/76.1 ± 9.6 mmHg, 25% using antihypertensive medications (AH)] and 7,220 [Validation cohort; 46% men, mean age = 58.6 ± 15.1 years, OBP = 136.8 ± 18.7/87.6 ± 13.0 mmHg, ABPM = 125.5 ± 12.6/77.7 ± 10.3 mmHg; 32% using AH] unique individuals who underwent OBP and ABPM measurements. We compared the sensitivity, specificity, positive (PPV) and negative (NPV) predictive values and area under the curve (AUC) of 8 different ↗BP thresholds to detect WCH (↗systolicBP/↗diastolicBP = +28/+17, +20/+15, +20/+10, +16/+11, +15/+9, +14/+9 mmHg and ↗systolicBP = +13 and +10 mmHg) and eight different ↗BP thresholds to detect MH (↗systolicBP/↗diastolicBP = -14/-9, -5/-2, -3/-1, -1/-1, 0/0, +2/+2 mmHg and ↗systolicBP = -5 and -3 mmHg), built from formerly reported criteria in the literature. WCH was defined as OBP> = 140/90mmHg and ABPM < 130/80mmHg, and MH was defined as OBP < 140/90mmHg and ABPM> = 130/80mmHg. Results: The +20/+15 mmHg threshold showed the best AUC (0.804, 95%CI = 0.794 - 0.814) to detect WCH in the Derivation cohort, with sensitivity, specificity, PPV and NPV of 80.6%, 80.2%, 42.3%, and 95.8%, respectively. The +2/+2 mmHg threshold showed the highest AUC (0.741, 95%CI = 0.728 - 0.754) to detect MH, with sensitivity, specificity, PPV and NPV of 78.9%, 69.3%, 22.0% and 96.8%, respectively. Both threshold values also had the best accuracy to detect WCH (0.767, 95%CI = 0.754 - 0.780) and MH (0.767, 95%CI = 0.750 - 0.784) in the Validation cohort. In secondary analyses, these thresholds had the best accuracy to detect WCH and MH in individuals using or not AH, and to detect individuals with higher and lower office-than-home BP stages, respectively, in both cohorts. Conclusions: The +20/+15 and +2/+2 mmHg ↗BP thresholds had the best accuracy to detect hypertensive patients with WCH and MH, respectively, and may be indicators of marked white-coat and masked BP effects.