Extracorporeal shockwave myocardial therapy is efficacious in improving symptoms in patients with refractory angina pectoris – a multicenter study

Abstract

Objective Medically refractory angina remains a significant health concern despite major advances in revascularization techniques and emerging medical therapies. We aimed to determine the safety and efficacy of extracorporeal shockwave myocardial therapy (ESMT) in managing angina pectoris. Methods A single-arm multicenter prospective study was designed aiming to determine the safety and efficacy of ESMT. Patients of functional Canadian Cardiovascular Society class 11–IV, despite stable and optimal medical management, with documented myocardial segments with reversible ischemia and/or hibernation on the basis of echocardiography/single-photon emission computerized tomography (SPECT) were enrolled from 2010 to 2012. A total of 111 patients were enrolled, 33 from Indonesia, 21 from Malaysia, and 57 from Philippines. Patients underwent nine cycles of ESMT over 9 weeks. Patients were followed up for 3–6 months after ESMT treatment. During follow-up, patients were subjected to clinical evaluation, the Seattle Angina Questionnaire, assessment of nitrate intake, the 6-min walk test, echocardiography, and SPECT. Results The mean age of the population was 62.9 ± 10.9 years. The summed difference score on pharmacologically induced stress SPECT improved from 9.53 ± 17.87 at baseline to 7.77 ± 11.83 at follow-up (P = 0.0086). Improvement in the total Seattle Angina Questionnaire score was seen in 83% of patients (P < 0.0001). Sublingual nitroglycerin use significantly decreased (1.14 ± 1.01 tablets per week at baseline to 0.52 ± 0.68 tablets per week at follow-up; P = 0.0215). There were no changes in left ventricular function on echocardiography (0.33 ± 9.97, P= 0.93). The Canadian Cardiovascular Society score improved in 74.1% of patients. Conclusion This multicenter prospective trial demonstrated that ESMT is both a safe and an efficacious means of managing medically refractory angina.

Cardiac shock-wave therapy in the treatment of coronary artery disease: systematic review and meta-analysis

“…(2010) [31]Placebo controlled844.7±16.250.5±16.2WtVainer J. et al (2012) [63]Single arm508.2±3.29.6±3.8MinutesKazmi W.H. et al (2012) [71]Controlled4312.2±7.820.1±15.7MinutesYang P. et al (2012) [79]Randomized, Placebo controlled25339.44±83.3427.9±63.3MetersWang Y. et al (2012) [24] b Randomized, controlled31344.3±106.4434.3±99.7MetersSchmid J.P. et al (2013) [78]Randomized, Placebo controlled1191.2±29.194.1±35.2WtPrinz C. et al (2013) [66]Single arm4378±5390±46WtCassar A. et al (2014) [27] Single arm15319.8±157.2422.1±183.3SecondsZhao L. et al (2015) [74] b Randomized, controlled32343.9±85.0489.4±72.2SecondsPrasad M. et al (2015) [68]Single arm111252.1±51.6 c 313.5±164.3Seconds457.0±146.8 d 606.0±126.4Kaller M. et al (2015) [49]Single arm1693±44101±41WtCai HY. et al (2015) [30]Single arm26360.7±116.8434.2±86.3MetersNirala S. et al (2016) [73]Controlled41336.7±120.5445.8±172.4MetersVainer J. et al (2016) [70]Single arm337.4±2.88.8±3.6Minutes

All valuables presented as mean ± SD, a valuable presented as mean ± SE, SE calculated into SD using standard formulas; b grou...

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The effects of microenergy acoustic pulses on animal model of obesity‐associated stress urinary incontinence. Part 2: In situ activation of pelvic floor and urethral striated muscle progenitor cells

“…9 Research works demonstrated that activation of Wnt/β-catenin signaling enhances myogenesis, 10 increases myoblast proliferation, and enhances muscle growth, 11,12 whereas, it has been reported that Wnt/β-catenin signaling can be activated by mechanotransduction. 13,14 Low-intensity extracorporeal shockwave therapy (Li-ESWT) is one example of a mechanical force that has been employed for many years to treat musculoskeletal disorders, 15 ischemic heart disease, 16,17 and vasculogenic ED. 18,19 We previously reported that Li-ESWT activated penile stem cells 20,21 and very recently, we have applied Li-ESWT effectively to improve SUI.…”

Cardiac shock wave therapy improves myocardial perfusion and preserves left ventricular mechanics in patients with refractory angina: A study with speckle tracking echocardiography

“…Other limitation of the current study is the lack of a sham arm, making it difficult to exclude the partial placebo effect. However, those benefits were associated and supported by objective data such as the improvement in SPECT/CT perfusion score demonstrated in other studies …”

“…However, those benefits were associated and supported by objective data such as the improvement in SPECT/CT perfusion score demonstrated in other studies. 18,19,24 It is important to note that CSWT is still an experimental therapy, with very few patients currently treated with this modality compared with other strategies used in refractory angina, and its long-term prognosis still remains unknown. A longer follow-up and the assessment of long-term effect on quality of life in a large randomized study should be considered.…”