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

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.

Extracorporeal shockwave myocardial revascularization therapy in refractory angina patients

“…Left ventricle ejection fraction as assessed by cardiac MRI significantly improved too, as reported in a recent study [6]. Moreover, ESMR therapy reduces hospitalization in a patient with refractory angina [5]. Data collected in our centre confirms that ESMR is both a safe and an efficacious means and needs to be considered in refractory angina patients with documented myocardial inducible ischemia.…”

“…This leads to the release of angiogenesis-mediating growth factors (i.e., endothelial nitric oxide synthase and vascular endothelial growth factor) and induces the recruitment of endothelial progenitor cells [3]. Several studies already evaluated ESMR in refractory angina patients and they all agree in its efficacy and safety [4][5][6]. Patients refer a marked symptom improvement and a decreased nitrate intake after the treatment.…”

Extracorporeal Shock Wave Therapy: Non‐Urological Indications and Recent Trends

“…Cardiac shock wave therapy (CSWT)-which is also known as extracorporeal shockwave myocardial revascularization (ESMR)-represents a recent option for the treatment of refractory angina [17,18]. Alunni et al [17] performed a prospective case-control study over 6 months.…”

“…Alunni et al [17] performed a prospective case-control study over 6 months. They studied the eicacy of ESMR on cardiac perfusion in 72 patients with refractory angina (RA), 43 patients in the ESMR group and 29 in the control group (did not receive ESMR).…”

“…Urolithiasis is not the only application for extracorporeal shock waves, but there are also other applications for it. Extracorporeal shock wave is used for the treatment of gall bladder stones [9], common bile duct stone clearance [10], pancreatic calculi [11,12], salivary stones [13,14], erectile dysfunction [15,16], refractory angina pectoris [17,18], and chronic wound healing [19,20].…”