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Cardiac shockwave therapy in patients with chronic refractory angina pectoris

(2016) NETHERLANDS HEART JOURNAL. 24(5). p.343-349
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Abstract
Background: Cardiac 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. Methods: We 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/mm(2)) 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. Results: One 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. Conclusion: CSWT 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.
Keywords
Angina, stable, Myocardial ischaemia, Radionuclide imaging, Echocardiography, Shock Waves, Ultrasonic, CORONARY-ARTERY-DISEASE, WAVE THERAPY, MYOCARDIAL-PERFUSION, VENTRICULAR-FUNCTION, HEART-FAILURE, DOUBLE-BLIND, TRIAL, ISCHEMIA, EFFICACY, MULTICENTER

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Chicago
Vainer, J, JHM Habets, S Schalla, AHP Lousberg, CDJM de Pont, SA Voo, Boudewijn Brans, JCA Hoorntje, and J Waltenberger. 2016. “Cardiac Shockwave Therapy in Patients with Chronic Refractory Angina Pectoris.” Netherlands Heart Journal 24 (5): 343–349.
APA
Vainer, J., Habets, J., Schalla, S., Lousberg, A., de Pont, C., Voo, S., Brans, B., et al. (2016). Cardiac shockwave therapy in patients with chronic refractory angina pectoris. NETHERLANDS HEART JOURNAL, 24(5), 343–349.
Vancouver
1.
Vainer J, Habets J, Schalla S, Lousberg A, de Pont C, Voo S, et al. Cardiac shockwave therapy in patients with chronic refractory angina pectoris. NETHERLANDS HEART JOURNAL. 2016;24(5):343–9.
MLA
Vainer, J et al. “Cardiac Shockwave Therapy in Patients with Chronic Refractory Angina Pectoris.” NETHERLANDS HEART JOURNAL 24.5 (2016): 343–349. Print.
@article{8510160,
  abstract     = {Background: Cardiac 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. 
Methods: We 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/mm(2)) 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. 
Results: One 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. 
Conclusion: CSWT 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.},
  author       = {Vainer, J and Habets, JHM and Schalla, S and Lousberg, AHP and de Pont, CDJM and Voo, SA and Brans, Boudewijn and Hoorntje, JCA and Waltenberger, J},
  issn         = {1568-5888},
  journal      = {NETHERLANDS HEART JOURNAL},
  keywords     = {Angina,stable,Myocardial ischaemia,Radionuclide imaging,Echocardiography,Shock Waves,Ultrasonic,CORONARY-ARTERY-DISEASE,WAVE THERAPY,MYOCARDIAL-PERFUSION,VENTRICULAR-FUNCTION,HEART-FAILURE,DOUBLE-BLIND,TRIAL,ISCHEMIA,EFFICACY,MULTICENTER},
  language     = {eng},
  number       = {5},
  pages        = {343--349},
  title        = {Cardiac shockwave therapy in patients with chronic refractory angina pectoris},
  url          = {http://dx.doi.org/10.1007/s12471-016-0821-y},
  volume       = {24},
  year         = {2016},
}

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