BACKGROUND: Medical therapy for refractory angina is limited and the prognosis is poor. Experimental data suggest that the use of extracorporeal shockwave myocardial revascularization (ESMR) can contribute to angiogenesis and improve symptoms of angina and left ventricular (LV) function. The objective of this study was to examine the effects of ESMR on clinical symptoms as well as LV function as assessed by cardiac MRI in patients with refractory angina. METHODS: Patients with Canadian Cardiovascular Society (CCS) class III-IV angina despite medical therapy and ischemia documented on thallium or echo-dobutamine were eligible for the study. ESMR therapy was applied with a commercially available cardiac shockwave generator system under echocardiographic guidance. LV function was assessed before and 6 months after therapy by cardiac MRI. RESULTS: Twenty patients (four women, 16 men; mean age 64 years, range 45-83) were included in the study. The CCS class after treatment improved in all patients (16 patients angina pectoris CCS from III to II and four patients from IV to III). The use of sublingual nitroglycerin was significantly reduced as well. There was a significant improvement in LV ejection fraction as assessed by blinded MRI following therapy in the overall population (51 vs. 59%, P<0.05). CONCLUSION: This study demonstrates the potential efficacy of ESMR for the treatment of refractory angina pectoris. The patients showed both a significant clinical response as well as improved LV ejection fraction on serial MRI imaging. Larger studies are needed to adequately define the clinical utility of this novel therapy.
BACKGROUND: Medical therapy for refractory angina is limited and the prognosis is poor. Experimental data suggest that the use of extracorporeal shockwave myocardial revascularization (ESMR) can contribute to angiogenesis and improve symptoms of angina and left ventricular (LV) function. The objective of this study was to examine the effects of ESMR on clinical symptoms as well as LV function as assessed by cardiac MRI in patients with refractory angina. METHODS:Patients with Canadian Cardiovascular Society (CCS) class III-IV angina despite medical therapy and ischemia documented on thallium or echo-dobutamine were eligible for the study. ESMR therapy was applied with a commercially available cardiac shockwave generator system under echocardiographic guidance. LV function was assessed before and 6 months after therapy by cardiac MRI. RESULTS: Twenty patients (four women, 16 men; mean age 64 years, range 45-83) were included in the study. The CCS class after treatment improved in all patients (16 patientsangina pectoris CCS from III to II and four patients from IV to III). The use of sublingual nitroglycerin was significantly reduced as well. There was a significant improvement in LV ejection fraction as assessed by blinded MRI following therapy in the overall population (51 vs. 59%, P<0.05). CONCLUSION: This study demonstrates the potential efficacy of ESMR for the treatment of refractory angina pectoris. The patients showed both a significant clinical response as well as improved LV ejection fraction on serial MRI imaging. Larger studies are needed to adequately define the clinical utility of this novel therapy.
Authors: Xin Zhang; James D Krier; Carolina Amador Carrascal; James F Greenleaf; Behzad Ebrahimi; Ahmad F Hedayat; Stephen C Textor; Amir Lerman; Lilach O Lerman Journal: J Am Soc Nephrol Date: 2016-06-13 Impact factor: 10.121
Authors: Megha Prasad; Wan Azman Wan Ahmad; Renan Sukmawan; Edward-Bengie L Magsombol; Andrew Cassar; Yuri Vinshtok; Muhammad Dzafir Ismail; Ahmad Syadi Mahmood Zuhdi; Sue Ann Locnen; Rodney Jimenez; Homobono Callleja; Amir Lerman Journal: Coron Artery Dis Date: 2015-05 Impact factor: 1.439
Authors: Andrew Cassar; Megha Prasad; Martin Rodriguez-Porcel; Guy S Reeder; Darshak Karia; Anthony N DeMaria; Amir Lerman Journal: Mayo Clin Proc Date: 2014-03 Impact factor: 7.616
Authors: Johannes Holfeld; Can Tepeköylü; Radoslaw Kozaryn; Anja Urbschat; Kai Zacharowski; Michael Grimm; Patrick Paulus Journal: Inflammation Date: 2014-02 Impact factor: 4.092
Authors: J Vainer; J H M Habets; S Schalla; A H P Lousberg; C D J M de Pont; S A Vöö; B T Brans; J C A Hoorntje; J Waltenberger Journal: Neth Heart J Date: 2016-05 Impact factor: 2.380