BaCKgroUNd: extracorporeal shockwave myocardial revascularization (eSMr) is a non-invasive treatment designed to improve symptoms in refractory angina (ra) patients. enhanced perfusion through local vasodilation and neo-capillarization is postulated to be the mechanism of the observed clinical benefit. However, the impact of ESMR on the ischemic burden of ra patients has not been adequately assessed. MeTHodS: one-hundred twenty-one consecutive ra patients suitable for eSMr were treated. Twenty-nine ra patients not suitable for treatment were clinically followed-up as a control group for clinical endpoints. eSMr-treated patients underwent baseline and 6-month single photon emission computed tomography (SPeCT) to evaluate the changes in ischemic burden. The operator was blinded to the pre/post-treatment status of the SPeCT exam. The primary endpoint was the difference in summed stress score (SSS) and summed difference score (SdS) between follow-up and baseline SPeCTs. Secondary endpoints included the changes in Canadian Cardiovascular Society (CCS) angina class and nitroglycerin use between 6-month follow-up and baseline. Clinical endpoints were further compared between eSMr-treated patients and the control group. RESULTS: Following ESMR, a significant reduction in the ischemic burden was observed (follow-up SSS: 14.2±10 vs. baseline SSS: 21.2±9.42, P<0.0001; follow-up SDS: 4.6±5.9 vs. baseline SDS 10.2±7.9, P<0.0001) including less patients with moderate to severe ischemia (19% vs. 46% P<0.0001). CCS class and nitroglycerin use were significantly reduced (CCS: 1.5±0.6 vs. 2.7±0.6, P<0.0001; patients needing nitroglycerin: 24% vs. 64%, P<0.0001). When compared to the control group, CCS class reduction, nitroglycerin use and hospitalizations were significantly lower for ESMR treated vs. non-treated ra patients at 6-month follow-up. CoNClUSioNS: in this single-center cohort of ra patients undergoing eSMr treatment and serial myocardial perfusion imaging, ESMR was associated with a significant reduction in the ischemic burden. These findings provide a physiological rationale and mechanism for the observed clinical benefit.
impact of extracorporeal shockwave myocardial revascularization on the ischemic burden of refractory angina patients: A single photon emission computed tomography study
Alunni G.;Fioravanti F.;Gallone G.;Marra S.;de Ferrari G. M.
2020-01-01
Abstract
BaCKgroUNd: extracorporeal shockwave myocardial revascularization (eSMr) is a non-invasive treatment designed to improve symptoms in refractory angina (ra) patients. enhanced perfusion through local vasodilation and neo-capillarization is postulated to be the mechanism of the observed clinical benefit. However, the impact of ESMR on the ischemic burden of ra patients has not been adequately assessed. MeTHodS: one-hundred twenty-one consecutive ra patients suitable for eSMr were treated. Twenty-nine ra patients not suitable for treatment were clinically followed-up as a control group for clinical endpoints. eSMr-treated patients underwent baseline and 6-month single photon emission computed tomography (SPeCT) to evaluate the changes in ischemic burden. The operator was blinded to the pre/post-treatment status of the SPeCT exam. The primary endpoint was the difference in summed stress score (SSS) and summed difference score (SdS) between follow-up and baseline SPeCTs. Secondary endpoints included the changes in Canadian Cardiovascular Society (CCS) angina class and nitroglycerin use between 6-month follow-up and baseline. Clinical endpoints were further compared between eSMr-treated patients and the control group. RESULTS: Following ESMR, a significant reduction in the ischemic burden was observed (follow-up SSS: 14.2±10 vs. baseline SSS: 21.2±9.42, P<0.0001; follow-up SDS: 4.6±5.9 vs. baseline SDS 10.2±7.9, P<0.0001) including less patients with moderate to severe ischemia (19% vs. 46% P<0.0001). CCS class and nitroglycerin use were significantly reduced (CCS: 1.5±0.6 vs. 2.7±0.6, P<0.0001; patients needing nitroglycerin: 24% vs. 64%, P<0.0001). When compared to the control group, CCS class reduction, nitroglycerin use and hospitalizations were significantly lower for ESMR treated vs. non-treated ra patients at 6-month follow-up. CoNClUSioNS: in this single-center cohort of ra patients undergoing eSMr treatment and serial myocardial perfusion imaging, ESMR was associated with a significant reduction in the ischemic burden. These findings provide a physiological rationale and mechanism for the observed clinical benefit.
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