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

• DOI: 10.1111/echo.14054
• Publication Date: 2018-07-02T06:49:03Z
• Authors: Anderson S. Duque; Conrado L. Ceccon; Wilson Mathias; Joana Diniz Majesky; Luis H. Gowdak; João C. N. Sbano; Luis Antonio Mach...; Maria Cristina Ab...; Márcio S. M. Lima; Paulo M. M. Dourado; Cecilia B. B. V. ...; Jeane M. Tsutsui
• Keywords: Extracorporeal Shockwave Therapy; Male; Technetium Tc 99m Sestamibi; Tomography, Emission-Computed, Single-Photon; Heart Ventricles; Heart; Middle Aged; Angina Pectoris; 3. Good health; Ventricular Dysfunction, Left; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Echocardiography; Humans; Female; Prospective Studies; Radiopharmaceuticals

BackgroundCardiac shockwave therapy (CSWT) is a new potential option for the treatment of patients with chronic coronary disease and refractory angina (RA). We aimed to study the effects of CSWT on left ventricular myocardial perfusion and mechanics in patients with RA.MethodWe prospectively studied 19 patients who underwent CSWT. Left ventricular mechanics were evaluated by speckle tracking echocardiography (STE), and myocardial perfusion by single‐photon emission computed tomography, using stress/rest–Technetium‐99 m Sestamibi, for determination of summed stress score (SSS). Canadian Cardiac Society (CCS), New York Heart Association (NYHA), and quality of life by Seattle Angina Questionnaire (SAQ) were assessed at baseline and 6 months after therapy.ResultsCSWT therapy was applied without major side effects. At baseline, 18 patients (94.7%) had CCS class III or IV, and after CSWT there was reduction to 3 (15.8%), P = .0001, associated with improvement in SAQ (38.5%; P < .001). Thirteen (68.4%) had class NYHA III or IV before treatment, with significant reduction to 7 (36.8%); P = .014. No change was observed in the global SSS from baseline to 6‐month follow‐up (15.33 ± 8.60 vs 16.60 ± 8.06; P = .157). However, there was a significant reduction in the average SSS of the treated ischemic segments (2.1 ± 0.87 pre vs 1.6 ± 1.19 post CSWT; P = .024). Global longitudinal strain by STE remained unaltered (‐13.03 ± 8.96 pre vs ‐15.88 ± 3.43 6‐month post CSWT; P = .256).ConclusionCSWT is a safe procedure for the treatment of patients with RA that results in better quality of life, improvement in myocardial perfusion of the treated segments with preservation of left ventricular mechanics.