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INITIAL CLINICAL RESULTS OF EXTRACORPOREAL SHOCK WAVE THERAPY IN TREATMENT OF CHRONIC ISCHEMIC HEART DISEASE... The aim of the study shock wave therapy in treatment of chronic ischemic h

INITIAL CLINICAL RESULTS OF EXTRACORPOREAL SHOCK WAVE THERAPY IN TREATMENT OF CHRONIC

ISCHEMIC HEART DISEASE

PRESENTATION CONTENT

 Background

 Overview

 Objective and method

 Results and discussions

 Conclusions

• CAD is a common disease with high risk complications and mortality

• In 2004, CAD caused 1.6 millions death in Europe.

• 3 main treatments: Medical therapy, CABG and PCI.

• A numbers of patients are unsuitable for PCI or CABG

the others even undergone with revascularization and optimal medical therapy still suffer from refractory

Shock Waves Characteristics

Shock waves energy

Physiological Effect

Shock waves

↓ Intracellular & Extracellular responses

↓ Stimulates endothelial Nitric Oxide Synthase (eNOS)

↓ Release of Vascular Endothelial Growth Factors (VEGF)

↓

Angiogenesis

Main Physiological Effects

Short Term

Effect Local Vasodilatation

Long Term

Effect

Angiogenesis

The aim of the study

shock wave therapy in treatment of chronic ischemic heart disease

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Objective and method

 Objective: 20 refractory angina patients with multiple vessel disease treated in the 108 Military Central Hospital from 05/2013 to 05/2014

 Method: A open label and prospective study

 Echocardiography

 SPECT imaging

Steps of studying

 Treated with ESWT , complications were assessed: rise

of cardiac enzyme (blood taken after 6 hours, monitor was recorded during therapy)

 All patients followed up after 3 months assessed by

- Clinical parameters

- Echocardiography

Main Arm

User Control Panel

XY Attachment

Shock Wave Applicator Motorized Arm

ECG & ECG

Remote

Control Unit

Ultra-Sound Probe Holder

ESWT

Treatment Protocol

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3 treatments per week at 3-5 ischemic zones, 100 shocks per zone

Week 6

3 months follow-up

Clinical: Angina, NYHA

exercise tolerance, breathlessness

Paraclinicals:

Blood tests, Ultrasound, SPECT

Treated by ESWT and

3 months follow-up

Demographics of patients

RESULTS AND DISSCUSION

Mean age: 78.5 ± 8.7

Table 1: patient’s characteristics

RESULTS AND DISSCUSION

Table 2: Clinicals and risk factors

Clinical and risk factors (n) (%)

Table 3: A number of vessel disease involved

Degree of diffuse lesions CA (n) (%)

RESULTS AND DISSCUSIONS

CAD disease

RESULTS AND DISSCUSIONS

Table 4: Characteristic of myocardial perfusion defects with gated SPECT

Characteristic of MP defects (n) (%) Recovery Reversible perfusion defects 17 85

Mixed perfusions defects 3 15

Table 5: improvement of clinical symtomps

after 3 month’s treatment

 Leon MB and et al: 28 CAD patients treated with ESWT,

numbers of angina, time of angina decreased (45 % 45 % ± 23 to 6%

± 20%)

RESULTS AND DISSCUSIONS

Improvement of clinical symtomps

after 3 months treatment

Wall motion score 21.68± 6.54 13.96 ± 3.89 <0.05

RESULTS AND DISSCUSIONS

Table 7: SPECT imaging before and after treatment

Parameters Before

X ± SD X ± SD After P

RESULTS AND DISSCUSIONS

BEFORE AFTER

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 The old MI patient with very low EF (20%): before; severe,

large extension defect at lateral,inferior, septal segments

 After: recovered at septal and inferior during rest phase and stress phase, EF (28%)

BEFORE AFTER

Another patient: refractory angina, no prior revascularization, multiple vessel disease: - before: severe, large extension defect at

 Complications:

 No rise of cardiac enzymes were observed

 No arrhythmias were recorded.

RESULTS AND DISSCUSIONS

1.ESWT in treatment of chronic ischemic heart

CONCLUSION

Thanks you for your attention!