Kaller M, Faber L, Bogunovic N, Horstkotte D, Burchert W, Lindner Oliver
Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center North Rhine-Westphalia, University Hospital of the Ruhr-University Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany.
Clinic for Cardiology, Heart and Diabetes Center North Rhine-Westphalia, University Hospital of the Ruhr-University Bochum, Bad Oeynhausen, Germany.
Clin Res Cardiol. 2015 Oct;104(10):843-9. doi: 10.1007/s00392-015-0853-0. Epub 2015 Apr 17.
Ultrasound guided cardiac shock wave therapy (CSWT) is a noninvasive therapeutic option in the treatment of chronic-refractory angina. Clinical trials have shown that CSWT reduces angina symptoms, improves regional systolic function, LV ejection fraction, myocardial perfusion and quality of life parameters. Absolute measurements of myocardial perfusion before and after CSWT have not been performed so far.
We studied a total of 21 CCS III patients with history of CAD and multiple interventions who suffered from disabling angina despite individually optimized medical therapy. An N-13 NH3 PET perfusion scan under adenosine was performed before and after CSWT treatment. CSWT was well tolerated in all patients. Absolute perfusion under adenosine of the global left-ventricular myocardium did not change under therapy or minimal coronary resistance. The treated segments, however, showed in terms of both perfusion and resistance a mild but significant improvement, by 11 and 15 %, respectively, whereas no change could be observed in the remote segments. Considering a threshold of increased perfusion of 5 %, 10 (77 %) out of 13 patients with a better target perfusion improved in their CCS class, whereas 3 (43 %) out of 7 patients without improved target perfusion improved in their CCS class too.
Standard CSWT has the potential to improve myocardial perfusion of the therapy zone and clinical CAD symptomatology without affecting global myocardial perfusion. As a noninvasive and well tolerated therapeutic option, these data suggest the use of CSWT in patients with end-stage CAD.
超声引导下心脏冲击波疗法（CSWT）是治疗慢性难治性心绞痛的一种非侵入性治疗选择。临床试验表明，CSWT可减轻心绞痛症状，改善局部收缩功能、左心室射血分数、心肌灌注和生活质量参数。迄今为止，尚未对CSWT前后的心肌灌注进行绝对测量。
我们共研究了21例有冠心病病史且接受过多次干预的加拿大心血管学会（CCS）III级患者，尽管他们接受了个体化优化药物治疗，但仍患有致残性心绞痛。在CSWT治疗前后，在腺苷负荷下进行了N-13氨正电子发射断层扫描（PET）灌注扫描。所有患者对CSWT耐受性良好。在治疗过程中或最小冠状动脉阻力情况下，腺苷负荷下左心室整体心肌的绝对灌注没有变化。然而，治疗节段在灌注和阻力方面均显示出轻度但显著的改善，分别提高了11%和15%，而在远离节段未观察到变化。考虑到灌注增加5%的阈值，13例目标灌注改善较好的患者中有10例（77%）CCS分级得到改善，而7例目标灌注未改善的患者中有3例（43%）CCS分级也得到改善。
标准CSWT有潜力改善治疗区域的心肌灌注和临床冠心病症状，而不影响整体心肌灌注。作为一种非侵入性且耐受性良好的治疗选择，这些数据表明CSWT可用于终末期冠心病患者。
