Effectiveness and Safety of Extracorporeal Shockwave Myocardial Revascularization in Patients With Refractory Angina Pectoris and Heart Failure

• Published in: The American journal of cardiology Vol. 144; pp. 26 - 32
• Main Authors: Martínez-Sánchez, Carlos, Azar-Manzur, Francisco, González-Pacheco, Héctor, Amezcua-Guerra, Luis M, Massó, Felipe, Márquez-Velasco, Ricardo, Bojalil, Rafael, Carvajal-Juárez, Isabel, Alexanderson-Rosas, Erick, Hernández, Salvador, Paez-Arenas, Araceli, López-Mora, Enrique, Venegas-Román, Alejandra, Brianza-Padilla, Malinalli, Gopar-Nieto, Rodrigo, Sandoval, Julio
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-04-2021; Elsevier Limited
• Subjects: Aged; Angina; Angina pectoris; Angina Pectoris - complications; Angina Pectoris - diagnostic imaging; Angina Pectoris - metabolism; Angina Pectoris - therapy; Angiogenesis; Angiopoietin; Angiopoietin-like Proteins - metabolism; Biomarkers; Cardiac stress tests; Cardiovascular disease; Cells (biology); Congestive heart failure; Coronary artery; Coronary artery disease; Coronary Artery Disease - complications; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - metabolism; Coronary Artery Disease - therapy; Coronary vessels; Cytokines - metabolism; Electrocardiography; Endothelial Progenitor Cells; Extracorporeal Shockwave Therapy - methods; Female; Heart failure; Heart Failure - complications; Heart Failure - metabolism; Heart Failure - physiopathology; Humans; Hypotheses; Interleukin 18; Interleukin-18 - metabolism; Interleukin-1beta - metabolism; Ischemia; Lipoxin A4; Lipoxins - metabolism; Male; Middle Aged; Myocardial ischemia; Myocardial Perfusion Imaging; Myocardial Revascularization - methods; Patients; Perfusion; Progenitor cells; Prospective Studies; Proteins; Radioisotopes; Safety; Severity of Illness Index; Shock waves; Side effects; Stem cells; Stroke Volume; Therapy; Transforming Growth Factor beta - metabolism; Treatment Outcome; Tumor necrosis factor-TNF; Vascular endothelial growth factor; Vascular Endothelial Growth Factor A - metabolism; Ventricle; Ventricular Dysfunction, Left - complications; Ventricular Dysfunction, Left - metabolism; Ventricular Dysfunction, Left - physiopathology; Walk Test; United States > US; Texas
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2020.12.065

Extracorporeal shockwave myocardial revascularization (ESMR) is a therapy for refractory angina pectoris. Our aim was to assess the efficacy and safety of ESMR in the management of patients with stable coronary artery disease (CAD) and heart failure as well as its effects on inflammation and angiogenesis. In this single-arm prospective trial, we included 48 patients with CAD, myocardial ischemia assessed by radionuclide imaging, echocardiographic evidence of left ventricular systolic dysfunction and without revascularization options. Changes in angina grading score, myocardial perfusion, left ventricular ejection fraction, and six-minute walk test after ESMR therapy were used for efficacy assessment. Changes of inflammation and angiogenesis biomarkers were also evaluated. ESMR therapy was performed using a commercially available cardiac shockwave generator system (Cardiospec; Medispec). After 9 weeks of ESMR therapy, a significant improvement was found regarding the initial angina class, severity of ischemia, left ventricular ejection fraction, and six-minute walk test in most patients. No deleterious side effects after treatment were detected. Regarding biomarkers, endothelial progenitor cells and angiopoietin-3 were significantly increased whereas IL-18 and TGF-β were significantly decreased after ESMR in the total group. Notably, VEGF, IL-1ß, and lipoxin A4 levels were significantly increased only in patients with myocardial ischemia improvement. In conclusion, ESMR therapy is safe and effective in most but not all patients with CAD and heart failure. ESMR is associated with increased markers of angiogenesis and decreased markers of inflammation. Myocardial ischemia improvement after ESMR is associated with increased markers of angiogenesis and pro-resolving mediators.