Cardiac shock wave therapy for chronic refractory angina pectoris. a prospective placebo-controlled randomised trial
Cardiovascular Therapeutics,  Clinical Article

Schmid JP et al. – This placebo controlled trial shows a significant improvement in symptoms, quality of life parameters and ischemic threshold during exercise in patients with chronic refractory angina pectoris treated with cardiac shock wave therapy (CSWT). Thus, CSWT represents a new option for the treatment of patients with refractory AP.

Methods
  • 21 patients (mean age 68.2±8.3 years, 14 males) with chronic refractory angina pectoris and evidence of inducible myocardial ischemia during MIBI–SPECT imaging, were randomised into a treatment (n = 11) and a placebo arm (n = 10).
  • The region of exercise induced ischemia was treated with echocardiographic guidance during nine sessions over a period of 3 months.
  • One session of CSWT consisted of 200 shots/ spot with an energy intensity of 0.09 mJ/ mm2.
  • In the control group acoustic simulation was performed without energy application.
  • Medication was kept unchanged during the whole treatment period.

Results
  • In the treatment group, symptoms improved in 9/11 patients, and the ischemic threshold, determined by cardiopulmonary exercise stress testing, increased from 80±28 to 95±28 W (p = 0.036).
  • In the placebo arm, only 2/10 patients reported an improvement and the ischemic threshold remained unchanged (98±23 to 107±23 W; p = 0.141).
  • The items “physical functioning” (p = 0.043), “general health perception” (p = 0.046) and “vitality” (p = 0.035) of the SF–36 questionnaire significantly improved in the treatment arm, whereas in the placebo arm, no significant change was noted.
  • Neither arrhythmias, troponin rise nor complications were observed during treatment.

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