EXTRACORPOREAL SH0CKWAVE MYOCARDIAL REVASCULARIZATION IN PATIENTS WITH ISCHEMIC HEART DISEASE: THE ST. LUKE

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EXTRACORPOREAL SH0CKWAVE MYOCARDIAL
REVASCULARIZATION IN PATIENTS WITH ISCHEMIC HEART
DISEASE THE ST. LUKES EXPERIENCE

• Palamine, M.T, Armada, F., Jimenez, R. Locnen,
  SA. , Magsombol,EB.,
• and Calleja, HB.
• St. Lukes Heart Institute

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We need more tools to bridge the gap.

Wide Variability of Outcomes Pertaining to
symptom relief among Interventional Studies
Wijeysundera HC et al. Ann Intern Med.
2010152370-379.
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Cardiospec System Components
A New Option to Achieve Revascularization ESMR

Shock Wave Applicator
User Control Panel
ECG Remote Control Unit
Ultrasound Probe Holder
ECG Monitor
Treatment Table
Shock Wave Power Unit Cabinet
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Collateral Development Post SWs in Rabbits
Nishida T, Shimokawa H et al. Circulation.
20041103055-3061
Tohoku J Exp Med. 2008 Feb 214 (2)151-8
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Background

• This study documents our experience with ESMR in
  patients with known Coronary Artery Disease,
  Refractory Angina Pectoris and Ischemic Heart
  Failure.

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Methods

• Inclusion Criteria
• CAD
• Ischemic cardiomyopathy
• Ischemic heart failure
• Refractory angina
• SPECT-documented reversible ischemia

• Exclusion criteria
• Non ischemic cardiomyopathy
• Decompensated heart failure
• Intraventricular thrombus
• Malignancy

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Methods
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Methods
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Results

• Table 1. Patient Demographics

• Table 2. Revascularization History

Revascularization History Number of Patients (n53)
Post-CABG 23
Post-PCI 12
Post CABG PCI 6
None 12
The mean age was 65.89 11.24 years.
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Table 4. ESMR Significantly improves symptoms
Seattle Angina Questionnaire
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Table 5. SPECT Analysis and LDEDV Measurement
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Table 6. Wilcoxon Signed Ranks Test- SIZE AND
SEVERITY OF ISCHEMIA
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6 mos Post ESMR
Pre ESMR
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Pre ESMR and Post ESMR
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Pre-ESMR
3 months Post-ESMR
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Results

• All patients tolerated the treatment well.
• No ECG changes, new wall motion abnormalities,
  and adverse events were reported.

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Conclusion

• Our experience with ESMR showed promising results
  for patients with CAD, ischemic cardiomyopathy
  and ischemic heart failure patients with
  refractory angina.
• ESMR improved symptoms, delayed the ischemic
  threshold and increased exercise tolerance and
  improved myocardial perfusion.
• ESMR appeared safe and may improve symptoms which
  could lead to less hospitalizations.

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Thank you for your kind attention!
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Results

• Table 3. Co-morbitdities