Results of low intensity extracorporeal shock wave therapy in patients with refractory angina

Authors

  • Eduardo Rodríguez González
  • Luis M. Reyes Hernández
  • Lilian Rodríguez González
  • Ana M. Correa Morales
  • Yannelys C. Gómez García
  • Tomás J. Pérez García

Abstract

Introduction: Low intensity extracorporeal shock wave therapy has proven useful in the treatment of patients with refractory angina pectoris.

Objective: To assess the results of this type of therapy in patients with refractory angina to drug treatment.

Method: A quasi-experimental study was carried out in 30 patients with refractory angina pectoris to treatment, selected in a non-probabilistic way, taking into account the following inclusion criteria. All patients were applied low intensity extracorporeal shock wave therapy in the Cardiocentro Ernesto Guevara of Santa Clara, in the period from January to December 2017. Epidemiological, clinical and echocardiographic variables were analyzed at the beginning of the treatment and six months after it was completed.

Results: The results obtained demonstrated an improvement of the functional class (FC) of the Canadian Cardiovascular Society (CCS). Previous to treatment, 76.7% of patients had a FC III and 23.3% a FC IV, and after six months of completed therapy, 73.3% improved to FC II and only 26.7 % remained in FC III. There was also an improvement with respect to echocardiographic parameters such as regional motility and left ventricular ejection fraction, which, in men, of an average at the start of therapy of 37.81% it reached 44.14% at six months of completed; and in women, of an average of 37.11% initially, it reached 47.22 % six months later.

Conclusions: The treatment with shock waves represents a therapeutic alternative for patients with refractory angina.

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References

1. Kloner RA, Chaitman B. Angina and its management. J Cardiovasc Pharmacol Ther. 2017;22(3):199-209.

2. Finegold JA, Asaria P, Francis DP. Mortality from ischaemic heart disease by country, region, and age: Statistics from World Health Organisation and United Nations. Int J Cardiol. 2013;168(2):934-45.

3. Park KE, Conti CR. Non-PCI/CABG therapies for refractory angina. Trends Cardiovasc Med. 2018;28(3):223-8.

4. Henry TD, Satran D, Jolicoeur EM. Treatment of refractory angina in patients not suitable for revascularization. Nat Rev Cardiol. 2014;11(2):78-95.

5. Kikuchi Y, Ito K, Shindo T, Hao K, Shiroto T, Matsumoto Y, et al. A multicenter trial of extracorporeal cardiac shock wave therapy for refractory angina pectoris: report of the highly advanced medical treatment in Japan. Heart Vessels. 2019;34(1):104-13.

6. Burneikaitė G, Shkolnik E, Čelutkienė J, Zuozienė G, Butkuvienė I, Petrauskienė B, et al. Cardiac shock-wave therapy in the treatment of coronary artery disease: systematic review and meta-analysis. Cardiovasc Ultrasound [Internet]. 2017 [citado 14 Ene 2019];15(1):11. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5389112/pdf/12947_2017_Article_102.pdf

7. Yahata K, Kanno H, Ozawa H, Yamaya S, Tateda S, Ito K, et al. Low-energy extracorporeal shock wave therapy for promotion of vascular endothelial growth factor expression and angiogenesis and improvement of locomotor and sensory functions after spinal cord injury. J Neurosurg Spine. 2016 Dec;25(6):745-55.

8. Zhang C, Liu X, Wang X, Wang Q, Zhang Y, Ge Z. Efficacy of enhanced external counterpulsation in patients with chronic refractory angina on Canadian Cardiovascular Society (CCS) Angina Class: An updated meta-analysis. Medicine (Baltimore) [Internet]. 2015 [citado 14 Ene 2019];94(47):e2002. Disponible en: http://doi.org/10.1097/MD.0000000000002002

9. Kloppe A, Lawo T, Mijic D, Schiedat F, Muegge A, Lemke B. Long-term survival with Cardiac Contractility Modulation in patients with NYHA II or III symptoms and normal QRS duration. Int J Cardiol. 2016;209:291-5.

10. Myhr KA, Pedersen FH, Kristensen CB, Visby L, Hassager C, Mogelvang R. Semi-automated estimation of left ventricular ejection fraction by two-dimensional and three-dimensional echocardiography is feasible, time-efficient, and reproducible. Echocardiography. 2018;35(11):1795-805.

11. Tarkin JM, Kaski JC. Nicorandil and Long-acting Nitrates: Vasodilator Therapies for the Management of Chronic Stable Angina Pectoris. Eur Cardiol. 2018;13(1):23-28.

12. Church CC. A theoretical study of cavitation generated by an extracorporeal shock wave lithotripter. J Acoust Soc Am. 1989;86(1):215-27.

13. Crum LA. Cavitation microjets as a contributory mechanism for renal calculi disintegration in ESWL. J Urol. 1988;140(6):1587-90.

14. Jaalouk DE, Lammerding J. Mechanotransduction gone awry. Nat Rev Mol Cell Biol. 2009;10(1):63-73.

15. Ruiz-Garcia J, Lerman A. Cardiac shock-wave therapy in the treatment of refractive angina pectoris. Interv Cardiol. 2011;3(2):191-201.

16. Mittermayr R, Antonic V, Hartinger J, Kaufmann H, Redl H, Téot L, et al. Extracorporeal shock wave therapy (ESWT) for wound healing: technology, mechanisms, and clinical efficacy. Wound Repair Regen. 2012;20(4):456-65.

17. Takakuwa Y, Sarai M, Kawai H, Yamada A, Shiino K, Takada K, et al. Extracorporeal shock wave therapy for coronary artery disease: Relationship of symptom amelioration and ischemia improvement. Asia Ocean J Nucl Med Biol.;6(1):1-9.

18. Zuozienė G, Laucevičius A, Leibowitz D. Extracorporeal shockwave myocardial revascularization improves clinical symptoms and left ventricular function in patients with refractory angina. Coron Artery Dis. 2012;23(1):62-7.

19. Silveira Duque A. Efeitos da terapia com ondas de choque na mecânica ventricular avaliada pela técnica de speckle tracking em pacientes com angina refratária [Tesis doctoral en Internet]. São Paulo: Faculdad de Medicina de la Universidad de São Paulo; 2017 [10 Feb 2019]. Disponible en: https://referenciaincor.com.br/wp-content/uploads/2018/01/pe_teses_literatura-incor_teses_24jan2018_anderson-silveira-duque.pdf

20. Prasad M, Wan Ahmad WA, Sukmawan R, Magsombol EB, Cassar A, Vinshtok Y, et al. Extracorporeal shockwave myocardial therapy is efficacious in improving symptoms in patients with refractory angina pectoris - A multicenter study. Coron Artery Dis. 2015;26(2):194-200.

21. Kikuchi Y, Ito K, Ito Y, Shiroto T, Tsuburaya R, Aizawa K, et al.: Double-blind and placebo-controlled study of the effectiveness and safety of extracorporeal cardiac shock wave therapy for severe angina pectoris. Circ J. 2010;74(3):589-91.

22. Vainer J, Habets JH, Schalla S, Lousberg AH, de Pont CD, Vöö SA, et al. Cardiac shockwave therapy in patients with chronic refractory angina pectoris. Neth Heart J. 2016;24(5):343-9.

23. Faber L, Prinz C, Lindner O, Bogunovic N, Hering D, Burchert W, et al.: Echoguided extracorporeal shock wave therapy for refractory angina improves regional left ventricular function along with myocardial blood flow. Eur Heart J. 2014;35(Abstract Suppl):658 [Resumen].

24. Wang J, Zhou C, Liu L, Pan X, Guo T. Clinical effect of cardiac shock wave therapy on patients with ischaemic heart disease: a systematic review and meta-analysis. Eur J Clin Invest. 2015;45(12):1270-85.

25. Wang Y, Guo T, Cai HY, Ma TK, Tao SM, Sun S, et al. Cardiac shock wave therapy reduces angina and improves myocardial function in patients with refractory coronary artery disease. Clin Cardiol. 2010;33(11):693-9.

26. Alunni G, Marra S, Meynet I, D'amico M, Elisa P, Fanelli A, et al. The beneficial effect of extracorporeal shockwave myocardial revascularization in patients with refractory angina. Cardiovasc Revasc Med. 2015;16(1):6-11.

Published

2019-07-14

How to Cite

1.
Rodríguez González E, Reyes Hernández LM, Rodríguez González L, Correa Morales AM, Gómez García YC, Pérez García TJ. Results of low intensity extracorporeal shock wave therapy in patients with refractory angina. CorSalud [Internet]. 2019 Jul. 14 [cited 2025 Jun. 28];11(3):203-10. Available from: https://revcorsalud.sld.cu/index.php/cors/article/view/487

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Section

ORIGINAL ARTICLES