EXTRACORPOREAL SH0CKWAVE MYOCARDIAL REVASCULARIZATION IN

PATIENTS WITH ISCHEMIC HEART DISEASE: THE ST. LUKE’S EXPERIENCE

Palamine, M.T, Armada, F., Jimenez, R. Locnen, SA. , Magsombol,EB.,

and Calleja, HB.St. Luke’s Heart Institute

• Meta-analysis gathering 14 trials enrolling 7,818 patients.

A significant overall benefit in favor of PCI

SummaryO.R. :1.69 [95% CI, 1.24 to 2.30)

A significant heterogeneity accross studies

BUT

Wijeysundera HC et al. Ann Intern Med. 2010;152:370-379.

We need more tools

to bridge the gap.

Wide Variability of Outcomes Pertaining to symptom relief among Interventional Studies

ECG Remote Control Unit

User Control Panel

Treatment Table

Shock Wave Applicator

Ultrasound Probe Holder

Shock Wave Power UnitCabinet

ECG Monitor

Cardiospec System Components

A New Option to Achieve Revascularization: ESMR

Collateral Development Post SW’s in Rabbits

Tohoku J Exp Med. 2008 Feb ;214 (2):151-8 Nishida T, Shimokawa H et al. Circulation. 2004;110:3055-3061

Background

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

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

Methods

Methods

ResultsTable 1. Patient Demographics

Table 2. Revascularization HistoryRevascularization History

Number of Patients (n=53)

Post-CABG 23

Post-PCI 12

Post CABG+ PCI 6

None 12

The mean age was 65.89 +11.24 years.

Table 4. ESMR Significantly improves symptoms Seattle Angina Questionnaire

Table 5. SPECT Analysis and LDEDV Measurement

Table 6. Wilcoxon Signed Ranks Test- SIZE AND SEVERITY OF ISCHEMIA

20

Pre ESMR 6 mos Post ESMR

Pre ESMR and Post ESMR

Pre-ESMR 3 months Post-ESMR

Results

• All patients tolerated the treatment well.

• No ECG changes, new wall motion abnormalities, and adverse events were reported.

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.

Thank you for your kind attention!