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

Autor: Martínez-Sánchez C; Coronary Care Unit, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico., Azar-Manzur F; Coronary Care Unit, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico., González-Pacheco H; Coronary Care Unit, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico., Amezcua-Guerra LM; Immunology Department, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico., Massó F; UNAM-INC Researh Unit, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico., Márquez-Velasco R; Immunology Department, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico., Bojalil R; Immunology Department, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico., Carvajal-Juárez I; Department of Nuclear Medicine , Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico., Alexanderson-Rosas E; Department of Nuclear Medicine , Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico., Hernández S; Department of Nuclear Medicine , Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico., Paez-Arenas A; UNAM-INC Researh Unit, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico., López-Mora E; Heart Failure Clinic, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico., Venegas-Román A; Coronary Care Unit, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico., Brianza-Padilla M; Immunology Department, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico., Gopar-Nieto R; Coronary Care Unit, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico., Sandoval J; Immunology Department, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico. Electronic address: sandovalzarate@prodigy.net.mx.
Jazyk: angličtina
Zdroj: The American journal of cardiology [Am J Cardiol] 2021 Apr 01; Vol. 144, pp. 26-32. Date of Electronic Publication: 2020 Dec 29.
DOI: 10.1016/j.amjcard.2020.12.065
Abstrakt: 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.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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