Palamine, M.T, Armada, F., Jimenez, R. Locnen, SA. , Magsombol,EB., and Calleja, HB.
description
Transcript of Palamine, M.T, Armada, F., Jimenez, R. Locnen, SA. , Magsombol,EB., and Calleja, HB.
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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
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• 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
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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
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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
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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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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.
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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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20
Pre ESMR 6 mos Post 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!