Global left ventricular myocardial deformation study of extracorporeal cardiac shock wave therapy in stable angina


DOI: https://dx.doi.org/10.18565/therapy.2019.2.64-70

Scherbak M.M., Shkolnik E.L., Vasyuk Yu.A., Yushchyuk E.N., Trush E.Yu., Burneikaite G., Celutkiene E., Zuoziene G., Petrauskiene B., Laucevicius A.

1) A.I. Evdokimov Moscow State University of medicine and dentistry of the Ministry of Healthcare of Russia; 2) Yale New Haven Health Bridgeport hospital, Connecticut, USA; 3) Clinic of cardiac and vascular diseases of the Institute of clinical medicine of the medicine faculty of Vilnius University
The aim of the study is to evaluate value of 2D-strain in assessment of extracorporeal cardiac shock wave therapy (CSWT) in patients with stable angina. Material and methods. 89 patients were included in the study. The mean age of examined patients was 67,9±8,1 years. Inclusion criteria: angina pectoris II-IV CCS, stable therapy for at least 1 month before inclusion in the study and a stable course of coronary artery disease for more than 3 months (no cardiovascular events) before inclusion in the study. Patients were divided into 3 groups. The Group 1 (n=37) received optimal medicamentous therapy (OMT) + CSWT standard-modified protocol. The Group 2 (n=16) received OMT + CSWT rapid-modified protocol. The Group 3 (n=36) received OMT only. Echocardiography with assessment of global longitudinal strain were performed at inclusion and 6 months follow up. Results. In the Group 1 there was a significant decrease in the end-diastolic volume from 111,7±29,1 to 104,5±25,5 ml (p=0.003), and a decrease in the end-systolic volume from 49,8±19,7 to 45,6±20,3 ml (p=0.01). In addition, there was a tendency to increase of the left ventricular ejection fraction from 56±9 to 57,9±10,3% (p=0.07). In the control group during the evaluation of echocardiographic parameters there were no significant changes during the observation period. In the Group 2 there was a significant decrease in the diameter and volume of the left atrium from 40,4±7,2 to 37,7±6,8 mm (p <0.01) and from 63,8±22,9 to 55,4±16,8 ml (p=0.001), respectively. When assessing the volume indexes and ejection fraction of the left ventricle changes were not observed. There was a significant improvement in the global longitudinal strain of the left ventricle from -14,3±3,9 to -15,4±4,2% (p=0.02). In patients with preserved ejection fraction of the left ventricle in the Groups 1 and 2 the volume indices and the ejection fraction of the left ventricle were not significantly affected. In Group 2, the absolute value of the global longitudinal strain of the left ventricle increased significantly from -15,1±3,3 to -16±3,6% (p=0.02). In the control group there was a significant decrease in the left ventricular ejection fraction from 59,9±4,1 to 57±6,2% (p=0.004). In addition, the global longitudinal strain of the left ventricle significantly worsened from -15±2,3 to -13±1,6% (p=0.02). In patients with reduced left ventricular ejection fraction in all groups according to echocardiography no significant dynamics of ejection fraction and index of global longitudinal strain of the left ventricle were revealed. Conclusion. In our study in patients with preserved ejection fraction of the left ventricle shock wave therapy had a protective effect on myocardial contractility, while in the control group the left ventricular systolic function was significantly reduced.
Keywords: extracorporeal cardiac shock wave therapy, global longitudinal strain, stable angina, coronary artery disease
Read entire article

Literature


  1. Montalescot G., Sechtem U., Achenbach S. et al. 2013 ESC guidelines on the management of stable coronary artery disease. Eur Heart J. 2013; 34: 2949–3003. doi: 10.1093/eurheartj/eht296

  2. Васюк Ю.А., Хадзегова А.Б., Школьник Е.Л. и соавт. Ударно-волновая терапия сердца: особенности механизма действия и возможности применения. Доктор.Ру. 2013; 10: 14–19.

  3. Taylor R.S., De Vries J., Bucher E. et al. Spinal cord stimulation in the treatment of refractory angina: systematic review and metaanalysis of randomized controlled trials. BMC Cardiovasc Disord. 2009; 9: 13. doi: 10.1186/1471-2261-9-13

  4. Assmus B., Schachinger V., Teupe C. et al. Transplantation of Progenitor Cells and Regeneration Enhancement in Acute Myocardial Infarction (TOPCARE-AMI). Circulation. 2002; 106: 3009–17.

  5. Fu M., Sun C.K., Lin Y.C. et al. Extracorporeal shock wave therapy reverses ischemia-related left ventricular dysfunction and remodeling: molecular-cellular and functional assessment. PLoS One. 2011; 6: 24342. doi: 10.1371/journal.pone.0024342

  6. Fukumoto Y., Ito A., Uwatoku T. et al. Extracorporeal cardiac shock wave therapy ameliorates myocardial ischemia in patients with severe coronary artery disease. Coron Artery Dis. 2006; 1: 63–70.

  7. Khattab A.A., Brodersen B., Schuermann-Kuchenbrandt D. et al. Extracorporeal cardiac shock wave therapy: First experience in the everyday practice for treatment of chronic refractory angina pectoris. Int J Cardiol. 2007; 121(1): 184–85. doi: 10.1016/j.ijcard.2006.08.030

  8. Shkolnik E., Burneikaite G., Jakutis G. et al. A randomized, triple-blind trial of cardiac shock-wave therapy on exercise tolerance and symptoms in patients with stable angina pectoris. Coron Artery Dis. 2018; 29(7): 579–86. doi: 10.1097/MCA.0000000000000648

  9. Uwatoku T. Extracorporeal cardiac shock wave therapy improves left ventricular remodeling after acute myocardial infarction in pigs. Coron Artery Dis. 2007; 18: 397–404.

  10. Myers J., Arena R., Franklin S. Recommendations for clinical exercise laboratories: a scientific statement from the American Heart Association. Circulation. 2009; 119: 3144–16.

  11. Biswas M., Sudhakar A., Nanda N.C. Two- and three-dimensional speckle tracking echocardiography: clinical applications and future directions. Echocardiography. 2013; 30: 88–105.

  12. Lanza G.A., Sestito A., Sgueglia G.A. Current Clinical features, diagnostic assessment and prognostic determinants with variant angina. Int J Cardiol. 2007; 118: 41–47.

  13. Lang M.R., Badano L.P., Mor-Avi V. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. 2015; 28(1): 1–39.e14.

  14. Shkolnik E., Burneikaite G., Celutkiene J., Scherbak M., Zuoziene G., Petrauskiene B., Trush E., Laucevicius A., Vasyuk Y. Efficacy of cardiac shock wave therapy in patients with stable angina: the design of randomized, triple blind, sham-procedure controlled study. Anatol J Cardiol. 2018 Feb; 19(2): 100–09.

  15. Shkolnik E., Scherbak M., Burneikaite G., Celutkiene J., Scherbak MPetrauskiene B., Trush E., Laucevicius A., Vasyuk Y. Efficacy of extracorporeal shockwave myocardial revascularization therapy in patients with stable angina pectoris: multicentre randomized double blind placebo controlled study. Volume 71, Issue 11, Supplement, p. A216.

  16. Щербак М.М., Школьник Е.Л. Влияние различных режимов ударно-волновой терапии на клиническое течение стабильной стенокардии. VI Евразийский конгресс кардиологов. Сборник тезисов. 2018. С.70–71.

  17. Kagaya Y., Ito K., Takahashi J. Low-energy cardiac shockwave therapy to suppress left ventricular remodeling in patients with acute myocardial infarction: a first-in-human study. Coron Artery Dis. 2018; 29(4): 294–300.

  18. Matskeplishvili S.T. Impact of shock-wave therapy on the clinical and functional status of patients with coronary heart disease. Ter Arkh. 2017; 89: 22–28.

  19. Vasyuk Y.A., Hadzegova A.B., Shkolnik E.L., Kopeleva M.V. Initial clinical experience with extracorporeal shock wave therapy in treatment of ischemic heart failure. Congestive Heart Failure. 2010; 16(5): 226–30.

  20. Lang M.R., Baldano L.P., Mor-Avi V. et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015; 28(1): 1–39.e14.


About the Autors

Mikhail M. Scherbak, PhD, assistant of the Department of functional diagnostics of A.I. Evdokimov Moscow State University of medicine and dentistry of the Ministry of Healthcare of Russia. Address: 107014, Moscow, 7 Stromynka Str. Tel./fax: +7 (499) 268-44-59; +7 (985) 182-51-16. E-mail: fundiag@mail.ru
Yevgeny L. Shkolnik, MD, Yale New Haven Health Bridgeport hospital, Connecticut, USA
Yuri A. Vasyuk, MD, professor, Head of the Department of hospital therapy No 1 of A.I. Evdokimov Moscow State University of medicine and dentistry of the Ministry of Healthcare of Russia. Address: 107014, Moscow, 7 Stromynka Str. Tel./fax: +7 (495) 268-75-22. E-mail: emaichuk@yandex.ru
Elena N. Yushchyuk, MD, professor, Head of the Department of functional diagnostics of A.I. Evdokimov Moscow State University of medicine and dentistry of the Ministry of Healthcare of Russia. Address: 107014, Moscow, 7 Stromynka Str. Tel./fax: +7 (499) 268-44-59; +7 (985) 182-51-16. E-mail: fundiag@mail.ru
Ekaterina Yu. Trush, PhD candidate of functional diagnostics of A.I. Evdokimov Moscow State University of medicine and dentistry of the Ministry of Healthcare of Russia. Address: 107014, Moscow, 7 Stromynka Str. Tel./fax: +7 (499) 268-44-59; +7 (985) 182-51-16. E-mail: fundiag@mail.ru
Greta Burneikaite, Doctor of Clinic of cardiac and vascular diseases of the Institute of clinical medicine of the medicine faculty of Vilnius University
Elena Celutkiene, Doctor of Clinic of cardiac and vascular diseases of the Institute of clinical medicine of the medicine faculty of Vilnius University
Gitana Zuoziene, Doctor of Clinic of cardiac and vascular diseases of the Institute of clinical medicine of the medicine faculty of Vilnius University
Birute Petrauskiene, Doctor of Clinic of cardiac and vascular diseases of the Institute of clinical medicine of the medicine faculty of Vilnius University
Alexandras Laucevicius, Doctor of Clinic of cardiac and vascular diseases of the Institute of clinical medicine of the medicine faculty of Vilnius University


Similar Articles

Back to Content

Бионика Медиа