The effect of cardiac shock wave therapy on myocardial function and perfusion in the randomized, triple-blind, sham-procedure controlled study.

BACKGROUND: Recent triple-blind sham procedure-controlled study revealed neutral effects of the cardiac shock wave therapy (CSWT) on exercise tolerance and symptoms in patients with stable angina. Current data about the effects of CSWT on global and regional myocardial contractility and perfusion is limited. Hereby we report the results of an imaging sub-study that evaluated the capacity of CSWT to ameliorate myocardial ischemia induced during dobutamine stress echocardiography (DSE) and cardiac single photon emission computed tomography (SPECT). METHODS: Prospective, randomized, triple-blind, sham procedure-controlled study enrolled 72 adult subjects who complied with defined inclusion criteria. The subjects were assigned to the OMT + CSWT and the OMT + sham procedure study groups with 1:1 ratio. Application of the CSWT covered all segments of the left ventricle. Imaging ischemia tests were performed in 59 study patients: DSE and SPECT before the CSWT treatment and after 6 months, with DSE carried out additionally at 3 months after randomization. Co-primary endpoints of the study were: change in wall motion score index (WMSI), representing the stress-induced impairment of regional myocardial function, and change in summed difference score (SDS), representing the amount of perfusion defect. RESULTS: OMT + CSWT and OMT + sham procedure study groups included 30 and 29 patients, respectively. Regional myocardial contractility during DSE significantly improved at 3 months follow-up in OMT + CSWT group compared to baseline as shown by WMSI at stress (1.4 ± 0.4 vs 1.6 ± 0.4, p = 0.001), but not in OMT + sham procedure group (1.5 ± 0.3 vs 1.6 ± 0.4, p = 0.136). The difference in stress DSE results between both study groups disappeared after 6 months. SPECT results demonstrated a significant reduction of inducible ischemia in OMT + CSWT group compared to OMT + sham procedure group at 6 months follow-up (SDS dropped from 5.4 ± 3.7 to 3.6 ± 3.8 vs 6.4 ± 5.9 to 6.2 ± 5 respectively, p = 0.034). CONCLUSIONS: Cardiac shock wave treatment showed the ability to reduce stress-induced myocardial ischemia, as assessed by wall motion abnormalities and perfusion defects, compared to sham procedure. TRIAL REGISTRATION: Clinicaltrials.gov ( NCT02339454 ). The trial was registered retrospectively on 12 January 2015.

How to interpret 24-h arterial stiffness markers: comparison of 24-h ambulatory Mobil-O-Graph with SphygmoCor office values.

OBJECTIVES: Although applanation tonometry is the most widely used method for evaluating arterial stiffness, oscillometric ambulatory blood pressure monitoring devices using specific algorithms for pulse wave analyses have been validated more recently. Currently, it is not clear how to interpret 24-h mean values of arterial stiffness parameters. The objective of this study was to compare 24-h mean values of arterial stiffness parameters obtained using 24-h ambulatory blood pressure monitoring device (Mobil-O-Graph) against a validated single-measure tonometric system (SphygmoCor). MATERIALS AND METHODS: We measured brachial and central arterial pressure, augmentation index (AIx), and carotid-to-femoral pulse wave velocity (cfPWV) using SphygmoCor device in 82 high and very high cardiovascular risk patients. The Mobil-O-Graph device for the 24-h blood pressure and arterial stiffness parameter monitoring was used on the same day and started within 2 h after measurements using SphygmoCor were done. RESULTS: Mean AIx values were 26.38±9.95 for SphygmoCor office measurement and 26.69±8.45 for Mobil-O-Graph 24-h mean values. The mean difference was -0.31±9.78 (P=0.775). CfPWV values were 10.56±2.59 m/s for SphygmoCor office measurement and 8.72±1.29 m/s for Mobil-O-Graph 24-h mean values. The difference of 1.84±2.15 m/s was statistically significant (P<0.001). Correlation coefficients for AIx and cfPWV between two methods were 0.444 and 0.468, respectively (P<0.001). CONCLUSION: The agreement between SphygmoCor single measurement and Mobil-O-Graph 24-h mean values of arterial stiffness parameters is moderate. The 24-h mean values of cfPWV obtained by Mobil-O-Graph are significantly lower than SphygmoCor values obtained in the office, whereas 24-h AIx mean values do not have a significant bias.

Value of Duke treadmill score in predicting coronary artery lesion and the need for revascularisation.

BACKGROUND: Exercise electrocardiography is a long-standing method for the evaluation of coronary artery disease (CAD), and it remains the initial test for most patients who can exercise adequately with a baseline interpretable electrocardiogram. However, there is little information about the relationship between Duke treadmill test score (DTS) and severity of coronary artery lesion, as well as estimating the need for revascularisation. AIM: The aim of the study was to ascertain whether the DTS could be an efficient parameter in choosing coronary revascularisation in different DTS groups. METHODS: Two hundred and fifty-eight (n = 258) patients had positive exercise testing for CAD and underwent coronary angiography. The patients were divided into three groups according to the DTS: low-risk (with a score of ≥ +5), moderate-risk (with scores ranging from -10 to +4), and high-risk (with a score of ≤ -11). Coronary angiography was done by the Judkins technique. A coronary lesion was considered significant when stenosis of the coronary artery was ≥ 70% and stenosis of the trunk was ≥ 50%. The SYNTAX score was determined. RESULTS: The study group included 258 patients with mean age 62.66 ± 9.6 years, and most of them were men (72.8%). Patients with high- and intermediate-risk DTS had the same SYNTAX score (16.35 ± 7.3, 15.09 ± 10.08 and 11.80 ± 9.88, respectively; p = 0.064) compared to low-risk DTS. A negative correlation between DTS and significant coronary artery stenosis (r = -0.181; p = 0.005), SYNTAX score (r = -0.173; p = 0.007), and cardiac revascularisations (r = -0.213; p = 0.001) were found. In multiple linear regressions to predict coronary revascularisation the SYNTAX score (B = 0.018; p = 0.0001), DTS (B = -0.014, p = 0.008) and previous myocardial infarction (B = -0.143; p = 0.047) were significant predictors. CONCLUSIONS: The DTS alone is a useful tool in suspecting a significant coronary artery stenosis, but it is not accurate enough for revascularisation. Thus, by adding clinical information, its value may be maximised.