Long-Term Clinical Benefits and Outcomes of Patients with Ischemic Heart Disease and Left Ventricular Dysfunction who underwent Extracorporeal Shockwave Myocardial Revascularization (ESMR)
Background: Management of ischemic heart disease (IHD) includes medical treatment, percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG). These procedures are invasive and are associated with serious complications. Extracorporeal cardiac shock wave therapy can provide an alternative and non-invasive treatment for IHD. It effectively induces angiogenesis and markedly ameliorates myocardial ischemia and dysfunction. This study aims to determine the long-term clinical benefits and outcomes of patients with IHD with refractory angina and/or chronic heart failure who underwent extracorporeal shockwave myocardial revascularization (ESMR).
Methods: This is a retrospective cohort study that included patients who underwent ESMR at St. Luke’s Medical Center-Quezon City, Philippines from March 2009 to December 2012. The population of the study included patients with ischemic heart disease, with refractory or stable angina, single photon emission tomography (SPECT) documented stress-induced ischemia, Ischemic Cardiomyopathy, and heart failure NYHA Class I or II. Medical records were reviewed and analyzed for quality of life and outcome.
Results: A total of 65 patients were included. Significant improvement of symptoms were noted and validated in the analysis of the Seattle Angina Questionnaire domains which included physical activity, angina frequency and stability, patient satisfaction, and quality of life. Repeat imaging after 2 years showed no significant statistical improvement in the size and severity of ischemia, left ventricular systolic function and ejection fraction compared to baseline and after 6 months. Outcome of patients after 2 years showed 45% alive, 28% expired and 27% were re-admitted during the follow-up period mostly due to congestive heart failure.
Conclusion: Long-term benefits of ESMR showed significant improvement only in terms of subjective parameter. SPECT-documented ischemia and 2D echo-documented depressed ejection fraction showed no significant improvement after 2 years.