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Updated: January 2009 MILITARY CENTRAL HOSPITAL 108 INITIAL CLINICAL RESULTS OF EXTRACORPOREAL SHOCK WAVE THERAPY IN TREATMENT OF CHRONIC ISCHEMIC HEART DISEASE Dr Le Duy Thanh, MD Military Heart Institute PRESENTATION CONTENT  Background  Overview  Objective and method  Results and discussions  Conclusions BACKGROUND • CAD is a common disease with high risk complications and mortality • In 2004, CAD caused 1.6 millions death in Europe • main treatments: Medical therapy, CABG and PCI • A numbers of patients are unsuitable for PCI or CABG the others even undergone with revascularization and optimal medical therapy still suffer from refractory angina Shock Waves Characteristics Shock waves energy ~900 Bar 0.9 ~400 Bar 500 0.25 Orthopedics ~100 Bar Cardio-Vascular 100 80’s (mJ/mm²) Urology Energy Density Level Shock Wave Pressure Level (Bar) 1000 0.05 2000+ 90’s Clinical Field Physiological Effect Shock waves ↓ Intracellular & Extracellular responses ↓ Stimulates endothelial Nitric Oxide Synthase (eNOS) ↓ Release of Vascular Endothelial Growth Factors (VEGF) ↓ Angiogenesis Advantages of SW therapy • Precise regions to be treated • Local effect • No affect on near-by tissue Main Physiological Effects Short Term Effect Local Vasodilatation Long Term Effect Angiogenesis The aim of the study  Evaluating the effectiveness and safety of shock wave therapy in treatment of chronic ischemic heart disease Objective and method  Objective: 20 refractory angina patients with multiple vessel disease treated in the 108 Military Central Hospital from 05/2013 to 05/2014  Method: A open label and prospective study 10 RESULTS AND DISSCUSION Demographics of patients Mean age: 78.5 ± 8.7 RESULTS AND DISSCUSION Table 1: patient’s characteristics Characteristics n (%) No p 16 (80%) < 0.05 Revascularisation PCI (10%) CABG (10%) Yes 20 RESULTS AND DISSCUSION Table 2: Clinicals and risk factors Clinical and risk factors (n) (%) Angina 20 100 DM 13 65 Hypertension 18 90 Smoking 11 55 Dyslipidemia 16 80 MI 12 60 Obesity 13 65 21 RESULTS AND DISSCUSIONS Table 3: A number of vessel disease involved Degree of diffuse lesions CA (n) (%) One vessel disease 0 Two vessel disease 15 Three vessel disease 15 75 LM disease 10 22 RESULTS AND DISSCUSIONS CAD disease RESULTS AND DISSCUSIONS Table 4: Characteristic of myocardial perfusion defects with gated SPECT Characteristic of MP defects Recovery Severity Extent (n) (%) Reversible perfusion defects 17 85 Fixed perfusion defects 0 Mixed perfusions defects 15 Mild 0 Moderate 10 Severe 18 90 Small 0 Moderate 20 Large 16 80 24 RESULTS AND DISSCUSIONS Table 5: improvement of clinical symtomps after month’s treatment Clinicals Number of angina/w Time of angina/w (s) Before X ± SD After X ± SD p 14.5±3.7 3.2±1.3 [...]... improvement of clinical symtomps after 3 month’s treatment Clinicals Number of angina/w Time of angina/w (s) Before X ± SD After X ± SD p 14.5±3.7 3.2±1.3