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Symptomatic relief precedes improvement of myocardial blood flow in patients under spinal cord stimulation.

Diedrichs H, Zobel C, Theissen P, Weber M, Koulousakis A, Schicha H, Schwinger RH - Curr Control Trials Cardiovasc Med (2005)

Bottom Line: Therefore doubts remain whether SCS has a direct effect on myocardial perfusion.Quality of life increased (SAQ) significantly after 3 month compared to baseline, as well.However, since improvement in symptoms and exercise capacity starts much earlier, decreased myocardial ischemia might not be a direct effect of neurostimulation but rather be due to a better coronary collateralisation because of an enhanced physical activity of the patients.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department III of Internal Medicine, University of Cologne, Cologne, Germany. holger.diedrichs@uni-koeln.de

ABSTRACT

Background: Spinal cord electrical stimulation (SCS) has shown to be a treatment option for patients suffering from angina pectoris CCS III-IV although being on optimal medication and not suitable for conventional treatment strategies, e.g. CABG or PTCA. Although many studies demonstrated a clear symptomatic relief under SCS therapy, there are only a few short-term studies that investigated alterations in cardiac ischemia. Therefore doubts remain whether SCS has a direct effect on myocardial perfusion.

Methods: A prospective study to investigate the short- and long-term effect of spinal cord stimulation (SCS) on myocardial ischemia in patients with refractory angina pectoris and coronary multivessel disease was designed. Myocardial ischemia was measured by MIBI-SPECT scintigraphy 3 months and 12 months after the beginning of neurostimulation. To further examine the relation between cardiac perfusion and functional status of the patients we measured exercise capacity (bicycle ergometry and 6-minute walk test), symptoms and quality of life (Seattle Angina Questionnaire [SAQ]), as well.

Results: 31 patients (65 +/- 11 SEM years; 25 male, 6 female) were included into the study. The average consumption of short acting nitrates (SAN) decreased rapidly from 12 +/- 1.6 times to 3 +/- 1 times per week. The walking distance and the maximum workload increased from 143 +/- 22 to 225 +/- 24 meters and 68 +/- 7 to 96 +/- 12 watt after 3 months. Quality of life increased (SAQ) significantly after 3 month compared to baseline, as well. No further improvement was observed after one year of treatment. Despite the symptomatic relief and the improvement in maximal workload computer based analysis (Emory Cardiac Toolbox) of the MIBI-SPECT studies after 3 months of treatment did not show significant alterations of myocardial ischemia compared to baseline (16 patients idem, 7 with increase and 6 with decrease of ischemia, 2 patients dropped out during initial test phase). Interestingly, in the long-term follow up after one year 16 patients (of 27 who completed the one year follow up) showed a clear decrease of myocardial ischemia and only one patient still had an increase of ischemia compared to baseline.

Conclusion: Thus, spinal cord stimulation not only relieves symptoms, but reduces myocardial ischemia as well. However, since improvement in symptoms and exercise capacity starts much earlier, decreased myocardial ischemia might not be a direct effect of neurostimulation but rather be due to a better coronary collateralisation because of an enhanced physical activity of the patients.

No MeSH data available.


Related in: MedlinePlus

Results of the MIBI-SPECT analysis with the "Emory Cardiac Toolbox" software. Black arrows indicate the shift of the patients between the three groups (worse, equal or improved myocardial perfusion) during 3 and 12 months follow up.
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Figure 2: Results of the MIBI-SPECT analysis with the "Emory Cardiac Toolbox" software. Black arrows indicate the shift of the patients between the three groups (worse, equal or improved myocardial perfusion) during 3 and 12 months follow up.

Mentions: As described above, data were interpreted with the „Emory Cardiac Toolbox“ software. The examinations 3 months after SCS implantation (n = 29) showed unchanged SPECT results in most patients (n = 16). Only 6 patients showed a better myocardial perfusion while in 7 ischemia worsened (figure 2). Interestingly, a shift towards an improved myocardial perfusion could be found after one year. Of 27 examined patients a worsened situation compared to baseline was found only in one patient. 16 patients showed clearly less myocardial ischemia. Results of the MIBI-SPECT analysis with the "Emory Cardiac Toolbox" software are shown in figure 2. Black arrows indicate the shift of the patients between the three groups (worse, equal or improved myocardial perfusion) during 3 and 12 months follow up. An exemplary scintigram prior to and twelve months after implantation is shown in figure 3.


Symptomatic relief precedes improvement of myocardial blood flow in patients under spinal cord stimulation.

Diedrichs H, Zobel C, Theissen P, Weber M, Koulousakis A, Schicha H, Schwinger RH - Curr Control Trials Cardiovasc Med (2005)

Results of the MIBI-SPECT analysis with the "Emory Cardiac Toolbox" software. Black arrows indicate the shift of the patients between the three groups (worse, equal or improved myocardial perfusion) during 3 and 12 months follow up.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC1173130&req=5

Figure 2: Results of the MIBI-SPECT analysis with the "Emory Cardiac Toolbox" software. Black arrows indicate the shift of the patients between the three groups (worse, equal or improved myocardial perfusion) during 3 and 12 months follow up.
Mentions: As described above, data were interpreted with the „Emory Cardiac Toolbox“ software. The examinations 3 months after SCS implantation (n = 29) showed unchanged SPECT results in most patients (n = 16). Only 6 patients showed a better myocardial perfusion while in 7 ischemia worsened (figure 2). Interestingly, a shift towards an improved myocardial perfusion could be found after one year. Of 27 examined patients a worsened situation compared to baseline was found only in one patient. 16 patients showed clearly less myocardial ischemia. Results of the MIBI-SPECT analysis with the "Emory Cardiac Toolbox" software are shown in figure 2. Black arrows indicate the shift of the patients between the three groups (worse, equal or improved myocardial perfusion) during 3 and 12 months follow up. An exemplary scintigram prior to and twelve months after implantation is shown in figure 3.

Bottom Line: Therefore doubts remain whether SCS has a direct effect on myocardial perfusion.Quality of life increased (SAQ) significantly after 3 month compared to baseline, as well.However, since improvement in symptoms and exercise capacity starts much earlier, decreased myocardial ischemia might not be a direct effect of neurostimulation but rather be due to a better coronary collateralisation because of an enhanced physical activity of the patients.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department III of Internal Medicine, University of Cologne, Cologne, Germany. holger.diedrichs@uni-koeln.de

ABSTRACT

Background: Spinal cord electrical stimulation (SCS) has shown to be a treatment option for patients suffering from angina pectoris CCS III-IV although being on optimal medication and not suitable for conventional treatment strategies, e.g. CABG or PTCA. Although many studies demonstrated a clear symptomatic relief under SCS therapy, there are only a few short-term studies that investigated alterations in cardiac ischemia. Therefore doubts remain whether SCS has a direct effect on myocardial perfusion.

Methods: A prospective study to investigate the short- and long-term effect of spinal cord stimulation (SCS) on myocardial ischemia in patients with refractory angina pectoris and coronary multivessel disease was designed. Myocardial ischemia was measured by MIBI-SPECT scintigraphy 3 months and 12 months after the beginning of neurostimulation. To further examine the relation between cardiac perfusion and functional status of the patients we measured exercise capacity (bicycle ergometry and 6-minute walk test), symptoms and quality of life (Seattle Angina Questionnaire [SAQ]), as well.

Results: 31 patients (65 +/- 11 SEM years; 25 male, 6 female) were included into the study. The average consumption of short acting nitrates (SAN) decreased rapidly from 12 +/- 1.6 times to 3 +/- 1 times per week. The walking distance and the maximum workload increased from 143 +/- 22 to 225 +/- 24 meters and 68 +/- 7 to 96 +/- 12 watt after 3 months. Quality of life increased (SAQ) significantly after 3 month compared to baseline, as well. No further improvement was observed after one year of treatment. Despite the symptomatic relief and the improvement in maximal workload computer based analysis (Emory Cardiac Toolbox) of the MIBI-SPECT studies after 3 months of treatment did not show significant alterations of myocardial ischemia compared to baseline (16 patients idem, 7 with increase and 6 with decrease of ischemia, 2 patients dropped out during initial test phase). Interestingly, in the long-term follow up after one year 16 patients (of 27 who completed the one year follow up) showed a clear decrease of myocardial ischemia and only one patient still had an increase of ischemia compared to baseline.

Conclusion: Thus, spinal cord stimulation not only relieves symptoms, but reduces myocardial ischemia as well. However, since improvement in symptoms and exercise capacity starts much earlier, decreased myocardial ischemia might not be a direct effect of neurostimulation but rather be due to a better coronary collateralisation because of an enhanced physical activity of the patients.

No MeSH data available.


Related in: MedlinePlus