Limits...
Extracorporeal cardiac shock wave therapy ameliorates clinical symptoms and improves regional myocardial blood flow in a patient with severe coronary artery disease and refractory angina.

Prinz C, Lindner O, Bitter T, Hering D, Burchert W, Horstkotte D, Faber L - Case Rep Med (2009)

Bottom Line: PET imaging showed a substantial improvement of myocardial stress perfusion.Since the patient reported that she now was fully capable to deal with her everyday life, further treatment options were postponed.Our case report suggests that ultrasound-guided CSWT is able to improve symptoms and perfusion in ischemic myocardium.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, 32545 Bad Oeynhausen, Germany.

ABSTRACT
Different therapeutic options are being used for chronic coronary artery disease (CAD). We report about a 51-year-old female with CAD and refractory angina pectoris despite maximally tolerated medical therapy and after both percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). The patient received cardiac shock wave therapy (CSWT) over a period of 6 month. There was no arrhythmia during or after treatment; enzyme levels were normal at all times. PET imaging showed a substantial improvement of myocardial stress perfusion. Since the patient reported that she now was fully capable to deal with her everyday life, further treatment options were postponed. Our case report suggests that ultrasound-guided CSWT is able to improve symptoms and perfusion in ischemic myocardium.

No MeSH data available.


Related in: MedlinePlus

(a)–(e) PET imaging before (a)–(d) and after (e) 18 sessions of ultrasound-guided CSWT focused on the septal and inferior wall in this patient with chronic refractory angina and without a revascularization option. (a) Bulleye map of myocardial viability FDG PET at baseline, showing preserved viability (red). (b) Perfusion at rest as assessed with N-13-ammonia PET with quantitatively normal perfusion values. (c) Perfusion with N-13-ammonia under adenosine stress at baseline revealed severely reduced perfusion values in the anterior and anteroseptal wall, the apical half of the lateral wall and in the apex. (d) and (e) Blownup maps of stress perfusion at baseline (D=C) and followup (e) with improved stress perfusion in parts of the septum and the adjacent inferior wall.
© Copyright Policy - open-access
Related In: Results  -  Collection


getmorefigures.php?uid=PMC2734934&req=5

fig1: (a)–(e) PET imaging before (a)–(d) and after (e) 18 sessions of ultrasound-guided CSWT focused on the septal and inferior wall in this patient with chronic refractory angina and without a revascularization option. (a) Bulleye map of myocardial viability FDG PET at baseline, showing preserved viability (red). (b) Perfusion at rest as assessed with N-13-ammonia PET with quantitatively normal perfusion values. (c) Perfusion with N-13-ammonia under adenosine stress at baseline revealed severely reduced perfusion values in the anterior and anteroseptal wall, the apical half of the lateral wall and in the apex. (d) and (e) Blownup maps of stress perfusion at baseline (D=C) and followup (e) with improved stress perfusion in parts of the septum and the adjacent inferior wall.

Mentions: During the current evaluation, echocardiography showed a preserved global left ventricular function with an ejection fraction of 55%, and without significant regional hypokinesia. A bicycle stress test was terminated at 75 watts because of dyspnoea with ST segment depression in leads V5 and V6. A repeat coronary angiography documented occlusion of the LAD, the Rm, and the RCA. The venous grafts to LAD and Rm were fully functional, the RCA bypass was occluded. There was no possibility for a repeat revascularization. Myocardial viability and perfusion at rest and stress (under adenosine induced vasodilation) were assessed by positron emission tomography (PET) imaging, with F-18-FDG and N-13-ammonia, respectively. Areas of decreased stress perfusion were found predominantly in the apex and the anterior and inferior septal wall (Figures 1(c) and 1(d)), while viability (Figure 1(a)) and perfusion at rest (Figure 1(b)) were preserved.


Extracorporeal cardiac shock wave therapy ameliorates clinical symptoms and improves regional myocardial blood flow in a patient with severe coronary artery disease and refractory angina.

Prinz C, Lindner O, Bitter T, Hering D, Burchert W, Horstkotte D, Faber L - Case Rep Med (2009)

(a)–(e) PET imaging before (a)–(d) and after (e) 18 sessions of ultrasound-guided CSWT focused on the septal and inferior wall in this patient with chronic refractory angina and without a revascularization option. (a) Bulleye map of myocardial viability FDG PET at baseline, showing preserved viability (red). (b) Perfusion at rest as assessed with N-13-ammonia PET with quantitatively normal perfusion values. (c) Perfusion with N-13-ammonia under adenosine stress at baseline revealed severely reduced perfusion values in the anterior and anteroseptal wall, the apical half of the lateral wall and in the apex. (d) and (e) Blownup maps of stress perfusion at baseline (D=C) and followup (e) with improved stress perfusion in parts of the septum and the adjacent inferior wall.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2734934&req=5

fig1: (a)–(e) PET imaging before (a)–(d) and after (e) 18 sessions of ultrasound-guided CSWT focused on the septal and inferior wall in this patient with chronic refractory angina and without a revascularization option. (a) Bulleye map of myocardial viability FDG PET at baseline, showing preserved viability (red). (b) Perfusion at rest as assessed with N-13-ammonia PET with quantitatively normal perfusion values. (c) Perfusion with N-13-ammonia under adenosine stress at baseline revealed severely reduced perfusion values in the anterior and anteroseptal wall, the apical half of the lateral wall and in the apex. (d) and (e) Blownup maps of stress perfusion at baseline (D=C) and followup (e) with improved stress perfusion in parts of the septum and the adjacent inferior wall.
Mentions: During the current evaluation, echocardiography showed a preserved global left ventricular function with an ejection fraction of 55%, and without significant regional hypokinesia. A bicycle stress test was terminated at 75 watts because of dyspnoea with ST segment depression in leads V5 and V6. A repeat coronary angiography documented occlusion of the LAD, the Rm, and the RCA. The venous grafts to LAD and Rm were fully functional, the RCA bypass was occluded. There was no possibility for a repeat revascularization. Myocardial viability and perfusion at rest and stress (under adenosine induced vasodilation) were assessed by positron emission tomography (PET) imaging, with F-18-FDG and N-13-ammonia, respectively. Areas of decreased stress perfusion were found predominantly in the apex and the anterior and inferior septal wall (Figures 1(c) and 1(d)), while viability (Figure 1(a)) and perfusion at rest (Figure 1(b)) were preserved.

Bottom Line: PET imaging showed a substantial improvement of myocardial stress perfusion.Since the patient reported that she now was fully capable to deal with her everyday life, further treatment options were postponed.Our case report suggests that ultrasound-guided CSWT is able to improve symptoms and perfusion in ischemic myocardium.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, 32545 Bad Oeynhausen, Germany.

ABSTRACT
Different therapeutic options are being used for chronic coronary artery disease (CAD). We report about a 51-year-old female with CAD and refractory angina pectoris despite maximally tolerated medical therapy and after both percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). The patient received cardiac shock wave therapy (CSWT) over a period of 6 month. There was no arrhythmia during or after treatment; enzyme levels were normal at all times. PET imaging showed a substantial improvement of myocardial stress perfusion. Since the patient reported that she now was fully capable to deal with her everyday life, further treatment options were postponed. Our case report suggests that ultrasound-guided CSWT is able to improve symptoms and perfusion in ischemic myocardium.

No MeSH data available.


Related in: MedlinePlus