Myocardial perfusion after one year of spinal cord stimulation in patients with refractory angina.
OBJECTIVE
Spinal cord stimulation (SCS) is recommended for patients with coronary artery disease (CAD) and refractory angina. We used positron emission tomography (PET) to investigate the long-term effect of SCS on regional myocardial perfusion in patients suffering from angina pectoris refractory to medical treatment and without option for coronary intervention.


METHODS
We analyzed data of 44 patients with stable CAD (91% three vessel disease). At baseline, we determined coronary flow reserve (CFR) using 13N-ammonia-PET and myocardial viability with 18F-FDG. SCS was performed for one year (Medtronic Itrell III or Synergy, Düsseldorf, Germany). During follow-up, no cardiac interventions were necessary and no myocardial infarctions occurred. At one year follow-up, CFR was measured again.


RESULTS
In the majority of patients (77%), SCS led to an improvement of clinical symptoms. CFR did not change significantly during follow-up. Subjective improvement did not correlate with an increase of CFR.


CONCLUSIONS
Despite its clinical effect, SCS does not have a direct impact on CFR in patients with stable CAD. According to our results, the pain relief is not due to an improvement of the myocardial blood supply.
Fricke
Eva
E
Institut für Radiologie, Nuklearmedizin und Molekulare Bildgebung, Herz- und Diabeteszentrum Nordrhein-Westfalen, Georgstr. 11, 32545 Bad Oeynhausen, Germany. fricke.eva@t-online.de
Eckert
Siegfried
S
Dongas
Aristidis
A
Fricke
Harald
H
Preuss
Rainer
R
Lindner
Oliver
O
Horstkotte
Dieter
D
Burchert
Wolfgang
W
D000368:Aged; D000787:Angina Pectoris / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*; D001783:Blood Flow Velocity; D003326:Coronary Circulation / Q000502:physiology*; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000628:therapy; D004599:Electric Stimulation Therapy / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000628:therapy; D049268:Positron-Emission Tomography; D012189:Retrospective Studies; D013116:Spinal Cord; D016019:Survival Analysis; D017741:Survivors; D016277:Ventricular Function, Left