title: Cardiac shock wave therapy and myocardial perfusion in severe coronary artery disease.
abstract: BACKGROUND
  Ultrasound guided cardiac shock wave therapy (CSWT) is a noninvasive therapeutic option in the treatment of chronic-refractory angina. Clinical trials have shown that CSWT reduces angina symptoms, improves regional systolic function, LV ejection fraction, myocardial perfusion and quality of life parameters. Absolute measurements of myocardial perfusion before and after CSWT have not been performed so far.
  
  
  RESULTS
  We studied a total of 21 CCS III patients with history of CAD and multiple interventions who suffered from disabling angina despite individually optimized medical therapy. An N-13 NH3 PET perfusion scan under adenosine was performed before and after CSWT treatment. CSWT was well tolerated in all patients. Absolute perfusion under adenosine of the global left-ventricular myocardium did not change under therapy or minimal coronary resistance. The treated segments, however, showed in terms of both perfusion and resistance a mild but significant improvement, by 11 and 15 %, respectively, whereas no change could be observed in the remote segments. Considering a threshold of increased perfusion of 5 %, 10 (77 %) out of 13 patients with a better target perfusion improved in their CCS class, whereas 3 (43 %) out of 7 patients without improved target perfusion improved in their CCS class too.
  
  
  CONCLUSIONS
  Standard CSWT has the potential to improve myocardial perfusion of the therapy zone and clinical CAD symptomatology without affecting global myocardial perfusion. As a noninvasive and well tolerated therapeutic option, these data suggest the use of CSWT in patients with end-stage CAD.
authors.affiliation: Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center North Rhine-Westphalia, University Hospital of the Ruhr-University Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Kaller
authors.affiliation: Clinic for Cardiology, Heart and Diabetes Center North Rhine-Westphalia, University Hospital of the Ruhr-University Bochum, Bad Oeynhausen, Germany.
authors.forename: L
authors.initials: L
authors.lastname: Faber
authors.affiliation: Clinic for Cardiology, Heart and Diabetes Center North Rhine-Westphalia, University Hospital of the Ruhr-University Bochum, Bad Oeynhausen, Germany.
authors.forename: N
authors.initials: N
authors.lastname: Bogunovic
authors.affiliation: Clinic for Cardiology, Heart and Diabetes Center North Rhine-Westphalia, University Hospital of the Ruhr-University Bochum, Bad Oeynhausen, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Horstkotte
authors.affiliation: Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center North Rhine-Westphalia, University Hospital of the Ruhr-University Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Burchert
authors.affiliation: Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center North Rhine-Westphalia, University Hospital of the Ruhr-University Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany. olindner@hdz-nrw.de.
authors.forename: Oliver
authors.initials: O
authors.lastname: Lindner
mesh_terms: D000368:Aged; D001783:Blood Flow Velocity; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy*; D003326:Coronary Circulation; D005260:Female; D057086:High-Intensity Focused Ultrasound Ablation / Q000379:methods*; D006801:Humans; D008297:Male; D016896:Treatment Outcome
keywords: Cardiac shock wave therapy; Coronary artery disease; Myocardial perfusion imaging; PET; Refractory angina