title: Evaluation of extracorporeal shock wave therapy for refractory angina pectoris with quantitative analysis using cardiac magnetic resonance imaging: a short communication.
abstract: OBJECTIVE
  There is a continuing search for new treatment options in patients who suffer from refractory angina pectoris to improve quality of life. Several studies have recently demonstrated promising results by stimulating angiogenesis using extracorporeal shockwave therapy in these patients. The purpose of this study is to quantitatively analyse the effect of extracorporeal shockwave therapy on myocardial perfusion in patients with refractory angina pectoris.
  
  
  METHODS
  We included 15 patients with NYHA class 3-4 of whom 8 patients underwent baseline and follow-up cardiac magnetic resonance imaging (CMR). All patients received 9 shockwave treatments of their ischaemic zone over a period of 3 months.
  
  
  RESULTS
  Quantitative analysis of myocardial perfusion using CMR revealed no significant improvement of myocardial perfusion after treatment (0.80 ± 0.22 vs 0.76 ± 0.31; p = 0.42). However, the total group of 15 patients did experience a significant improvement in NYHA class (p = 0.034) and reduction of nitroglycerin use (p = 0.012).
  
  
  CONCLUSIONS
  Although treatment with extracorporeal shockwave was associated with an improvement in NYHA class, we could not observe an improvement in myocardial ischaemic zone and perfusion with CMR. To unravel the exact mechanisms of shockwave treatment, more in vitro and animal studies as well as larger (placebo-controlled) studies are required.
authors.affiliation: Department of Cardiology and Institute of Cardiovascular Research, VU University Medical Center, De Boelelaan 1117, 1081, HV Amsterdam, the Netherlands. j.slikkerveer@vumc.nl.|Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands. j.slikkerveer@vumc.nl.
authors.forename: J
authors.initials: J
authors.lastname: Slikkerveer
authors.affiliation: Department of Cardiology and Institute of Cardiovascular Research, VU University Medical Center, De Boelelaan 1117, 1081, HV Amsterdam, the Netherlands.
authors.forename: K
authors.initials: K
authors.lastname: de Boer
authors.affiliation: Department of Cardiology and Institute of Cardiovascular Research, VU University Medical Center, De Boelelaan 1117, 1081, HV Amsterdam, the Netherlands.|Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands.
authors.forename: L F H J
authors.initials: LF
authors.lastname: Robbers
authors.affiliation: Department of Cardiology and Institute of Cardiovascular Research, VU University Medical Center, De Boelelaan 1117, 1081, HV Amsterdam, the Netherlands.
authors.forename: A C
authors.initials: AC
authors.lastname: van Rossum
authors.affiliation: Department of Cardiology and Institute of Cardiovascular Research, VU University Medical Center, De Boelelaan 1117, 1081, HV Amsterdam, the Netherlands.
authors.forename: O
authors.initials: O
authors.lastname: Kamp
keywords: Cardiac MRI; Myocardial perfusion; Quantitative analysis; Refractory angina pectoris; Shockwave therapy