Key result
In patients with end-stage CAD receiving cardiac ESWT, concomitant end-stage renal disease was associated with a lack of LVEF improvement at 6 months (-4.00% vs +4.87% without ESRD).
Why the study?
Little is known whether cardiac extracorporeal shock wave therapy remains effective on symptomatic relief and LVEF improvement for EnD-CAD patients with end-stage renal disease.
Does cardiac extracorporeal shock wave therapy improve symptoms, angiogenesis, and LVEF in patients with end-stage coronary artery disease and concomitant end-stage renal disease?
Cohort (n=16)
Does cardiac extracorporeal shock wave therapy improve symptoms, angiogenesis, and LVEF in patients with end-stage coronary artery disease and concomitant end-stage renal disease?
Absolute Event Rate: -4% vs 4.87%
Cardiac ESWT improves angina and dyspnea in end-stage CAD patients regardless of ESRD status, but fails to improve LVEF or angiogenesis in those with concomitant ESRD.
ESWT may relieve symptoms but not LVEF or angiogenesis in EnD-CAD with ESRD; leaves open efficacy in this high-risk subgroup.
BACKGROUND: Growing evidence have shown cardiac extracorporeal shock wave therapy (ESWT) improve clinical symptoms and left ventricular ejection fraction (LVEF) for patients with end-stage diffuse coronary artery disease (EnD-CAD) unsuitable for coronary interventions. However, little is known whether cardiac ESWT remains effective on symptomatic relief and improvement of LVEF for the EnD-CAD patients with end-stage renal disease (ESRD). METHODS: This was a small-scale prospective study. Between August 2016 and January 2019, a total of 16 subjects received cardiac ESWT for their EnD-CAD. They were divided into two groups according to ESRD or not, i.e., EnD-CAD group (n = 8) and EnD-CAD/ESRD group (n = 8). Clinical symptoms including angina and dyspnea, levels of circulating endothelial progenitor cells (EPC), LVEF, and adverse events were regularly followed up for one year to compare safety and efficacy of cardiac ESWT between the EnD-CAD patients with or without ESRD. RESULTS: All participants tolerated cardiac ESWT without any relevant side effects such as skin allergic reaction, local redness/tenderness or cardiac arrhythmia. There were similar baseline comorbidities and clinical features between two groups, but the EnD-CAD/ESRD group had significantly higher serum potassium level as well as lower renal function and lipid profile (all p-values <0.03). After cardiac ESWT, the patients in both groups had significant improvement in angina and dyspnea at 1 year (all p-values <0.03). However, the EnD-CAD/ESRD group did not have increase in either circulating EPC levels or LVEF at 6 months (mean change in LVEF: -4.00% ± 8.32%, p = 1.000). In contrast, the EnD-CAD group had gradually improving levels of circulating EPC surface markers and increased LV systolic function (mean change in LVEF: +4.87% ± 8.76%, p = 0.092). Notably, patients in the EnD-CAD/ESRD group suffered from high incidental clinical adverse events before and after enrollment into the ESWT study (75% vs. 25%, p = 0.132). CONCLUSION: Although cardiac ESWT provided improvement of clinical symptoms in the EnD-CAD patients, its long-term effects on the angiogenesis and LVEF were reduced for those high-risk patients with concomitant EnD-CAD and ESRD. TRIAL REGISTRATION: none.
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Sung et al. (2020) conducted a cohort in End-stage diffuse coronary artery disease (EnD-CAD) (n=16). End-stage renal disease (ESRD) vs. No ESRD (EnD-CAD only) was evaluated on Mean change in left ventricular ejection fraction (LVEF) at 6 months. In patients with end-stage CAD receiving cardiac ESWT, concomitant end-stage renal disease was associated with a lack of LVEF improvement at 6 months (-4.00% vs +4.87% without ESRD).
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