TY - JOUR
T1 - Cardiac shockwave therapy in addition to coronary bypass surgery improves myocardial function in ischaemic heart failure
T2 - the CAST-HF trial
AU - Holfeld, Johannes
AU - Nägele, Felix
AU - Pölzl, Leo
AU - Engler, Clemens
AU - Graber, Michael
AU - Hirsch, Jakob
AU - Schmidt, Sophia
AU - Mayr, Agnes
AU - Troger, Felix
AU - Pamminger, Mathias
AU - Theurl, Markus
AU - Schreinlechner, Michael
AU - Sappler, Nikolay
AU - Ruttmann-Ulmer, Elfriede
AU - Schaden, Wolfgang
AU - Cooke, John P.
AU - Ulmer, Hanno
AU - Bauer, Axel
AU - Gollmann-Tepeköylü, Can
AU - Grimm, Michael
N1 - © The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact [email protected] for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact [email protected].
PY - 2024/8/1
Y1 - 2024/8/1
N2 - BACKGROUND AND AIMS: In chronic ischaemic heart failure, revascularisation strategies control symptoms but are less effective in improving left ventricular ejection fraction (LVEF). The aim of this trial is to investigate the safety of cardiac shockwave therapy (SWT) as a novel treatment option and its efficacy in increasing cardiac function by inducing angiogenesis and regeneration in hibernating myocardium.METHODS: In this single-blind, parallel-group, sham-controlled trial (cardiac shockwave therapy for ischemic heart failure, CAST-HF; NCT03859466) patients with LVEF ≤40% requiring surgical revascularisation were enrolled. Patients were randomly assigned to undergo direct cardiac SWT or sham treatment in addition to coronary bypass surgery. The primary efficacy endpoint was the improvement in LVEF measured by cardiac magnetic resonance imaging from baseline to 360 days.RESULTS: Overall, 63 patients were randomized, out of which 30 patients of the SWT group and 28 patients of the Sham group attained 1-year follow-up of the primary endpoint. Greater improvement in LVEF was observed in the SWT group (Δ from baseline to 360 days: SWT 11.3%, SD 8.8; Sham 6.3%, SD 7.4, P = .0146). Secondary endpoints included the 6-minute walking test, where patients randomized in the SWT group showed a greater Δ from baseline to 360 days (127.5 m, SD 110.6) than patients in the Sham group (43.6 m, SD 172.1) (P = .028) and Minnesota Living with Heart Failure Questionnaire score on day 360, which was 11.0 points (SD 19.1) for the SWT group and 17.3 points (SD 15.1) for the Sham group (P = .15). Two patients in the treatment group died for non-device-related reasons.CONCLUSIONS: In conclusion, the CAST-HF trial indicates that direct cardiac SWT, in addition to coronary bypass surgery improves LVEF and physical capacity in patients with ischaemic heart failure.
AB - BACKGROUND AND AIMS: In chronic ischaemic heart failure, revascularisation strategies control symptoms but are less effective in improving left ventricular ejection fraction (LVEF). The aim of this trial is to investigate the safety of cardiac shockwave therapy (SWT) as a novel treatment option and its efficacy in increasing cardiac function by inducing angiogenesis and regeneration in hibernating myocardium.METHODS: In this single-blind, parallel-group, sham-controlled trial (cardiac shockwave therapy for ischemic heart failure, CAST-HF; NCT03859466) patients with LVEF ≤40% requiring surgical revascularisation were enrolled. Patients were randomly assigned to undergo direct cardiac SWT or sham treatment in addition to coronary bypass surgery. The primary efficacy endpoint was the improvement in LVEF measured by cardiac magnetic resonance imaging from baseline to 360 days.RESULTS: Overall, 63 patients were randomized, out of which 30 patients of the SWT group and 28 patients of the Sham group attained 1-year follow-up of the primary endpoint. Greater improvement in LVEF was observed in the SWT group (Δ from baseline to 360 days: SWT 11.3%, SD 8.8; Sham 6.3%, SD 7.4, P = .0146). Secondary endpoints included the 6-minute walking test, where patients randomized in the SWT group showed a greater Δ from baseline to 360 days (127.5 m, SD 110.6) than patients in the Sham group (43.6 m, SD 172.1) (P = .028) and Minnesota Living with Heart Failure Questionnaire score on day 360, which was 11.0 points (SD 19.1) for the SWT group and 17.3 points (SD 15.1) for the Sham group (P = .15). Two patients in the treatment group died for non-device-related reasons.CONCLUSIONS: In conclusion, the CAST-HF trial indicates that direct cardiac SWT, in addition to coronary bypass surgery improves LVEF and physical capacity in patients with ischaemic heart failure.
KW - Heart Failure
KW - Ischaemic cardiomyopathy
KW - Shockwave Therapy
KW - Surgical Revascularization
KW - Single-Blind Method
KW - Myocardial Ischemia/therapy
KW - Humans
KW - Middle Aged
KW - Male
KW - Stroke Volume/physiology
KW - Treatment Outcome
KW - High-Energy Shock Waves/therapeutic use
KW - Combined Modality Therapy
KW - Coronary Artery Bypass
KW - Female
KW - Aged
KW - Heart Failure/therapy
UR - https://www.scopus.com/pages/publications/85198707839
UR - https://www.scopus.com/inward/citedby.url?scp=85198707839&partnerID=8YFLogxK
U2 - 10.1093/eurheartj/ehae341
DO - 10.1093/eurheartj/ehae341
M3 - Article
C2 - 38898573
AN - SCOPUS:85198707839
SN - 0195-668X
VL - 45
SP - 2634
EP - 2643
JO - European heart journal
JF - European heart journal
IS - 29
ER -