Ira M. Grais, MD

Surgeries & Interventions

Shockwave Therapy’s Ischemic Heart Failure Potential

New research out of Austria suggests that cardiac shockwave therapy could help address ischemic heart failure patients’ myocardial regeneration challenges, allowing meaningful LVEF and quality of life improvements, and potentially better outcomes.

• Chronic ischemic heart failure patients are commonly treated with CABG revascularization, which helps control symptoms, but is less effective at improving LVEF. 
• Shockwave therapy (SWT) transmits sonic pressure waves, generating a physical stimulus that’s shown to improve regeneration of ischemic myocardium in animal models, and has been used to treat humans for a range of conditions (tendonitis, leg ulcers, wounds, spinal cord injury, ED). 

With this in mind, Innsbruck University spin-off Heart Regeneration Technologies developed a SWT system that applies shock waves directly to patients’ hearts, with the goal of improving cardiac function by inducing angiogenesis and myocardium regeneration.

The new CAST-HF trial suggests that Heart Regeneration Technologies’ SWT combined with CABG does indeed lead to major LVEF improvements. 

The researchers randomized 63 patients with ischemic heart failure (LVEF ≤40%) to undergo CABG plus SWT or CABG plus a sham procedure, finding that at one year the SWT group had…

• Greater improvements in LVEF (11.3% vs. 6.3%), the primary endpoint
• Greater improvements in the 6-minute walking test (+127.5 vs. +43.6 meters)
• Lower MLHFQ scores (11 vs. 17.3 points)

SWT’s potential was actually visible by six months, when it already had notable improvements to LVEF (10.5 vs. 5.7) and both of the quality of life metrics, with no device-related adverse or serious adverse events throughout the entire period. 

• The SWT step also only takes about 10-15 minutes, and is performed during the usual reperfusion time, so it doesn’t affect anesthesia or operating times.

These are encouraging results to say the least, noting the strong association between better LVEF and improvements in survival and hospitalizations.

The next step is to hold larger trials to confirm if SWT’s myocardial function improvements actually translate to better outcomes, although Heart Regeneration Technologies is already targeting European regulatory approval by late 2024 and the first non-trial patient treatments in 2025.

The Takeaway

There’s still more to prove, but these results suggest that cardiac shockwave therapy could drive significant improvements for patients with chronic ischemic heart failure.

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