Clinical trial NCT02339454: Efficacy of Extracorporeal Shockwave Myocardial Revascularization Therapy in Patients With Stable Angina Pectoris
Official title: Efficacy of Extracorporeal Shockwave Myocardial Revascularization Therapy in Patients With Stable Angina Pectoris - A Randomized, Double Blind, Placebo Controlled, Multicenter Study
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE3
Conditions: Stable Angina Pectoris
Keywords: Cardiac Shock wave therapy
stable angina
exercise tolerance
Lead sponsor: Moscow State University of Medicine and Dentistry
Sponsor class: OTHER
Collaborators: name: Vilnius University
name: Medispec
First posted: 2015-01-15
Enrollment: 72
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: Low intensity shockwaves have been proven in animal and pilot clinical studies to induce local growth of new blood vessels. Small single-center clinical trials with shockwave therapy showed promising results in reducing angina symptoms, improving perfusion and contractility in patients with refractory angina and stress-induced ischemia on imaging test.

The hypothesis of this study is that shockwave therapy could improve angina symptoms and exercise tolerance in broader population of patients with stable angina regardless of imaging test results Study aims to demonstrate anti-anginal efficacy of Extracorporeal Shockwave Myocardial Revascularization Therapy (ESMR), on top of stable optimal medical treatment in patients with stable angina.

Detailed description: Low intensity shockwaves (0.09 millijoule/mm2) are delivered to myocardial tissue. Shockwaves are created by a special generator and are focused using a shockwave applicator device. The treatment is guided by standard echocardiography equipment. The shockwaves are delivered in synchronization with Patient R-wave (ECG) to avoid arrhythmias. The treatment is painless.

At first, the patient undergoes modified Bruce treadmill test, to assess exercise induced ischemia.

Exercise induced ECG ischemia is defined as the new development of horizontal or down - sloping ST segment depression (≥1 mm at 60 ms after J point) versus baseline tracing.

Study treatment consists of 9 sessions, with 3 sessions per week 1, 5 and 9. 100 shocks are delivered per spot, 1200 shocks per session.

During 1st treatment week ESMR will be delivered 3 times (every other day) to basal segments (2 spots in each wall in apical 4-, 2-, 3- chamber positions).

During 2nd treatment week ESMR will be delivered 3 times (every other day) to middle segments (2 spots in each wall in apical 4-, 2-, 3- chamber positions).

During 3rd treatment week ESMR will be delivered 3 times (every other day) to apical segments (2 spots in each wall in apical 4-, 2-, 3- chamber positions).

The spots are localized by the ultra-sound device and the shockwaves are focused to this area. Several treatments are required for optimal results.

Eligibility criteria: Inclusion Criteria:

* Male and female patients (females of childbearing potential must be using adequate contraceptive precautions such as implants, injectables, combined oral contraceptives, intrauterine devices, sexual abstinence or vasectomized partner).
* Patients aged ≥ 18 years.
* Patients with coronary artery disease confirmed by angiography, prior MI, prior revascularization (PCI, CABG) and with exercise angina not controlled by the optimal medical therapy.
* Patient should be on a stable dosage of medication used to treat angina for at least 4 weeks prior to enrollment.
* ST-segment depression ≥ 1mm during exercise ECG.
* Able and willing to sign informed consent and to comply with study procedures.
* Written informed consent prior to enrolment into the study.

Exclusion Criteria:

* Angina at rest.
* ECG abnormalities at rest (left bundle-branch block, resting ST-segment depression ≥ 1mm, digoxin therapy, WPW-syndrome).
* Planned coronary intervention or CABG within 6 months.
* Heart failure (class III or IV NYHA).
* Moderate-severe hypertension (SBP\>160 mmHg and/or DBP\>100 mmHg).
* Hypotension (SBP\<100 mmHg).
* Acute coronary syndrome or coronary revascularization procedure within the prior 3 months before enrolment.
* Females who are pregnant or nursing.
* Any clinically relevant hematological or biochemical abnormality on routine screening, according to Investigator's judgment.
* Severe concurrent pathology, including terminal illness (cancer, AIDS, etc.).
* Renal impairment defined as Creatinine \>150 mcmol/l.
* Mild, moderate or severe hepatic impairment or hepatic insufficiency defined as: SGOT or SGPT \> 3 times greater than normal upper limit or total serum bilirubin \> 1.5 times greater than normal upper limit
* Existing contraindications for exercise testing (e.g. acute myocarditis or pericarditis, DVT, severe aortic stenosis)
* Dementia, psychosis, alcoholism (\>350 g ethanol/week) or chronic abuse of medicines, drugs or psychoactive substances.
* Conditions which in the Investigator's opinion may interfere with the study's execution or due to which the patient should not participate for safety reasons.
* Risk of low patient cooperation.
* Inability or unwillingness to issue the informed consent.
* Patient is simultaneously participating in another device or drug study, or has participated in any clinical trial involving an experimental device or drug, including other drugs or devices enhancing cardiac neovascularization, or any cardiac shock wave therapy machine of a competitor company within 3 months of entry into the study.

Primary outcomes:
measure: Change in Total Exercise duration
timeFrame: 6 months
Secondary outcomes:
measure: Time to 1 mm ST-segment depression in modified Bruce treadmill test
timeFrame: 6 months
measure: Time to angina in modified Bruce treadmill test
timeFrame: 6 months
measure: Number of angina attacks per week
timeFrame: 6 months
measure: Number of sublingual nitroglycerin consumption per week
timeFrame: 6 months
measure: CCS angina functional class
timeFrame: 6 months
measure: Seattle angina questionnaire score
timeFrame: 6 months
Other outcomes:
Locations:
city: Vilnius
country: Lithuania
facility: Vilnius University Hospital, Santariskiu klinkos
city: Moscow
country: Russian Federation
facility: Moscow state university of medicine&dentistry
Study officials:
affiliation: Vilnius University Hospital, Santariskiu klinikos
name: Jelena Celutkiene, MD, PhD
role: PRINCIPAL_INVESTIGATOR
affiliation: Moscow State University of Medicine&Dentistry
name: Evgeny Shkolnik, MD, PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Celutkiene J, Burneikaite G, Shkolnik E, Jakutis G, Vajauskas D, Cerlinskaite K, Zuoziene G, Petrauskiene B, Puronaite R, Komiagiene R, Butkuviene I, Steponeniene R, Misiura J, Laucevicius A. The effect of cardiac shock wave therapy on myocardial function and perfusion in the randomized, triple-blind, sham-procedure controlled study. Cardiovasc Ultrasound. 2019 Jul 4;17(1):13. doi: 10.1186/s12947-019-0163-1.