In chronic ischemic heart failure, revascularization strategies have traditionally focused on symptom control, often falling short in significantly enhancing left ventricular ejection fraction (LVEF). A recent study published in the European Heart Journal explores the potential of cardiac shockwave therapy (SWT) as a novel treatment aimed at boosting cardiac function through angiogenesis and myocardial regeneration.
The study, known as the CAST-HF trial (NCT03859466), employed a single-blind, parallel-group, sham-controlled design. Researchers enrolled patients with LVEF ≤40% who required surgical revascularization, randomly assigning them to receive either direct cardiac SWT or a sham treatment alongside coronary bypass surgery. The primary objective was to assess the improvement in LVEF from baseline to 360 days, as measured by cardiac magnetic resonance imaging.
Among the 63 randomized patients, 58 completed the one-year follow-up. Results showed a significant increase in LVEF in the SWT group (mean change of 11.3%, SD 8.8) compared to the sham group (mean change of 6.3%, SD 7.4), with a P-value of .0146. Secondary outcomes included the 6-minute walking test, where the SWT group demonstrated a greater improvement (127.5 meters, SD 110.6) than the sham group (43.6 meters, SD 172.1), with a P-value of .028. Additionally, the SWT group reported a lower score on the Minnesota Living with Heart Failure Questionnaire on day 360 (11.0 points, SD 19.1) versus the sham group (17.3 points, SD 15.1), although this difference was not statistically significant (P = .15). Two patients in the treatment group passed away due to non-device-related reasons.
The findings from the CAST-HF trial suggest that direct cardiac shockwave therapy, when combined with coronary bypass surgery, can significantly enhance LVEF and physical capacity in patients suffering from ischemic heart failure.
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Original article: Holfeld J et al. European Heart Journal. 2024.
