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Eur Heart J Cardiovasc Imaging. 2015 Apr;16(4):449-55. doi: 10.1093/ehjci/jeu276. Epub 2014 Dec 2.

Effect of spinal cord stimulation on myocardial perfusion reserve in patients with refractory angina pectoris.

Author information

1
Turku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, Turku FI-20520, Finland Heart Center, Turku University Hospital and University of Turku, Turku, Finland antsaras@utu.fi.
2
Heart Center, Turku University Hospital and University of Turku, Turku, Finland.
3
Turku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, Turku FI-20520, Finland.
4
Department of Anesthesiology, Turku University Hospital, Turku, Finland.
5
Department of Clinical Physiology, Nuclear Medicine and PET, Turku University Hospital, Turku, Finland.

Abstract

AIMS:

Epidural spinal cord stimulation (SCS) provides symptom relief in refractory angina pectoris, but its mechanism of action remains incompletely understood. We studied effects of short-term SCS therapy on myocardial ischaemia tolerance, myocardial perfusion reserve (MPR), and endothelium-mediated vasodilatation induced by cold pressor test (CPT) in patients with refractory angina pectoris.

METHODS AND RESULTS:

We prospectively recruited 18 patients with refractory angina pectoris and studied them after implantation of SCS device at baseline before starting the therapy and after 3 weeks of continuous SCS therapy. Myocardial ischaemia was evaluated by dobutamine stress echocardiography. Global and regional myocardial blood flow (MBF) were measured using positron emission tomography and (15)O-water at rest, during adenosine stress, and in response to CPT. Systemic haemodynamics were comparable before and after 3 weeks of SCS at rest, during adenosine stress and during CPT. Appearance of angina pectoris induced by dobutamine stress was delayed after SCS therapy. Global MPR increased (P = 0.02) from 1.7 ± 0.6 at baseline to 2.0 ± 0.6 after 3-week SCS therapy. This was associated with a significant reduction in global MBF at rest and increase in MBF induced by adenosine in the ischaemic regions. Global MBF response to CPT was improved after SCS (0.27 ± 0.20 vs. 0.40 ± 0.15, P = 0.03).

CONCLUSION:

Short-term SCS therapy improved myocardial ischaemia tolerance, absolute MPR, and endothelium-mediated vasomotor function in refractory angina pectoris, indicating that this therapy can alleviate myocardial perfusion abnormalities in advanced CAD.

KEYWORDS:

Angina pectoris; Coronary flow reserve; Myocardial blood flow; Positron emission tomography; Spinal cord stimulation

PMID:
25468958
DOI:
10.1093/ehjci/jeu276
[Indexed for MEDLINE]

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