Myocardial perfusion after one year of spinal cord stimulation in patients with refractory angina

E. Fricke; S. Eckert; A. Dongas; H. Fricke; R. Preuss; O. Lindner; D. Horstkotte; W. Burchert

doi:10.3413/nukmed-0210

Nuklearmedizin - NuclearMedicine, Inhaltsverzeichnis

Nuklearmedizin 2009; 48(03): 104-109
DOI: 10.3413/nukmed-0210

Original article

Schattauer GmbH

Myocardial perfusion after one year of spinal cord stimulation in patients with refractory angina

Untersuchung der myokardialen Perfusion nach einem Jahr Neuro stimulation bei Patienten mit therapie refraktärer Angina- pectoris- Symptomatik

E. Fricke

¹Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Centre North Rhine-Westphalia, Ruhr-University Bochum, Germany

,

S. Eckert

²Department of Cardiology

,

A. Dongas

³Institute of Anaesthesiology, Heart and Diabetes Centre North Rhine-Westphalia, Ruhr-University Bochum, Germany

,

H. Fricke

¹Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Centre North Rhine-Westphalia, Ruhr-University Bochum, Germany

,

R. Preuss

¹Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Centre North Rhine-Westphalia, Ruhr-University Bochum, Germany

,

O. Lindner

¹Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Centre North Rhine-Westphalia, Ruhr-University Bochum, Germany

,

D. Horstkotte

²Department of Cardiology

,

W. Burchert

¹Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Centre North Rhine-Westphalia, Ruhr-University Bochum, Germany

› Institutsangaben

Abstract

Summary

Aim: Spinal cord stimulation (SCS) is recommended for patients with coronary artery disease (CAD) and refractory angina. We used positron emission tomography (PET) to investigate the long-term effect of SCS on regional myocardial perfusion in patients suffering from angina pectoris refractory to medical treatment and without option for coronary intervention. Patients, methods: We analyzed data of 44 patients with stable CAD (91% three vessel disease). At baseline, we determined coronary flow reserve (CFR) using ¹³N-ammonia-PET and myocardial viability with ¹⁸F-FDG. SCS was performed for one year (Medtronic Itrell III or Synergy, Düsseldorf, Germany). During follow-up, no cardiac interventions were necessary and no myocardial infarctions occurred. At one year follow-up, CFR was measured again. Results: In the majority of patients (77%), SCS led to an improvement of clinical symptoms. CFR did not change significantly during follow-up. Subjective improvement did not correlate with an increase of CFR. Conclusions: Despite its clinical effect, SCS does not have a direct impact on CFR in patients with stable CAD. According to our results, the pain relief is not due to an improvement of the myocardial blood supply.

Zusammenfassung

Ziel: Neurostimulation (Spinal-Cord-Stimulation, SCS) ist eine anerkannte Therapie für Patienten mit refraktärer Angina-Pectoris-Symptomatik (AP) im Rahmen einer koronaren Herzerkrankung (KHK). Wir untersuchten mit Hilfe der Positronenemissionstomographie (PET) den Langzeiteffekt von SCS auf die regionale myokardiale Durchblutung bei Patienten mit medikamentös nicht beherrschbarer AP, bei denen keine Interventionsmöglichkeit bestand. Patienten, Patienten, Methodik: 44 Patienten mit stabiler KHK (bei 91% 3-Gefäß- KHK) erhielten eine Einschlussuntersuchung, bei der die koronare Flussreserve (CFR) mittels dynamischer PET mit ¹³N-Ammoniak bestimmt wurde und die Vitalität anhand einer PET-Untersuchung mit ¹⁸F-FDG beurteilt wurde. Danach erfolgte eine Neurostimulations- Therapie für ein Jahr (Medtronic Itrell III oder Synergy, Düsseldorf, Deutschland). Während dieses Jahres erhielt keiner der Patienten eine kardiale Intervention, und kein Patient erlitt einen Herzinfarkt. Bei der Jahreskontrolle erfolgte eine erneute Bestimmung der CFR. Ergebnisse: Bei den meisten Patienten (77%) führte die SCS zur Besserung der klinischen Symptomatik. Demgegenüber zeigte sich keine signifikante Änderung der CFR. Die vom Patienten empfundene Besserung der Symptomatik ging nicht mit einer Steigerung der CFR einher. Schlussfolgerungen: Trotz der klinischen Wirksamkeit hat die SCS keinen direkten Einfluss auf die CFR bei Patienten mit stabiler KHK. Unseren Ergebnissen zufolge ist die Schmerzbesserung nicht auf eine Verbesserung der myokardialen Durchblutung zurückzuführen.

Keywords

Coronary artery disease - spinal cord stimulation - angina pectoris - palliative care - positron emission tomography - myocardial blood flow

Schlüsselwörter

Koronare Herzerkrankung - Neurostimulation - Angina pectoris - PET - palliative Therapie - myokardialer Blutfluss

Volltext

Referenzen

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