A new hope for heart failure after infarction:
After a heart attack, the heart’s pumping ability may be permanently reduced – this condition is called ischemic cardiomyopathy. It can lead to shortness of breath, fatigue, swelling in the legs, and reduced quality of life.
The CAST-HF Trial demonstrated the significant increase of left ventricular ejection fraction at 12 months after shockwave therapy. This resulted in an improvement of the patients’ physical capacity, increased quality of life and a prolonged life expectancy.
Heart infarction often leads to reduced heart function, called “ischemic cardiomyopathy”. Reduced heart function causes limited physical capacity and thereby often severe limitation of everyday life – including shortness of breath, early exhaustion, leg edema and other symptoms. Current treatment options of heart infarction include besides medical therapy the revascularization of a diseased blood vessel with bypass surgery or interventional stent implantation. These strategies do preserve the residual heart function but cannot improve it. Therefore, regenerative treatment strategies are needed.
Several innovative treatment strategies have been developed during the last decades (e.g. stem cell or gene therapy). However, none of them has gained broad clinical use due to technical issues or lack in effectiveness.
Therefore, the investigators of the CAST-HF Trial aimed to prove a new regenerative option for the improvement of the heart function in addition to bypass surgery. Namely, this is cardiac shockwave therapy. It has been investigated for more than ten years in numerous pre-clinical experiments and has already been proven safe in human trials, including more than 60 patients.
Shockwaves are sound-pressure waves used in medicine since the early 80s. Therefore, this is a well-established clinical therapy which is in routine use for the treatment of bone, tendon and wound problems. Regenerative effects are well-described and the working mechanism as well as the more than favorable side-effect profile have been intensively investigated. In the CAST-HF Trial, shockwaves at low energy are applied directly to the heart muscle when the bypass surgery has already been performed. The heart at this time is still beating on circulatory support by the heart-lung-machine to avoid any safety issues.
Patients with reduced heart function (ejection fraction ≤40%) after a heart infarction in need of bypass surgery were included into the study.
The CAST- HF Trial demonstrated the significant increase of left ventricular ejection fraction at 12 months after shockwave therapy. This resulted in an improvement of the patients’ physical capacity, increased quality of life and a prolonged life expectancy.
