INTERNATIONAL WORKSHOP HELD BY STORZ MEDICAL (SWITZERLAND)

V.D. Turchin - GE “Sanatorium Concha Zaspa”, Kiev

Workshop participants: Sorokin A., Amaniyazova S. (Kazakhstan), Frosini, S. (Russia), Dusebekova L., Toyeva G. (Kazakhstan), Guterson A. (Germany), Yuvchik E., Turchin V., (Ukraine), Marlinghauz E. Shimor Y. (Switzerland).

Non-invasive methods of myocardial revascularization are widely adopted in the practice of the cardiologists. An international workshop on the clinical application of cardiologic shock wave therapy (CSWT) on the MODULITH SLC instrument manufactured by STORZ MEDICAL (Switzerland) took place on March 2010 in Moscow. To take part in the workshop were invited specialists from Germany, who were one of the originators of this method, as well as doctors from Russia, Ukraine, Kazakhstan, who have been applying practically this method in recent years. The guests of the workshop are clinicians and researchers from leading cardiologic hospitals of Moscow and St. Petersburg and representatives of the trading companies. The main objective of the workshop is to interchange the gained clinical experience between doctors of these countries and to inform concerned specialists on this form of therapy. In organizers’ opinion the seminar shall give a new impetus to the expansion of CSWT in cardiologic clinics and allow us to offer this method for helping a wider range of patients. The workshop took place in the hotel “Holiday Inn Moscow Sokolniki” hall Arbat.

As a preliminary, the organizers of the workshop suggested speakers to reflect some of the questions in their presentations. That concerned the terms of the application of the Modulit SLC instrument in a particular clinic and the amount of patients, their age, gender, selection criteria for treatment with the help of CSWT method; objectification and control methods (echocardiography, stress echocardiography, treadmill, coronary angiography, ECG, ambulatory Holter monitoring, biochemical indicators of blood tests, etc.).

After that it was necessary to present the conducting protocol for CSWT: number of shock waves per session, number of treatment’s areas per session and an average duration of therapy per session. Except that the organizers were asked to report on the results of the CSWT application in the speaker’s clinic and on the long-term results of treatment in a few years after it.

In conclusion, it was suggested to speak on the interesting occurrences from the practice of CSWT application and on the results of treating patients with stents or pacemakers.

The workshop was opened with the welcoming speech of Jurek Szymor - STORZ MEDICAL  Regional Director of Sales Central/Eastern Europe and North/West Africa and Cuba. He introduced the guests and participants of the workshop, spoke on the company’s shock-wave systems that are successfully adopted worldwide in the fields of cardiology, urology and traumatology.

On the history of the Modulit SLC instrument’s creation, its basic characteristics and biological effects of shock waves spoke Dr. E. Marlinghause - STORZ MEDICAL Director of Applications Development. Besides he has presented an overview of large-scale studies in vitro and in animals, as well as the results of clinical studies, conducted by scientists in Switzerland, Japan, Germany and Italy. As a result of these studies, the positive impact of the acoustic waves, focused on the production factors, that stimulate the process of angiogenesis, has been proved and the best level of therapeutic energy for this instrument has been chosen. He also has cited the results of a double-blind placebo-controlled study conducted by Japanese scientists who have shown the effectiveness and safety of extracorporeal shock wave therapy for severe angina. Nowadays the research concerning the possibility of using CSWT in the treatment of patients with acute myocardial infarction endures in Japan.

The topic of the clinical research was continued by one of the originators of the applying shock waves in cardiology - Dr. A. Guterson (Asklepios Kliniken GmbH hospital in Germany). He has presented the results of five-year clinical monitoring of patients with refractory angina and myocardial ischemia who have been treated by the standard CSWT method. The persistent decrease of the functional class of angina, increase of tolerance to physical activity, that has survived for five years after treatment, were pointed out.

The practical experience of CSWT application was demonstrated by doctors from the clinics of Russia, Kazakhstan and Ukraine in the second part of the workshop. CSWT method has been used in the regional cardiologic Center of Shymkent city since 2005. As it was reported by Dr. G.E. Toyeva, 133 patients have been treated during this period, among them 115 men and 18 women. Mean age 56 ± 11,2 years. Except common indications for treatment with the help of CSWT method, there is one of the new directions in this clinic - treatment of patients with “syndrome X”. In conclusions the following has been noted:

• reduction of episodes of myocardium ischemia, ventricular extrasystoles;
• increase tolerance to physical activity;
• reduction of quantity of stenocardia attacks and short-range sodium nitritums accepted per week;
• absence of complications.

Another report from Kazakhstan "Application of extracorporeal cardiologic shock wave therapy for the patients with severe coronary artery disease" was presented by Dr. R.D. Butembaev (Akmola Regional Hospital Kokshetau). The author has shared with his experience in treating 41 patients aged 47 to 77 years (mean age 62 years). As the result of treatment, the functional class of angina has decreased, frequency of angina attacks per day has decreased, and according to the echocardiography the systolic smooth function of the left ventricle has improved.

The report of Dr. A. Sorokin "Experience of CSWT application by treating the diseases of the cardiovascular system" was devoted to the analysis of patients’ treatment in the Municipal Clinical Hospital, Tolyatti. During two years 138 patients have undergone the whole CSWT course according to standard procedure, among them women - 52,2%, men - 47,8%. The patients’ age is 20 up to 89 years. "The effectiveness of the new non-invasive treatment of the ischemic heart disease with the help of extracorporeal shock wave therapy (ECSWT) in patients with "refractory angina" - so was called the report of doctor S.A.Frosina from Russia (the District hospital of Hunt-Mansijsky, Autonomous region). In the report it was informed on 50 patients with an angina of exertion FC III (45 persons) and FC IV (5 persons) from the age of 37  to 79 years.

Doctors from Russia ascertained:

• a non-invasive cardiologic revascularization – is a new safe and effective method of treatment of a chronic myocardial ischemia in patients who are not subject of treatment by other methods;
• the improvement of vascularization of a myocardium leads to improvement of conductivity through the ventriculonector and to the reduction of ventricular extrasystoles.

The report "Cardiologic shock wave therapy: first results and new perspectives" (V.D. Turchin, E.V. Yuvchik, SE Sanatorium “Concha Zaspa”, Kiev) was based on experience of treatment of 26 patients from the age of 51 years to 79 years (17 men and 9 women). 17 of them had myocardial infarction in the case history (three of them - recurring). Three patients had aorta-coronary shunting, two patients had - stenting. During the process of treatment two groups has been allocated: monitoring up to six months (12 patients) and right after treatment (14 patients). The results of treatment are as follows:

• the quantity of the attacks of a stenocardia has decreased; 
• the tolerance to physical activity has raised; 
• the left ventricular function has improved; 
• the quality of life has improved. 

Besides, it was expressed the opinion, that the application of CSWT  for treating the patients with ischemic cardiomyopathy is possible as a preliminary stage before ACS application, which is supposed to improve left ventricular systolic function and to reduce postoperative complications and hospital mortality.

In conclusion, the participants responded to several questions, mostly concerned the mechanisms of the influence of the shock waves on the ischemic myocardium, the effectiveness and safety of the method. All reporters have pointed that during the whole period of the method’s application there were no complications either during the treatment period or after treatment. There were no changes in cardiac rhythm, blood pressure, ECG, enzyme kinetics during the course treatment. Modulit SLC instrument manufactured by STORZ MEDICAL (Switzerland) is convenient in use and allows precisely to localize the therapeutic focus in the target area. All participants used a standard treatment protocol: implementation of 9 procedures in a day three procedures per week with a three-week break between each week of treatment. The density of the energy is 0.05 to 0.10 mJ / mm2; 5400 impulses of shock waves during the whole course of therapy. The treatment’s session takes 25-30 minutes on average (including the preparation of the patient). According to the results of the reports the total number of patients who have undergone the complete CSWT on the Modulit SLC instrument in the CIS countries is 427 persons with the working life of the equipment from 1 to 5 years in different hospitals. 

“The round-table” of the workshop was devoted to summarizing the meeting’s results, discussion of the plans, prospects, interesting occurrences, new methods and possible extending of the areas of CSWT application. The list of the references is in the editorial.