Abstract 14068: Repeated Thermal Therapy Improves Myocardial Perfusion in Patients with Chronically Occluded Coronary Artery
Backgrounds: It has been shown that repeated thermal therapy (TT) increases peripheral blood flow and relieves ischemic symptoms in patients with peripheral arterial disease. TT might activate eNOS which is relevant to angiogenesis in ischemic lesion. Accordingly, we investigated in patients with coronary artery disease whether TT could improve myocardial flow in the area of chronically and totally occluded (CTO) coronary artery.
Methods: Nineteen patients (age 69±10yo) who had stress-induced myocardial ischemia in the area of CTO were studied. Severity of ischemia was quantified by thallium-201 myocardial perfusion scintigraphy (MPS) with adenosine. Summed stress (SSS) and summed difference scores (SDS, SSS — summed rest score) were determined using a 17-segment model of left ventricle with a grading scale of 0 to 4. Patients were divided into TT group (n=14) and control group (CON, n=5). TT group treated with a 60°C far infrared-ray dry sauna bath for 15 minutes and then kept in a bed covered with blankets for 30 minutes once a day for 3 weeks. At baseline and 3 weeks later, MPS was performed and the defect score, flow mediated dilation (FMD) of the brachial artery, the number of circulating endothelial progenitor cells (EPC) positive for CD34, and treadmill-exercise indices were determined.
Results: SSS (12±9 vs 13±9, ns) and SDS (5±3 vs 6±4, ns) at baseline and 3 weeks later were unchanged in CON group, but both SSS (16±7 vs 9±6, p<0.01) and SDS (6±4 vs 2±2, p<0.01) were improved in TT group. Eleven of 14 TT patients were responders to TT, defined as ΔSSS (baseline — 3 weeks later) ≥2. TT improved symptom-limited exercise time (443±180 to 529±181sec, p<0.01) and had a weak trend to improving FMD (4.4±1.5 to 5.8±2.3% p=0.12). TT tended to decrease the number of EPC (0.68±0.34 to 0.55±0.27/μl p=0.06), probably due to TT-induced reduction in ischemic stimuli. In 5 patients, serial changes in EPC during 3 weeks were performed and 3 of these 5 patients were accompanied by transient increases in EPC at the initial period.
Conclusions: TT improves CTO-related myocardial perfusion and exercise tolerance in patients with CTO. Therefore, TT might be a useful complementary and alternative medicine in patients with severe coronary lesions not suitable for coronary intervention.
- © 2010 by American Heart Association, Inc.