Cardiac Shockwave Therapy in Addition to CABG Improves Myocardial Function in Ischemic Heart Failure: The CAST-HF Trial

This study evaluated the outcomes after the use of cardiac shockwave therapy (SWT) combined with coronary artery bypass surgery (CABG) in patients with reduced left ventricular ejection fraction (LVEF) due to ischemic cardiomyopathy. Patients with LVEF ≤ 40 percent requiring CABG were enrolled in this single-blind, parallel-group, sham-controlled trial. Patients were randomly assigned to undergo direct cardiac SWT or sham treatment in addition to CABG. The primary efficacy endpoint was the improvement in LVEF measured by cardiac magnetic resonance imaging from baseline to 360 days. A total of 63 patients were randomized, 30 patients in the SWT group and 28 patients in the sham group. A greater improvement in LVEF was observed in the SWT group (Δ from baseline to 360 days: SWT 11.3 percent; Sham 6.3 percent, SD 7.4, P = 0.0146). Furthermore, patients in the SWT group significantly improved in the six minute walking test 360 days after randomization. The authors conclude that direct cardiac SWT, in addition to CABG, improves LVEF and physical capacity in patients with ischemic heart failure.