Cardiac Shock Wave Therapy for Coronary Heart Disease: an Updated Meta-analysis

Huang, Yang; Xie, Xiang; Hou, Xian‐Geng; Xiu, Wen-Juan; Wang, Tingting

doi:10.21470/1678-9741-2019-0276

Cited by 6 publications

(10 citation statements)

References 39 publications

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“…The bodily pain and general health domain of physical health component quality of life scores improved in all patients in our case series after ESMR therapy. Concordance with our findings, a metaanalysis study found ESMR therapy could improve CCS class up to one severity class (13). Another study by Schmid et al (18) demonstrated improvement of general health, physical function, and vitality domain in 11 patients with refractory angina after ESMR therapy.…”

Section: Discussionsupporting

confidence: 89%

“…Based on the current guidelines, the position of ESMR therapy is recognized as a potential treatment for refractory angina (1). Previous clinical studies of ESMR found beneficial effects for patients with refractory angina pectoris that do not have options for invasive approaches (13). However, most EMSR therapy trials only include a small sample of patients for each group (16)(17)(18).…”

Section: Discussionmentioning

confidence: 99%

“…In a triple-blind randomized clinical trial of patients with refractory angina, ESMR therapy demonstrated significantly improved myocardial perfusion during 6-month follow-up compared to medical therapy alone (9). A recent meta-analysis comparing ESMR vs. optimal medical therapy alone in patients with refractory angina shows a significant improvement in the 6-min walking test distance achieved and quality of life measured using the Seattle angina questionnaire (13). A limited study describes the efficacy of ESMR to treat indicated invasive revascularization patients with SAP.…”

Section: Introductionmentioning

confidence: 99%

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Case Series: Extracorporeal Shockwave Myocardial Revascularization Therapy Improves Ischemic Response, Functional Capacity, and Quality of Life in Indicated CABG-Stable Angina Pectoris Patients

Akbar

Adiputro

Tiksnadi

et al. 2022

Front. Cardiovasc. Med.

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IntroductionExtracorporeal shockwave myocardial revascularization (ESMR) is included in the guidelines only for patients with refractory angina pectoris having no option for invasive revascularization. We intend to report a case series with ESMR therapy is indicated patients with coronary artery bypass grafting-stable angina pectoris (CABG-SAP) who refuse the surgery, irrespective of angina symptoms.MethodsWe review medical records of patients with SAP admitted to ESMR therapy in Dr. Hasan Sadikin General Hospital, Bandung, Indonesia from January 2018 to December 2019. Recorded variables at baseline and after therapy extracted, namely, (1) ischemic response, double product, and (2) functional capacity measured as metabolic equivalent (MET) using treadmill test; (3) six-minute walking test distance achieved; and (4) quality of life using SF-36 Questionnaire.ResultsA total of four indicated patients with CABG-SAP from 50 to 75 years old were included in this study. At baseline, one patient is CCS class I and two patients are CCS class II with SDS ranging from 3 to 17. Ischemic response improved in all the patients. The double product improved in patient 1 9,600–14,872 mm Hg × bpm, patient 2 9,460–10,640 mm Hg × bpm, and patient 4 17,220–20,480 mm Hg × bpm. The functional capacity improved in Patient 1 8.07–8.91 METs, patient 2 1.91–4.01 METs, patient 3 3.45–6.39 METs, and patient 4 3.9–4.43 METs. The 6-min walking distance improved in patient 1 540–570 m and patient 2 345–405 m. The CCS class, bodily pain, and general health domain scores improved in all patients.ConclusionESMR therapy might be beneficial for indicated patients with CABG-SAP to improve ischemic response, functional capacity, and physical component of quality of life.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Case Series: Extracorporeal Shockwave Myocardial Revascularization Therapy Improves Ischemic Response, Functional Capacity, and Quality of Life in Indicated CABG-Stable Angina Pectoris Patients

Akbar

Adiputro

Tiksnadi

et al. 2022

Front. Cardiovasc. Med.

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“…At present, some studies indicated that CSWT could effectively improve myocardial function and perfusion in patients with stable angina and severe CAD at rest and during stress ( 11 , 14 , 21 , 38 , 39 ). Yang et al ( 17 ) showed that CSWT significantly improved LVEF compared to baseline in their meta-analysis based on six single-arm studies and one cohort study, while the improvement may be due to optimal medical therapy and lifestyle modifications. Our study based on RCTs minimized various confounders and selection bias and had a higher level of statistical reliability.…”

Section: Discussionmentioning

confidence: 99%

“…Some studies demonstrated that CSWT could enhance left ventricular (LV) systolic function and alleviate myocardial ischemia ( 11 – 13 ), whereas others found that there were no significant associations between CSWT and cardiac function or myocardial perfusion ( 14 , 15 ). To address this issue, Burneikaitë et al ( 16 ) and Yang et al ( 17 ) performed meta-analyses in 2017 and 2020, respectively. However, they missed several important studies reported in Chinese, and additional studies have since been published.…”

Section: Introductionmentioning

confidence: 99%

Cardiac Shock Wave Therapy in Coronary Artery Disease: A Systematic Review and Meta-Analysis

Qiu

Chen

Qiu

et al. 2022

Front. Cardiovasc. Med.

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ObjectiveCoronary artery disease (CAD) has been one of the leading causes of morbidity and mortality worldwide. Cardiac shock wave therapy (CSWT) is a novel and non-invasive therapy for CAD. Therefore, we conducted a systematic review and meta-analysis to evaluate the efficacy of CSWT on CAD.Methods and resultsWe performed a comprehensive search of electronic databases such as PubMed, Embase, the Cochrane Library, and Wanfang Data in October 2021. The results were reported as weighted mean difference (WMD) with a 95% confidence interval (CI). Statistical heterogeneity scores were assessed with the standard Cochran’s Q test and the I2 statistic. A total of 8 randomized trials and 2 prospective cohort studies, together involving 643 patients (n = 336 CSWT and n = 307 control), were included in our study. Eight studies with 371 patients showed significantly improved rest left ventricular ejection fraction (LVEF) with CSWT as compared to that of the control group (WMD 3.88, 95% CI 1.53–6.23, p = 0.001, I2 = 51.2%). Seven studies with 312 patients reported left ventricular internal diameter in diastole (LVIDd) were markedly decreased in the CSWT group compared to the control group (WMD −1.81, 95% CI −3.23 to −0.39, p = 0.012, I2 = 20.3%). The summed stress score significantly favored the CSWT group (WMD −3.76, 95% CI −6.15 to −1.37, p = 0.002, I2 = 56.8%), but there was no significant difference for the summed rest score. Our data were acquired from studies without a perceived high risk of bias, so plausible bias is unlikely to seriously affect the main findings of the current study.ConclusionBased on data from our present meta-analysis, CSWT was shown to moderately improve myocardial perfusion and cardiac function among patients with CAD, which would provide the clinicians with a meaningful and valuable option.Systematic Review RegistrationThe meta-analysis was registered on the Open Science Framework (OSF) (https://osf.io/r2xf9).

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Effects of Cavitation from Extracorporeal Shock Wave Combined with Sulfur Hexafluoride Microbubble on Myocardial Ultrastructure in Rats

et al. 2023

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Background: In the present study, the effects of extracorporeal cardiac shock waves combined with different concentrations of sulfur hexafluoride ultrasound microbubbles on myocardial ultrastructure in rats were observed. Methods: Thirty-six rats were randomly divided into 6 groups: control group (N), extracorporeal cardiac shock wave group, and combined group, i.e., extracorporeal cardiac shock wave combined with different concentrations of sulfur hexafluoride microbubble (0.225 mL/kg/min, 0.45 mL/kg/min, 0.9 mL/kg/min, 1.8 mL/kg/min). The combination of extracorporeal cardiac shock wave combined with sulfur hexafluoride microbubbles of different concentrations had no significant effect on hemodynamic indexes and left ventricular function in rats. Results: There were significant differences in cardiac troponin I (cTnI) and nitric oxide among different groups. Histopathology showed that inflammatory cells infiltrated in the shock wave + microbubble 0.9 and shock wave + microbubble 1.8 groups. The myocardial ultrastructural injury score of shock wave + microbubble1.8 group was significantly higher than that of the N group, shock wave group, shock wave + microbubble 0.225 group, and shock wave + microbubble 0.45 group. The score of shock wave + microbubble 0.9 group was higher than that of the control group ( P = .009). Western blot results showed that the expression of vascular endothelial growth factor and endothelial nitric oxide synthase (eNOS) protein in the rats treated with extracorporeal cardiac shock wave combined with sulfur hexafluoride microbubbles of different concentrations was higher than that in the N group and shock wave group, with shock wave + microbubble 0.45 group having the strongest expression. Conclusion: Myocardial ultrastructure damage occurs when high concentrations of sulfur hexafluoride microbubbles are present, but a proper concentration of sulfur hexafluoride microbubbles could promote the cavitation effect of extracorporeal cardiac shock waves. Thus combination therapy may become a new paradigm in coronary heart disease, especially contributing to the treatment of refractory angina. Combination therapy may change coronary heart disease treatment, especially for refractory angina.

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Cardiac Shock Wave Therapy for Coronary Heart Disease: an Updated Meta-analysis

Cited by 6 publications

References 39 publications

Case Series: Extracorporeal Shockwave Myocardial Revascularization Therapy Improves Ischemic Response, Functional Capacity, and Quality of Life in Indicated CABG-Stable Angina Pectoris Patients

Case Series: Extracorporeal Shockwave Myocardial Revascularization Therapy Improves Ischemic Response, Functional Capacity, and Quality of Life in Indicated CABG-Stable Angina Pectoris Patients

Cardiac Shock Wave Therapy in Coronary Artery Disease: A Systematic Review and Meta-Analysis

Effects of Cavitation from Extracorporeal Shock Wave Combined with Sulfur Hexafluoride Microbubble on Myocardial Ultrastructure in Rats

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