Cardiac shock-wave therapy in the treatment of coronary artery disease: systematic review and meta-analysis

Abstract

AimTo systematically review currently available cardiac shock-wave therapy (CSWT) studies in humans and perform meta-analysis regarding anti-anginal efficacy of CSWT.MethodsThe Cochrane Controlled Trials Register, Medline, Medscape, Research Gate, Science Direct, and Web of Science databases were explored. In total 39 studies evaluating the efficacy of CSWT in patients with stable angina were identified including single arm, non- and randomized trials. Information on study design, subject’s characteristics, clinical data and endpoints were obtained. Assessment of publication risk of bias was performed and heterogeneity across the studies was calculated by using random effects model.ResultsTotally, 1189 patients were included in 39 reviewed studies, with 1006 patients treated with CSWT. The largest patient sample of single arm study consisted of 111 patients. All selected studies demonstrated significant improvement in subjective measures of angina symptoms and/or quality of life, in the majority of studies left ventricular function and myocardial perfusion improved. In 12 controlled studies with 483 patients included (183 controls) angina class, Seattle Angina Questionnaire (SAQ) score, nitrates consumption were significantly improved after the treatment.In 593 participants across 22 studies the exercise capacity was significantly improved after CSWT, as compared with the baseline values (in meta-analysis standardized mean difference SMD = −0.74; 95% CI, −0.97 to −0.5; p < 0.001).ConclusionsSystematic review of CSWT studies in stable coronary artery disease (CAD) demonstrated consistent improvement of clinical variables. Meta-analysis showed a moderate improvement of exercise capacity.Overall, CSWT is a promising non-invasive option for patients with end-stage CAD, but evidence is limited to small sample single-center studies. Multi-center adequately powered randomised double blind studies are warranted.

New Advances in the Management of Refractory Angina Pectoris

“…50,52,53 To date, several randomised controlled studies in stable angina have demonstrated promising clinical outcomes without serious adverse effects. 54 The largest study (n=45) to date showed that CCS class, Step 1…”

“…NYHA class, myocardial perfusion, nitroglycerin usage, SAQ score, 6-minute walk test and left ventricular ejection fraction were all significantly improved at 3 months compared to controls as well as baseline (0 months). In the control group, none the above parameters had changed significantly from baseline at 3 months 55. A recent metaanalysis of ECSWT for angina was able to demonstrate significant improvements in angina class, SAQ score, nitrate consumption and exercise capacity.…”

“…However, it should be noted that this study included single-arm, non-randomised and randomised trials and considered studies of chronic stable angina (the majority) as well as RA. Most trials were also small -the largest randomised, placebo-controlled study had a treatment arm consisting of 45 individuals -and they had varying durations of follow-up (range 1-72 months) 54. ECSWT has been investigated specifically for RA in several studies, all of which suggest its efficacy and safety.…”

Various protocols of extracorporeal shock wave therapy in the treatment of stable angina

“…Во всех отобранных исследованиях УВТ продемонстрировала достоверное снижение функционального класса (ФК) стенокардии, улучшение КЖ по данным опросника SAQ (Seattle Angina Questionnaire), уменьшение количества приступов стенокардии и приема нитратов. УВТ показала достоверное улучшение ТФН по данным нагрузочных проб и улучшение перфузии миокарда левого желудочка (ЛЖ) по данным сцинтиграфии [9].…”

Ударно-Волновая Терапия: Состояние Проблемы И Возможности Применения В Клинической Практике

“…Исследованиями последних лет показана перспективность приме-нения метода УВТ в кардиологии у пациентов, страдающих ишемической болезнью сердца [10,23,27,54]. Показано, что использование метода в низкоэнергетических режимах приводит к суще-ственному снижению потребности в короткодей-ствующих нитратах: для нитроглицерина сниже-ние составило 70,2%.…”