Cardiac Shock Wave Therapy Reduces Angina and Improves Myocardial Function in Patients With Refractory Coronary Artery Disease

Abstract

Background: Safe and effective therapeutic management of refractory coronary artery disease (CAD) in heart patients is critical to enhance cardiovascular function and improve quality of life. Current therapies for refractory CAD are inadequate in ameliorating angina and promoting revascularization of ischemic myocardium. Hypothesis: Cardiac shock wave therapy (CSWT) is a safe and effective noninvasive intervention in the management of patients with refractory CAD. Methods: The study enrolled 9 male patients age 50 to 70 years (5.11 ± 5.46 years) with a diagnosis of CAD and stent implantation (3.00 ± 2.24 stents). CSWT was carried out for 3 months at 3 intervals during the first week of each month (first, third, and fifth day), for a total of 9 therapies per patient. Dobutamine stress echocardiography and radionuclide angiography identified the myocardial ischemic segments. The effects of CSWT on myocardial perfusion and systolic function were examined. Other outcome measures included myocardial injury enzyme markers, angina scale, nitroglycerin dosage, and cardiopulmonary fitness assessments. Results: Improved myocardial blood flow and regional systolic function (stress peak systolic strain rate −1.10 to −1.60 s −1 , P = 0.002) were detected in patients following CSWT. Reductions in creatine kinase (87.89 ± 36.69 to 86.22 ± 35.96 IU/L, P = 0.046), creatine kinase MB (10.89 ± 5.73 to 10.11 ± 5.93 IU/L, P = 0.008), aspartate transaminase (interquartile range [IQR], 28.00 to 27.00 IU/L, P = 0.034) were also found. Angina (Canadian Cardiovascular Society scale IQR 3.0 to 2.0, P = 0.035) and nitroglycerin dose reduction (IQR 3.0 to 1.0 times/wk, P = 0.038) were reported.Conclusions: This study is a preliminary assessment of CSWT in patients with refractory CAD. We report that CSWT is a noninvasive, effective, and safe intervention in the treatment of refractory CAD.

Extracorporeal shockwave myocardial therapy is efficacious in improving symptoms in patients with refractory angina pectoris – a multicenter study

“…Finally, perhaps the most compelling advantage of ESMT is its safety. As in previous studies, we did not observe any adverse effects from ESMT [1,12,13,16]. …”

“…Our study extends the findings of previous studies, which have suggested that ESMT may be safe and efficacious in small groups of patients [1,7,9,12,13,16,28]. This is at present the first and largest international multicenter study showing that ESMT decreases nitroglycerin consumption, increases myocardial perfusion on SPECT, improves CCS scores, and increases exercise capacity.…”

“…It has been shown to improve both myocardial perfusion and left ventricular ejection fraction (LVEF) [12,13]. Several small human studies have also suggested that ESMT is both safe and potentially clinically efficacious in the management of chronic refractory angina [1,7,16]. In our multicenter study, we aimed to test the hypothesis that ESMT improves myocardial ischemia and functional status in patients with chronic refractory angina.…”

Extracorporeal Shock Wave Therapy for Ischemic Cardiovascular Disorders

“…[23] Following our initial report, several clinical studies with positive results were reported worldwide. [34][35][36][37] To confirm the usefulness and safety of our SW therapy, we performed a second clinical trial in a randomized and placebo-controlled manner. In this second trial, again we were able to demonstrate that the low-energy SW therapy not only improved symptoms and reduced nitroglycerin use, but also improved LV function ( figure 7), establishing cardiac SW therapy as an effective and safe angiogenic strategy for severe ischemic heart disease.…”

Study of generation and trigger system of the Extracorporeal Cardiac Shock Wave

“…In vitro studies have demonstrated that ECSWT can enhance vascular endothelial growth factor (VEGF) mRNA expression in cultured human umbilical vein endothelial cells and in rat bone marrow cells (BMCs) as well as promote BMCs differentiation into cells with endothelial phenotype [3,4]. Swiss company STORZ MEDICAL developed the first extracorporeal cardiac shock wave apparatus MODLITH SLC in the world in 2003 [5]. In 2010, Kikuchi performed a double-blind placebo-controlled trial in patients with severe angina pectoris to further confirm the effectiveness and safety of ECSWT [6].…”