Noninvasive therapy for the management of patients with advanced coronary artery disease

Kazmi, Waqar; Rasheed, Syed Zahed; Ahmed, Saeed; Saadat, Mohammad; Altaf, Saqib; Samad, Abdus

doi:10.1097/mca.0b013e328358a606

Cited by 18 publications

(14 citation statements)

References 11 publications

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“…The current study extends previous smaller clinical trials and showed that ESMR therapy is an effective and safe option for patients with refractory angina pectoris and improves exercise capacity and reduces nitroglycerin use in patients with end-stage ischemic heart disease with no procedural complications or side effects [30,33,34,37–39]. The clinical improvement of myocardial ischemia correlates with the SPECT finding that shows a significantly improved myocardial perfusion after the ESMR.…”

Section: Discussionsupporting

confidence: 84%

The beneficial effect of extracorporeal shockwave myocardial revascularization in patients with refractory angina

Alunni

Marra

Meynet

et al. 2015

Cardiovascular Revascularization Medicine

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Objectives The incidence of patients with refractory angina (RA) is increasing. Medical therapy for RA is limited and prognosis is poor. Experimental data suggest that the use of Extracorporeal shockwave myocardial revascularization (ESMR) may contribute to angiogenesis and improve symptoms of angina in patients with RA. Purpose of our study is to determine the efficacy of cardiac shock wave therapy (ESMR) in the management of patients with nonrevascolarized coronary artery disease (CAD). Methods We performed a prospective cohort study to examine the efficacy of ESMR applcation in patients with RA despite optimal medical therapy, not suitable for further PCI or CABG. Characteristics such as angina class scores (CCS class score), nitroglycerin consumption and hospitalization rate among cases (patients with RA who received ESMR) and controls (patients with RA who did not receive ESMR) were compared at baseline and 6 months after ESMR therapy. In patients receiveing d ESMR the effect of on cardiac perfusion was assessed. Results There were 43 patients in the case group and 29 patients in the control group. The mean age of the patients was 70 ± 9.5 years in the case group and 71 ± 5.3 years in the control group. Other characteristics (diabetes, coronary artery bypass graft, percutaneus coronary intervention, baseline CCS class score) were similar in both groups. There was a significant improvement in CCS class score (1.33 ± 0.57 in cases and 1.92 ± 0.69 in controls; p = 0.0002), nitroglycerin consumption (20% in case cases, and 44.8% in controls; P < 0.03) and hospitalization rate significantly reduced (13.9% in case cases, and 37.9% in controls; P < 0.03). The patients who received ESMR, there was a significantly improvement in myocardial perfusion after 6 months with a 33% relative reduction of summed stress score (SSS) (p = 0.002). Conclusion This case control study demonstrates the beneficial effect of ESMR therapy on cardiac symptoms, myocardial perfusion and reduced hospitalization in patients with refractory angina. Ther current study supports a role for ESMR as a non-invasive therapuetic option for patients with RA.

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Section: Discussionsupporting

confidence: 84%

The beneficial effect of extracorporeal shockwave myocardial revascularization in patients with refractory angina

Alunni

Marra

Meynet

et al. 2015

Cardiovascular Revascularization Medicine

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“…Kikuchi 2010 [31]Test group (N=8)Baseline3.04.0--Post treatment2.25*1.0*--Placebo group (N=8)Baseline2.754.0--Post treatment2.753.0*--W.H. Kazmi 2012 [71]Test group (N=43)Baseline2.63±0.7-2.48±0.6-Post treatment1.95±0.8**-1.95±0.5**-Control group (N=43)Baseline2.63±0.7-2.48±0.6-Post treatment2.63±0.7-2.46±0.6-G. Alunni 2014 [72]Test group (N=43)Baseline2.67±0.7526(60.5%)2.51±0.74-Post treatment1.33±0.57**9 (20%)*1.23±0.42**-Control group (N=29)Baseline2.52±0.7818 (41%)*2.32±0.79-Post treatment1.92±0.6913 (44.8%)*1.73±0.59-

CCS Canadian Cardiovascular Society Angina Class, nitroglycerine consumption is expressed as number of tablets per day, NYHA New York Heart Association class, * = p <0.05 compared to baseline, ** = p <0.001 compared to baseline

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Section: Resultsmentioning

confidence: 99%

“…(2010) [31]Placebo controlled844.7±16.250.5±16.2WtVainer J. et al (2012) [63]Single arm508.2±3.29.6±3.8MinutesKazmi W.H. et al (2012) [71]Controlled4312.2±7.820.1±15.7MinutesYang P. et al (2012) [79]Randomized, Placebo controlled25339.44±83.3427.9±63.3MetersWang Y. et al (2012) [24] b Randomized, controlled31344.3±106.4434.3±99.7MetersSchmid J.P. et al (2013) [78]Randomized, Placebo controlled1191.2±29.194.1±35.2WtPrinz C. et al (2013) [66]Single arm4378±5390±46WtCassar A. et al (2014) [27] Single arm15319.8±157.2422.1±183.3SecondsZhao L. et al (2015) [74] b Randomized, controlled32343.9±85.0489.4±72.2SecondsPrasad M. et al (2015) [68]Single arm111252.1±51.6 c 313.5±164.3Seconds457.0±146.8 d 606.0±126.4Kaller M. et al (2015) [49]Single arm1693±44101±41WtCai HY. et al (2015) [30]Single arm26360.7±116.8434.2±86.3MetersNirala S. et al (2016) [73]Controlled41336.7±120.5445.8±172.4MetersVainer J. et al (2016) [70]Single arm337.4±2.88.8±3.6Minutes

All valuables presented as mean ± SD, a valuable presented as mean ± SE, SE calculated into SD using standard formulas; b grou...

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Section: Resultsmentioning

confidence: 99%

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

Burneikaitė

Shkolnik

Čelutkienė

et al. 2017

Cardiovasc Ultrasound

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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.

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“…CSWT is a new technology, and some studies have been made in European nations such as Switzerland, Germany, Italy, Russia, and Japan at present, achieved some good effect, and made a tendency to gradually expand the application [20,21,22,23,24]. Although many clinical studies have preliminary confirmed that CSWT can treat myocardial ischemia, improving the patient's symptoms, the precise mechanism by which this occurs remains unclear.…”

Section: Discussionmentioning

confidence: 99%

Cardiac Shock Wave Therapy Attenuates H9c2 Myoblast Apoptosis by Activating the AKT Signal Pathway

Shen

Liu

et al. 2014

Cell Physiol Biochem

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Background: Previous studies have demonstrated that Cardiac Shock Wave Therapy (CSWT) improves myocardial perfusion and cardiac function in a porcine model of chronic myocardial ischemia and also ameliorates myocardial ischemia in patients with severe coronary artery disease (CAD). Apoptosis plays a key role in ischemic myocardial pathogenesis. However, it remains unclear whether CSWT is beneficial for ischemia/hypoxia (I/H)-induced myocardial cell apoptosis and by which mechanism CSWT could improve heart function. We put forward the hypothesis that CSWT might protect heart function during ischemia/hypoxia by decreasing apoptosis. Methods: We generated ischemia/hypoxia (I/H)-induced apoptosis in the H9c2 myoblast cell line to examine the CSWT function and possible mechanisms. H9c2 cells were treated under hypoxic serum-starved conditions for 24 h and then treated with or without CSWT (500 shots, 0.06, 0.09, 0.12mJ/mm²). The apoptotic cell rate was determined by flow cytometry assay, cell viability was examined by the MTT assay, nuclear fragmentation was detected by Hoechst 33342 staining, and the mitochondrial-mediated intrinsic pathway of apoptosis was assessed by the expression of Bax and Bcl-2 protein and Caspase3 activation. Results: First, apoptosis could be induced by ischemia/hypoxia in H9c2 cells. Second, CSWT attenuates the cell death and decreases the H9c2 cell apoptosis rate induced by ischemia and hypoxia. Third, CSWT suppresses the expression of apoptosis molecules that regulate the intrinsic pathway of apoptosis in H9c2 cells. Fourth, CSWT increases the phosphorylation of AKT, which indicates the activation of the PI3K-AKT pathway. Conclusions: These results indicate that CSWT exerts a protective effect against I/H-induced cell death, potentially by preventing the activation of components of the mitochondrial-dependent intrinsic apoptotic pathway. We also demonstrate that the PI3K-Akt pathway may be involved in the CSWT effects on apoptosis.

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Noninvasive therapy for the management of patients with advanced coronary artery disease

Abstract: The present study shows that CSWT application to the ischemic myocardium in patients with refractory angina pectoris improved symptoms and reduced the severity of ischemic areas at 6 months after CSWT treatment compared with the baseline. No side effects were observed with this therapy.

Cited by 18 publications

References 11 publications

The beneficial effect of extracorporeal shockwave myocardial revascularization in patients with refractory angina

The beneficial effect of extracorporeal shockwave myocardial revascularization in patients with refractory angina

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

Cardiac Shock Wave Therapy Attenuates H9c2 Myoblast Apoptosis by Activating the AKT Signal Pathway

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