ABSTRACT
Objective To investigate the effectiveness and mechanism of extracorporeal cardiac shock wave therapy(CSWT)in the patients with coronary atherosclerotic heart disease(CAD) complicating heart failure.Methods One hundred and eighty cases of CAD complicating heart failure in this hospital From June 2015 to June 2016 were selected and divided into the observation group and control group,90 cases in each group.The two groups were given the roune medication therapy for at least 2 months.On this basis the observation group conducted extracorporeal CSWT therapy(9 times within 3 months);the control group was given the sham shockwave treatment without giving shockwave energy.before and after treatment were observed The left ventricular end diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF),left ventricular perfusion and metabolic score,NYHA heart function grade,CCS angina grade,nitroglycerin dosage,SAQ score and plasma cTn-Ⅰ,BNP and VEGF level changes in the two groups were observed before and after treatment.Results LVEDD,LVEF,left ventricular perfusion and metabolic score,NYHA heart function grade and CCS angina grade,nitroglycerin dosage,SAQ scores and plasma cTn-Ⅰ,BNP and VEGF levels before treatment had no statistical differences between the two groups(P＞0.05);among the above indicators in the two groups,except the cTn-Ⅰ had no obvious change,the other indicators after treatment were significantly improved,the difference was statistically significant(P＜0.05),moreover the improvement degree of the observation group was obviously superior to that of the control group,the difference was statistically significant(P＜0.05).Conclusion CSWT has significantly clinical effect in treating CAD complicating heart failure,its mechanism may be related with promoting vascular regeneration and improving myocardial perfusion and metabolism.
ABSTRACT
Objective The extracorporeal cardiac shock wave therapy ( CSWT ) can promote angiogenesis in ischemic myo-cardium and improve myocardial perfusion , but its mechanisms remain to be clarified .This study aimed to explore the effects of CSWT on the endothelial progenitor cells (EPCs), vascular endothe-lial growth factor ( VEGF) and Interleukin-8 ( IL-8) as well as its re-lieving effect on angina pectoris in patients with coronary heart dis-ease. Methods After Dobutamine stress echocardiography ( DSE) and 99 mTc-MIBI myocardial perfusion imaging (MPI) at rest and un-der stress, 25 patients with coronary heart disease underwent 9 three-month cycles of CSWT .Before and after the treatment , we obtained the results of 6-min walk test, NYHA cardiac function grades , CCS angina pectoris classes, Seattle Angina Questionnaire (SAQ) scores, doses of nitroglycerin administered , left ventricular diastolic di-ameter ( LVDD) , and left ventricular ejection fraction ( LVEF) .We evaluated myocardial perfusion and myocardial contractile function using MPI and the peak systolic strain rate (PSSR) at rest and under stress, respectively. Results After CSWT, the numbers of EPCs and EPC-CFUs cultured in vitro were significantly increased as compared with the baseline (34.52±6.58 vs 19.56±4.28, P0.05).The PSSR showed no significant changes at rest (1.21±0.62 vs 1.04±0.43, P>0.05) but remark-ably increased under stress after CSWT (2.02±1.00 vs 1.35±0.66, P<0.01). Conclusion CSWT can up-regulate the expressions of VEGF and IL-8 and improve the function of EPCs in the peripheral blood , and thus plays an important role in relieving the symptoms of angina pectoris , promoting cardiac function and enhancing exercise tolerance in patients with coronary heart disease .
ABSTRACT
Objective To evaluate the efficacy and safety of cardiac shock wave therapy(CSWT) in coronary heart disease in elderly patients.Methods Eleven patients with refractory angina pectoris were enrolled.The ischemic area was determined by the 99mTechnetium-MIBI single-photon emission computed tomography (SPECT) and coronary angiography,and treated with CSWT.The CSWT were performed during treatment of 3 months,with 9 times totally.The clinical evaluations included the clinical symptoms,Canadian Cardiovascular Society (CCS) class scores,New York Heart Association class (NYHA),Seattle angina questionnaire (SAQ),6-min walking distance and the use of dosage of nitroglycerin,left ventricular end diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF).The amelioration of ischemic myocardial was analyzed by SPECT.The safety of CSWT was evaluated by changes in clinical symptoms,ECG monitoring,blood pressure and oxygen saturation,blood levels of creatine kinase,creatine kinase myocardial band isoenzymes (CK-MB),troponin T (TnT),alanine transfer enzyme (ALT),creatinine (CR),brain natriuretic peptide and high sensitive C reactive protein (hs CRP).Results The CCS class scores,NYHA,6-min walking distance and the dosage of nitroglycerin were significantly improved at 4 and 12 months after treatment as compared with pretreatment.The steady state of angina pectoris and the frequency score in SAQ were significantly improved.The 21 cardio-vessel segments were treated,and the improvement rate of resting myocardial perfusion was 46.2％ (6/13),the effective rate was 38.5％ (5/13),and the obvious effective rate was 7.8％ (1/13) after treatment.The improvement rate of loaded myocardial perfusion was 57.1％ (12/21),the effective rate was 47.6％ (10/21),and the obvious effective rate after treatment was 9.5％ (2/21).There were no significant changes in levels of CK,CK-MB,TNT,ALT,Cr,BNP and hs CRP,heart rate,systolic blood pressure,diastolic blood pressure and oxygen saturation after treatment as compared with pretreatment.Conclusions The CSWT is a safe and effective treatment for coronary heart disease in the elderly,and the curative effect could maintain at least one year.