Previous experimental studies have suggested a beneficial effect of extracorporeal shock wave therapy (ESWT) in patients with ischemic heart failure. Twenty-four patients with ischemic heart failure and left ventricular ejection fraction (LVEF) <40% received ESWT in addition to their stable treatment. ESWT was performed in 9 sessions with 100 shocks per spot in viable segments detected by dobutamine stress echocardiography. Patients were evaluated at baseline and at 3 and 6 months after ESWT. Tc-99m MIBI single photon emission computed tomography was performed on inclusion and at 6 months. ESWT significantly decreased New York Heart Association class from 2.2±0.8 to 1.7±0.7 at 3 months (P<.01) and 6 months after ESWT (1.7±0.7). Six-minute walk test improved from 414±141 to 509±141 and 538±116 (P<.01) at 3 and 6 months, respectively. A steady decrease of Canadian Cardiovascular Society angina class from 2.6±0.7 to 2.1±0.8 and 1.9±0.7 (P<.01) at 3 and 6 months, respectively, was observed. A significant increase in LVEF at rest at 3 and 6 months after ESWT (from 32.2±6.0 to 34.8±9.6 and 37.7±9.5, P=.03, respectively) was noted. Summed rest score (from 23.9±8.1 to 21.4±7.1, P=.03) and stress score improvement (from 28.2±8.4 to 24.6±6.4, P=.04) by single photon emission computed tomography was registered. Significant clinical improvement accompanied by beneficial changes of LVEF and rest/stress perfusion was found after ESWT.