Department of Cardiology, 1st Hospital of Kumming Medical College, Kumming, Yunnan, China.
Clin Cardiol. 2010 Nov;33(11):693-9. doi: 10.1002/clc.20811.
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.
Cardiac shock wave therapy (CSWT) is a safe and effective noninvasive intervention in the management of patients with refractory CAD.
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.
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.
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.
安全有效的治疗管理难治性冠状动脉疾病（CAD）在心脏病患者是至关重要的，以提高心血管功能，改善生活质量。目前难治性 CAD 的治疗方法在改善心绞痛和促进缺血性心肌再血管化方面效果不足。
心脏冲击波治疗（CSWT）是一种安全有效的非侵入性干预手段，用于管理难治性 CAD 患者。
该研究纳入了 9 名年龄在 50 至 70 岁之间（5.11 ± 5.46 岁）的男性 CAD 患者和支架植入患者（3.00 ± 2.24 个支架）。CSWT 在每个月的第一周的第 3 天、第 5 天进行 3 次，每个患者共进行 9 次治疗。多巴酚丁胺负荷超声心动图和放射性核素血管造影术确定了心肌缺血节段。检查 CSWT 对心肌灌注和收缩功能的影响。其他观察指标包括心肌损伤酶标志物、心绞痛量表、硝酸甘油剂量和心肺功能评估。
CSWT 后患者的心肌血流和局部收缩功能得到改善（应激峰值收缩应变率-1.10 至-1.60 s(-1)，P = 0.002）。肌酸激酶（87.89 ± 36.69 至 86.22 ± 35.96 IU/L，P = 0.046）、肌酸激酶 MB（10.89 ± 5.73 至 10.11 ± 5.93 IU/L，P = 0.008）和天门冬氨酸转氨酶（IQR，28.00 至 27.00 IU/L，P = 0.034）也有所下降。报告了心绞痛（加拿大心血管学会量表 IQR 3.0 至 2.0，P = 0.035）和硝酸甘油剂量减少（IQR 3.0 至 1.0 次/周，P = 0.038）。
本研究初步评估了 CSWT 在难治性 CAD 患者中的应用。我们报告 CSWT 是一种非侵入性、有效且安全的难治性 CAD 治疗干预措施。
