Peng Yun-zhu, Guo Tao, Yang Ping, Yang Hong-wen, Zhou Ping, Wang Yu, Luo Zhi-ling, Gu Yun, Pan Jia-hua
Department of Cardiology, Kunming Medical College, Kunming, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2012 Feb;40(2):141-6.
To evaluate the feasibility, safety and efficiency of extracorporeal cardiac shock wave therapy (CSWT) in patients with ischemic heart failure.
Fifty patients with ischemic heart failure and left ventricular ejection fraction (LVEF) < 50% were randomized to CSWT (shots/spot at 0.09 mJ/mm(2) for 9 spots, 9 times within 3 month) or control group. Dual isotope simultaneous acquisition single-photon emission computed tomography with (99)Tc(m)-sestamibi/(18)F-fluorodeoxyglucose ((99)Tc(m)-MIBI/(18)F-FDG) was performed before randomization and at 1 month after CSWT/control to locate and evaluate viable myocardium region. Canadian cardiovascular society (CCS) class sores, NYHA, Seattle Angina Questionnaire (SAQ), 6-min walk test (6 MWT), left ventricular ejection fraction (LVEF), left ventricular end-diastolic dimension (LVEDD) and the dosage of nitroglycerin use were compared between two groups at each time point.
All patients completed the study protocol without procedural complications. At 1 month, patients in CSWT group experienced improvement in NYHA (P < 0.01), CCS (P < 0.01), SAQ (P = 0.021), 6 MWT (P = 0.012) and dosage of nitroglycerin use (P < 0.01) compared to baseline. LVEF [45.0 (39.0, 48.0) vs. 47.0 (42.0, 50.0) P = 0.001], LVEDD [58.0 (56.0, 59.0) vs. 56.0 (55.0, 58.0) P = 0.002], summed perfused score [23.0 (20.5, 24.5) vs. 20.0 (18.0, 22.0) P < 0.01] and metabolic score [25.0 (23.0, 26.0) vs. 24.0 (21.5, 25.0) P = 0.028] were also improved in CSWT group. All these parameters remained unchanged in control group between baseline and at 1 month. CSWT was independent factor for improved cardiac function, quality of life and echocardiography parameters after adjusting for known factors which might affect outcome.
CSWT could improve symptom, cardiac function, quality of life and exercise tolerance in patients with ischemic heart failure, CSWT might serve as a new, non-invasive, safe and efficient therapy for these patients.
评估体外心脏冲击波疗法（CSWT）治疗缺血性心力衰竭患者的可行性、安全性及有效性。
将50例缺血性心力衰竭且左心室射血分数（LVEF）<50%的患者随机分为CSWT组（能量为0.09 mJ/mm²，每个部位9次冲击，共9个部位，3个月内进行9次）和对照组。在随机分组前及CSWT/对照治疗后1个月，采用双核素同时采集单光子发射计算机断层扫描（99Tc(m)-甲氧基异丁基异腈/18F-氟脱氧葡萄糖，即99Tc(m)-MIBI/18F-FDG）定位并评估存活心肌区域。比较两组在各时间点的加拿大心血管学会（CCS）分级、纽约心脏协会（NYHA）分级、西雅图心绞痛问卷（SAQ）评分、6分钟步行试验（6 MWT）结果、左心室射血分数（LVEF）、左心室舒张末期内径（LVEDD）及硝酸甘油使用剂量。
所有患者均完成研究方案，无手术相关并发症。1个月时，与基线相比，CSWT组患者的NYHA分级（P<0.01）、CCS分级（P<0.01）、SAQ评分（P = 0.021）、6 MWT结果（P = 0.012）及硝酸甘油使用剂量（P<0.01）均有改善。CSWT组的LVEF[45.0（39.0，48.0）对47.0（42.0，50.0），P = 0.001]、LVEDD[58.0（56.0，59.0）对56.0（55.0，58.0），P = 0.002]、总灌注评分[23.0（20.5，24.5）对20.0（18.0，22.0），P<0.01]及代谢评分[25.0（23.0，26.0）对24.0（21.5，25.0），P = 0.028]也有所改善。对照组在基线和1个月时这些参数均无变化。在校正可能影响结果的已知因素后，CSWT是改善心功能、生活质量及超声心动图参数的独立因素。
CSWT可改善缺血性心力衰竭患者的症状、心功能、生活质量及运动耐量，可能成为这些患者一种新的、无创、安全且有效的治疗方法。
