Qiu Quan, Chen Shenjie, Qiu Yuangang, Mao Wei
Department of Cardiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.
Front Cardiovasc Med. 2022 Jul 25;9:932193. doi: 10.3389/fcvm.2022.932193. eCollection 2022.
Coronary artery disease (CAD) has been one of the leading causes of morbidity and mortality worldwide. Cardiac shock wave therapy (CSWT) is a novel and non-invasive therapy for CAD. Therefore, we conducted a systematic review and meta-analysis to evaluate the efficacy of CSWT on CAD.
We performed a comprehensive search of electronic databases such as PubMed, Embase, the Cochrane Library, and Wanfang Data in October 2021. The results were reported as weighted mean difference (WMD) with a 95% confidence interval (CI). Statistical heterogeneity scores were assessed with the standard Cochran's test and the statistic. A total of 8 randomized trials and 2 prospective cohort studies, together involving 643 patients ( = 336 CSWT and = 307 control), were included in our study. Eight studies with 371 patients showed significantly improved rest left ventricular ejection fraction (LVEF) with CSWT as compared to that of the control group (WMD 3.88, 95% CI 1.53-6.23, = 0.001, = 51.2%). Seven studies with 312 patients reported left ventricular internal diameter in diastole (LVIDd) were markedly decreased in the CSWT group compared to the control group (WMD -1.81, 95% CI -3.23 to -0.39, = 0.012, = 20.3%). The summed stress score significantly favored the CSWT group (WMD -3.76, 95% CI -6.15 to -1.37, = 0.002, = 56.8%), but there was no significant difference for the summed rest score. Our data were acquired from studies without a perceived high risk of bias, so plausible bias is unlikely to seriously affect the main findings of the current study.
Based on data from our present meta-analysis, CSWT was shown to moderately improve myocardial perfusion and cardiac function among patients with CAD, which would provide the clinicians with a meaningful and valuable option.
The meta-analysis was registered on the Open Science Framework (OSF) (https://osf.io/r2xf9).
冠状动脉疾病（CAD）一直是全球发病和死亡的主要原因之一。心脏冲击波疗法（CSWT）是一种针对CAD的新型非侵入性治疗方法。因此，我们进行了一项系统评价和荟萃分析，以评估CSWT对CAD的疗效。
2021年10月，我们对PubMed、Embase、Cochrane图书馆和万方数据等电子数据库进行了全面检索。结果以加权平均差（WMD）和95%置信区间（CI）报告。采用标准Cochran检验和统计量评估统计异质性得分。我们的研究共纳入8项随机试验和2项前瞻性队列研究，涉及643例患者（CSWT组336例，对照组307例）。八项研究共371例患者显示，与对照组相比，CSWT显著改善了静息左心室射血分数（LVEF）（WMD 3.88，95%CI 1.53 - 6.23，P = 0.001，I² = 51.2%）。七项研究共312例患者报告，与对照组相比，CSWT组舒张末期左心室内径（LVIDd）明显减小（WMD -1.81，95%CI -3.23至-0.39，P = 0.012，I² = 20.3%）。总应力评分明显有利于CSWT组（WMD -3.76，95%CI -6.15至-1.37，P = 0.002，I² = 56.8%），但总静息评分无显著差异。我们的数据来自无明显高偏倚风险的研究，因此合理的偏倚不太可能严重影响本研究的主要结果。
基于我们目前荟萃分析的数据，CSWT被证明可适度改善CAD患者的心肌灌注和心脏功能，这将为临床医生提供一个有意义且有价值的选择。
该荟萃分析已在开放科学框架（OSF）（https://osf.io/r2xf9）上注册。
