Extracorporeal cardiac shock wave therapy ameliorates myocardial ischemia in patients with severe coronary artery disease
Extracorporeal cardiac shock wave therapy ameliorates myocardial ischemia in patients with severe coronary artery disease
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DOI：
10.1097/00019501-200602000-00011
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发表时间：
2006-02-01
影响因子：
1.8
通讯作者：
Shimokawa, H
中科院分区：
文献类型：
--
作者：
Fukumoto, Y;Ito, A;Shimokawa, H
目的 没有经皮冠状动脉介入治疗或冠状动脉旁路移植指征的严重冠状动脉疾病的预后仍然很差。我们最近在猪体内模型中证明，冲击波疗法可有效诱导新生血管形成并改善心肌缺血。方法经本所伦理委员会许可，我们采用心脏冲击波疗法（200 次/点，0.09 mJ/mm(2)，每次 20-40 次）治疗了 9 名无经皮冠状动脉介入治疗或冠状动脉旁路移植指征的终末期冠状动脉疾病患者（55-82 岁，5 名男性和 4 名女性）。点，每周 3 次/系列）。我们在治疗后 1、3、6 和 12 个月对患者进行随访，以检查心肌缺血的改善情况。需要时，在第 0、1、3 或 6 个月时进行最多三个系列的冲击波治疗。结果 心脏冲击波治疗改善了症状（加拿大心血管协会功能分级评分，从 2.7 +/- 0.2 至 1.8 +/- 0.2，P < 0.01）并减少了硝酸甘油的使用（从 5.4 +/- 2.5 至 0.3 +/- 0.3/周，P < 0.01）。 0.05）。通过双嘧达莫应激铊闪烁扫描评估，该治疗还改善了心肌灌注（严重程度评分，改善 25.2 +/- 7.2%，P < 0.05；程度评分，改善 23.3 +/- 9.0%，P=0.10；清除率，20 +/- 3 至 34 +/- 3，P < 0.05）。仅在接受治疗的缺血区域心肌灌注得到改善。这些有益效果持续了 12 个月。未发现手术并发症或不良反应。 结论 这些结果表明，我们的体外心脏冲击波疗法是治疗终末期冠状动脉疾病的一种有效且非侵入性的治疗方法，尽管还需要进一步仔细评估。
Objective Prognosis of severe coronary artery disease with no indication of percutaneous coronary intervention or coronary artery bypass grafting remains poor. We have recently demonstrated that shock wave therapy effectively induces neovascularization and improves myocardial ischemia in a porcine model in vivo.Methods With permission from the Ethical Committee of our Institute, we treated nine patients with end-stage coronary artery disease with no indication of percutaneous coronary intervention or coronary artery bypass grafting (55-82 years old, five men and four women) with our cardiac shock wave therapy (200 shots/spot at 0.09 mJ/mm(2) for 20-40 spots, 3 times a week/series). We followed-up the patients at 1, 3, 6, and 12 months after the therapy to examine the amelioration of myocardial ischemia. When needed, shock wave therapy was performed up to three series at 0, and 1, 3 or 6 months.Results The cardiac shock wave therapy improved symptoms (Canadian Cardiovascular Society functional class score, from 2.7 +/- 0.2 to 1.8 +/- 0.2, P < 0.01) and reduced nitroglycerin use (from 5.4 +/- 2.5 to 0.3 +/- 0.3/week, P < 0.05). The treatment also improved myocardial perfusibn as assessed by dipyridamole stress thallium scintigraphy (severity score, 25.2 +/- 7.2% improvement, P < 0.05; extent score, 23.3 +/- 9.0% improvement, P=0.10; washout rate, 20 +/- 3 to 34 +/- 3, P < 0.05). Myocardial perfusion was improved only in the ischemic area treated with the therapy. These beneficial effects persisted for 12 months. No procedural complications or adverse effects were noted.Conclusion These results indicate that our extracorporeal cardiac shock wave therapy is an effective and non-invasive treatment for end-stage coronary artery disease, although further careful evaluation is needed.