The Study Of Extracorporeal Cardiac Shock Wave In The Patients With Severe Coronay Heart Disease

BACKGROUND For the most patients with coronary heart disease, the medical treatment was including drugs therapy, percutaneous coronary intervention and coronary artery bypass grafting. But even with all these treatments, there are still many patients who suffered from refractory angina pectoris. Cardiac Shock Wave Therapy (CSWT) is currently the most advanced technology developed in recent years. CSWT could induce angiogenesis and/or through other mechanism to ameliorate myocardial perfusion to treat refractory angina pectoris and improve the patient’symptoms of heart function. There are many hospitals in other countries have applied this technology to clinical, but there are few in our country.OBJECTIVE To evaluate the efficacy and safety of CSWT in treating refractory angina pectoris patients and to discuss its clinical significance.To provide more evidence for wide application of CSWT in the patients with severe coronary heart disease.METHOD Fifteen patients with severe coronary artery disease which was documented by coronary angiogram present with refractory angina pectoris were selected. The ischemic area was determined by the 99mTechnetium-MIBI single-photon emission computed tomography (SPECT). The CSWT were performed in 3 months, and 9 times totally. The clinical evaluations include the changes of symptoms, angina class scores (Canadian Cardiovascular Society CCS), heart function (New York Heart Association class NYHA), Seattle angina questionnaire (SAQ),6-min walking distance and the use of dosage of nitroglycerin; left ventricular end diastolic diameter (LVEDD) and left ventricular ejection of fraction (LVEF) were also measured by echocardiagraphy. The amelioration of ischemic myocardial was analyzed by SPECT, through comparison of myocardial perfusion scores and ischemic area before and after treatment. The variation of segment myocardial dysfunction was assessed by wall motion and wall thickening. We also observed all material one year later in 9 of these 15 patients to recognize one year efficacy.RESULT CSWT significantly ameliorated angina, heart function, and SAQ score: CCS angina classification reduced from 2.7±1.0 to 1.6±0.6 (p=0.000), NYHA heart function classification decreased from 2.1±0.5 to 1.6±0.6 (p=0.006).6-min walking distance in SAQ improved from 430.8±109.6 meters to 519.6±100.2 (p=0.001). In addition, the dosage of nitroglycerin reduced from 2.1±1.6 to 0.5±0.5 tablets per week (p=0.001). The steady state rating of angina pectoris in SAQ was improved from 41.07±21.05 to 75.00±16.98 (p=0.000),the frequency score was increased from 68.68±21.73 to 83.57±16.46 (p=0.027), and the disease recognition level in SAQ was increased from 29.26±17.40 to 47.61±17.72 (p=0.000). But there were no significant changes in LVEDD and LVEF. SPECT date showed that in the treated segment, the rest myocardial perfusion score decreased from 1.41±1.15 to 0.85±1.26 (p=0.008),and stress perfusion score also decreased from 2.07±1.74to 1.52±1.25(p=0.006). The rest ischemic area significantly decreased from 29.19%±33.85% to 15.56%±27.99% (P=0.028) and stress ischemic area from 63.15%±31.03% to 44.85%±35.8% (P=0.001). The ventricular wall motion motion (in treated segments) was improved from 6.48 ± 2.65mm to 7.52±2.39mm (p=0.004) and thickening from 44.19%±22.24% to 50.67%±19.56%(p=0.031) in the rest, the changes were significant. But in the stress, the segments wall motion was from 6.45±2.42mm to 6.26±2.49mm (p=0.501),thickening was from 40.81±18.64 to 43.04% ±24.24% (p=0.318), there were no significant changes. On the safety study, there were no significant changes in heart rate, blood pressure and SaO2, also there were no obvious changes in the serum CK、CKMB、TNT、ALT、CRE or HsCRP neither. The angina class scores (CCS), heart function (NYHA), dosage of using nitroglycerin and rest myocardial perfusion score were still significantly ameliorated after one year follow-up.CONCLUSION:1.CSWT can improve the symptoms of angina pectoris and increase activity tolerance in severe CHD patients.2.CSWT can significantly improved myocardial ischemia and improve the local ventricular systolic function.3.CSWT has very high security. 4.The effect of CSWT can maintain at least one year in the treatment of angina pectoris and ischemia.