Clinical study on treatment of extracorporeal cardiac shock wave therapy in refractory angina pectoris patients

Objective To evaluate the efficacy and safety of extracorporeal cardiac shock wave system (CSWT) in treating refractory angina pectoris patients. Methods 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 totally 9 times. The clinical evaluations include Canadian Cardiovascular Society (CCS) class scores, 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 evaluated by echocardiography. 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. Results CSWT obviously ameliorated CCS, NYHA, SAQ score, improved 6-min walking distance and decreased the use of nitroglycerin dose, but there was no significant changes in LVEDD and LVEF. SPECT date showed that in the treated segment, the rest myocardial perfusion score decreased from 1.89±0.94 to 1.37±1.07 (P=0.004) and stress perfusion score also decreased from 2.56±1.19 to 1.70±1.27 (P=0.000). The rest ischemic area decreased from 30.81%±36.60% to 17.19%±28.34% (P=0.004) and stress ischemic area from 61.85%±30.89% to 46.31%±35.72% (P=0.001). The ventricular wall motion was improved from (6.48±2.71) mm to (7.49±2.43) mm (P=0.007) and thickening from 44.00%±22.66% to 50.46%±19.91% (P=0.038) in the rest, but no significant changes in the stress. There was no significant changes in CK, CKMB, TNT and there was no obvious changes in ECG, blood pressure and SaO2 either. Conclusions CSWT is an effective and safe therapy for refractory angina pectoris patients. Key words: Coronary artery disease; Angina pectoris; Extracorporeal cardiac shock wave; Radionuclide imaging