Efficacy of cardiac shock wave therapy on coronary artery disease: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

ZHANG Yifan ¹ , LIU Shutong ² , ZHANG Ning ¹ , LIU Luyao ¹ , JIAO Xueyan ¹ , LAN Zhenzhen ³ , CHEN Yun ³ ,  LIU Xincan ³

1. Henan University of Traditional Chinese Medicine, Zhengzhou 450000, P. R. China;
2. Zhengzhou University, Zhengzhou 450000, P. R. China;
3. The First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou 450000, P. R. China;

Corresponding author：

LIU Xincan, Email: liuxincan103@163.com

Keywords：

Cardiac shock wave therapy; Coronary artery disease; Systematic review; Meta-analysis

DOI：

10.7507/1672-2531.202210181

Video：

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Objective To systematically review the impact of cardiac shock waves on coronary artery disease. Methods The PubMed, Cochrane Library, Wed of Science, EMbase, ClinicalTrials.gov, CNKI, WanFang Data, VIP and CBM databases were electronically searched to collect randomized controlled trials and cohort studies related to the treatment of coronary artery disease with cardiac shock waves from inception to August 2022. After two evaluators independently screened the literature, extracted data, and evaluated the risk of bias of the included studies, a meta-analysis was conducted by using RevMan 5.4.1 and Stata 15.0 software. Results A total of 11 studies with 519 patients were included. The meta-analysis results revealed that compared with the control group, cardiac shock wave therapy could reduce hospitalization rates (RR=0.38, 95%CI 0.25 to 0.57, P<0.01), increase exercise time (SMD=0.93, 95%CI 0.17 to 1.70, P=0.02), and improve the Canadian Cardiovascular Society (CCS) angina grading (MD=−0.62, 95%CI −0.73 to −0.51, P<0.01), the New York Heart Association (NYHA) cardiac function grading (MD=−0.60, 95%CI −0.85 to −0.35, P<0.01), left ventricular ejection fraction (MD=4.81,95%CI 3.17 to 6.46, P<0.01), total score of the Seattle angina questionnaire (SAQ) (MD=10.87, 95%CI 4.63 to 17.12, P<0.01), and 6-min walking test (MD=85.06, 95%CI 31.02 to 139.09, P<0.01). Conclusion Cardiac shock wave therapy can improve cardiac function as well as the prognosis and exercise ability. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.

Citation： ZHANG Yifan, LIU Shutong, ZHANG Ning, LIU Luyao, JIAO Xueyan, LAN Zhenzhen, CHEN Yun, LIU Xincan. Efficacy of cardiac shock wave therapy on coronary artery disease: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2023, 23(5): 539-543. doi: 10.7507/1672-2531.202210181 Copy

1.	Shah S, Dibben G, Ketkar A, et al. Identifying the optimal exercise prescription for patients with coronary artery disease undergoing cardiac rehabilitation: protocol for a systematic review and network meta-analysis of randomized control trials. Int J Environ Res Public Health, 2022, 19(19): 12317.
2.	Weijing L, Ximin F, Jianying S, et al. Cardiac shock wave therapy ameliorates myocardial ischemia in patients with chronic refractory angina pectoris: a randomized trial. Front Cardiovasc Med, 2021, 8: 664433.
3.	何青. 冠心病治疗的新理念—体外心脏震波治疗. 中国心血管杂志, 2018, 23(3): 189.
4.	Prinz C, Lindner O, Bitter T, et al. Extracorporeal cardiac shock wave therapy ameliorates clinical symptoms and improves regional myocardial blood flow in a patient with severe coronary artery disease and refractory angina. Case Rep Med, 2009, 2009: 639594.
5.	王钰. 体外心脏震波(CSWT)治疗冠心病的疗效、安全性和方法学研究. 昆明: 昆明医学院, 2010.
6.	杨祥. 运动负荷超声评价体外心脏震波治疗冠心病的疗效. 昆明: 昆明医科大学, 2018.
7.	杨萍, 郭涛, 彭云珠, 等. 体外心脏震波治疗冠心病的有效性研究. 重庆医学, 2011, 40(29): 2918-2921.
8.	Zhao L, Yang P, Tang Y, et al. Effect of cardiac shock wave therapy on the microvolt T wave alternans of patients with coronary artery disease. Int J Clin Exp Med, 2015, 8(9): 16463-16471.
9.	Slavich M, Pizzetti G, Vella AM, et al. Extracorporeal myocardial shockwave therapy; a precious blast for refractory angina patients. Cardiovasc Revasc Med, 2018, 19(3 Pt A): 263-267.
10.	Shkolnik E, Burneikaite G, Jakutis G, et al. A randomized, triple-blind trial of cardiac shock-wave therapy on exercise tolerance and symptoms in patients with stable angina pectoris. Coron Artery Dis, 2018, 29(7): 579-586.
11.	Kazmi WH, Rasheed SZ, Ahmed S, et al. Noninvasive therapy for the management of patients with advanced coronary artery disease. Coron Artery Dis, 2012, 23(8): 549-554.
12.	Alunni G, Marra S, Meynet I, et al. The beneficial effect of extracorporeal shockwave myocardial revascularization in patients with refractory angina. Cardiovasc Revasc Med, 2015, 16(1): 6-11.
13.	Kagaya Y, Ito K, Takahashi J, et al. Low-energy cardiac shockwave therapy to suppress left ventricular remodeling in patients with acute myocardial infarction: a first-in-human study. Coron Artery Dis, 2018, 29(4): 294-300.
14.	杨萍, 彭云珠, 郭涛, 等. 体外心脏震波治疗冠心病患者的临床研究. 重庆医学, 2012, 41(9): 847-851.
15.	杨春芳. 体外心脏震波对慢性冠脉综合征患者外周血SDF-1表达及EPCs增殖的影响. 昆明: 昆明医科大学, 2021.
16.	Schmid JP, Capoferri M, Wahl A, et al. Cardiac shock wave therapy for chronic refractory angina pectoris: a prospective placebo-controlled randomized trial. Cardiovasc Ther, 2013, 31(3): e1-e6.
17.	Kaller M, Faber L, Bogunovic N, et al. Cardiac shock wave therapy and myocardial perfusion in severe coronary artery disease. Clin Res Cardiol, 2015, 104(10): 843-849.
18.	Takakuwa Y, Sarai M, Kawai H, et al. Extracorporeal shock wave therapy for coronary artery disease: relationship of symptom amelioration and ischemia improvement. Asia Ocean J Nucl Med Biol, 2018, 6(1): 1-9.
19.	Jia N, Zhang R, Liu B, et al. Efficacy and safety of cardiac shock wave therapy for patients with severe coronary artery disease: a randomized, double-blind control study. J Nucl Cardiol, 2022, 29(5): 2404-2419.
20.	中国医师协会心血管内科医师分会, 中国医院学会心脏康复管理专业委员会, 中国心血管杂志编辑委员会. 体外心脏震波治疗冠心病中国专家共识(2022版). 中国心血管杂志, 2022, 27(1): 1-10.
21.	贾娜, 何青. 体外心脏震波治疗—晚期冠心病患者的新曙光. 中国心血管杂志, 2018, 23(3): 190-193.
22.	王蹿蹿, 谢华宁, 郭宏. 低能量体外冲击波治疗缺血性心脏病. 心血管病学进展, 2009, 30(6): 960-963.
23.	Qiu Q, Chen S, Qiu Y, et al. Cardiac shock wave therapy in coronary artery disease: a systematic review and meta-analysis. Front Cardiovasc Med, 2022, 9: 932193.
24.	李鹏, 谭潇, 刘保逸, 等. 体外心脏震波治疗对冠心病患者预后影响的荟萃分析. 中国心血管杂志, 2018, 23(3): 208-212.
25.	Yang HT, Xie X, Hou XG, et al. Cardiac shock wave therapy for coronary heart disease: an updated meta-analysis. Braz J Cardiovasc Surg, 2020, 35(5): 741-756.
26.	Ito K, Fukumoto Y, Shimokawa H. Extracorporeal shock wave therapy as a new and non-invasive angiogenic strategy. Tohoku J Exp Med, 2009, 219(1): 1-9.
27.	Yu W, Shen T, Liu B, et al. Cardiac shock wave therapy attenuates H9c2 myoblast apoptosis by activating the AKT signal pathway. Cell Physiol Biochem, 2014, 33(5): 1293-1303.
28.	Du L, Shen T, Liu B, et al. Shock wave therapy promotes cardiomyocyte autophagy and survival during hypoxia. Cell Physiol Biochem, 2017, 42(2): 673-684.

1. Shah S, Dibben G, Ketkar A, et al. Identifying the optimal exercise prescription for patients with coronary artery disease undergoing cardiac rehabilitation: protocol for a systematic review and network meta-analysis of randomized control trials. Int J Environ Res Public Health, 2022, 19(19): 12317.
2. Weijing L, Ximin F, Jianying S, et al. Cardiac shock wave therapy ameliorates myocardial ischemia in patients with chronic refractory angina pectoris: a randomized trial. Front Cardiovasc Med, 2021, 8: 664433.
3. 何青. 冠心病治疗的新理念—体外心脏震波治疗. 中国心血管杂志, 2018, 23(3): 189.
4. Prinz C, Lindner O, Bitter T, et al. Extracorporeal cardiac shock wave therapy ameliorates clinical symptoms and improves regional myocardial blood flow in a patient with severe coronary artery disease and refractory angina. Case Rep Med, 2009, 2009: 639594.
5. 王钰. 体外心脏震波(CSWT)治疗冠心病的疗效、安全性和方法学研究. 昆明: 昆明医学院, 2010.
6. 杨祥. 运动负荷超声评价体外心脏震波治疗冠心病的疗效. 昆明: 昆明医科大学, 2018.
7. 杨萍, 郭涛, 彭云珠, 等. 体外心脏震波治疗冠心病的有效性研究. 重庆医学, 2011, 40(29): 2918-2921.
8. Zhao L, Yang P, Tang Y, et al. Effect of cardiac shock wave therapy on the microvolt T wave alternans of patients with coronary artery disease. Int J Clin Exp Med, 2015, 8(9): 16463-16471.
9. Slavich M, Pizzetti G, Vella AM, et al. Extracorporeal myocardial shockwave therapy; a precious blast for refractory angina patients. Cardiovasc Revasc Med, 2018, 19(3 Pt A): 263-267.
10. Shkolnik E, Burneikaite G, Jakutis G, et al. A randomized, triple-blind trial of cardiac shock-wave therapy on exercise tolerance and symptoms in patients with stable angina pectoris. Coron Artery Dis, 2018, 29(7): 579-586.
11. Kazmi WH, Rasheed SZ, Ahmed S, et al. Noninvasive therapy for the management of patients with advanced coronary artery disease. Coron Artery Dis, 2012, 23(8): 549-554.
12. Alunni G, Marra S, Meynet I, et al. The beneficial effect of extracorporeal shockwave myocardial revascularization in patients with refractory angina. Cardiovasc Revasc Med, 2015, 16(1): 6-11.
13. Kagaya Y, Ito K, Takahashi J, et al. Low-energy cardiac shockwave therapy to suppress left ventricular remodeling in patients with acute myocardial infarction: a first-in-human study. Coron Artery Dis, 2018, 29(4): 294-300.
14. 杨萍, 彭云珠, 郭涛, 等. 体外心脏震波治疗冠心病患者的临床研究. 重庆医学, 2012, 41(9): 847-851.
15. 杨春芳. 体外心脏震波对慢性冠脉综合征患者外周血SDF-1表达及EPCs增殖的影响. 昆明: 昆明医科大学, 2021.
16. Schmid JP, Capoferri M, Wahl A, et al. Cardiac shock wave therapy for chronic refractory angina pectoris: a prospective placebo-controlled randomized trial. Cardiovasc Ther, 2013, 31(3): e1-e6.
17. Kaller M, Faber L, Bogunovic N, et al. Cardiac shock wave therapy and myocardial perfusion in severe coronary artery disease. Clin Res Cardiol, 2015, 104(10): 843-849.
18. Takakuwa Y, Sarai M, Kawai H, et al. Extracorporeal shock wave therapy for coronary artery disease: relationship of symptom amelioration and ischemia improvement. Asia Ocean J Nucl Med Biol, 2018, 6(1): 1-9.
19. Jia N, Zhang R, Liu B, et al. Efficacy and safety of cardiac shock wave therapy for patients with severe coronary artery disease: a randomized, double-blind control study. J Nucl Cardiol, 2022, 29(5): 2404-2419.
20. 中国医师协会心血管内科医师分会, 中国医院学会心脏康复管理专业委员会, 中国心血管杂志编辑委员会. 体外心脏震波治疗冠心病中国专家共识(2022版). 中国心血管杂志, 2022, 27(1): 1-10.
21. 贾娜, 何青. 体外心脏震波治疗—晚期冠心病患者的新曙光. 中国心血管杂志, 2018, 23(3): 190-193.
22. 王蹿蹿, 谢华宁, 郭宏. 低能量体外冲击波治疗缺血性心脏病. 心血管病学进展, 2009, 30(6): 960-963.
23. Qiu Q, Chen S, Qiu Y, et al. Cardiac shock wave therapy in coronary artery disease: a systematic review and meta-analysis. Front Cardiovasc Med, 2022, 9: 932193.
24. 李鹏, 谭潇, 刘保逸, 等. 体外心脏震波治疗对冠心病患者预后影响的荟萃分析. 中国心血管杂志, 2018, 23(3): 208-212.
25. Yang HT, Xie X, Hou XG, et al. Cardiac shock wave therapy for coronary heart disease: an updated meta-analysis. Braz J Cardiovasc Surg, 2020, 35(5): 741-756.
26. Ito K, Fukumoto Y, Shimokawa H. Extracorporeal shock wave therapy as a new and non-invasive angiogenic strategy. Tohoku J Exp Med, 2009, 219(1): 1-9.
27. Yu W, Shen T, Liu B, et al. Cardiac shock wave therapy attenuates H9c2 myoblast apoptosis by activating the AKT signal pathway. Cell Physiol Biochem, 2014, 33(5): 1293-1303.
28. Du L, Shen T, Liu B, et al. Shock wave therapy promotes cardiomyocyte autophagy and survival during hypoxia. Cell Physiol Biochem, 2017, 42(2): 673-684.

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