Effectiveness and Safety of Extracorporeal Shockwave Myocardial Revascularization in Patients With Refractory Angina Pectoris and Heart Failure

Martínez‐Sánchez, Carlos; Azar-Manzur, Francisco; González‐Pacheco, Héctor; Amezcua-Guerra, Luís M.; Massó, Felipe; Márquez-Velasco, Ricardo; Bojalil, Rafael; Carvajal-Juárez, Isabel; Alexánderson-Rosas, Erick; Hernández, Salvador; Páez, Araceli; López-Mora, Enrique; Venegas-Román, Alejandra; Brianza-Padilla, Malinalli; Gopar‐Nieto, Rodrigo; Sandoval, Julio

doi:10.1016/j.amjcard.2020.12.065

Cited by 9 publications

(6 citation statements)

References 30 publications

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“…The recently developed extracorporeal cardiac shock waves (ECSW) therapy is a new non-invasive treatment for CHD. Its safety and efficacy have been demonstrated in animal models and in clinical trials (5)(6)(7)(8). Current research suggests that, through tissue cavitation, ECSW produce a series of biochemical effects, including shear stress on cell membranes (9), increased endothelial nitric oxide synthase (eNOS) and nitric oxide (NO) synthesis, and upregulation of vascular endothelial growth factor (VEGF), which attenuates cell apoptosis, inflammatory responses and induces angiogenesis (10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

Extracorporeal Cardiac Shock Waves Therapy Improves the Function of Endothelial Progenitor Cells After Hypoxia Injury via Activating PI3K/Akt/eNOS Signal Pathway

Wang

Yang

et al. 2021

Front. Cardiovasc. Med.

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Background: Extracorporeal cardiac shock waves (ECSW) have great potential in the treatment of coronary heart disease. Endothelial progenitor cells (EPCs) are a class of pluripotent progenitor cells derived from bone marrow or peripheral blood, which have the capacity to migrate to ischemic myocardium and differentiate into mature endothelial cells and play an important role in neovascularization and endothelial repair. In this study, we investigated whether ECSW therapy can improve EPCs dysfunction and apoptosis induced by hypoxia and explored the underlying mechanisms.Methods: EPCs were separated from ApoE gene knockout rat bone marrow and identified using flow cytometry and fluorescence staining. EPCs were used to produce in vitro hypoxia-injury models which were then divided into six groups: Control, Hypoxia, Hypoxia + ECSW, Hypoxia + LY294002 + ECSW, Hypoxia + MK-2206 + ECSW, and Hypoxia + L-NAME + ECSW. EPCs from the Control, Hypoxia, and Hypoxia + ECSW groups were used in mRNA sequencing reactions. mRNA and protein expression levels were analyzed using qRT-PCR and western blot analysis, respectively. Proliferation, apoptosis, adhesion, migration, and angiogenesis were measured using CCK-8, flow cytometry, gelatin, transwell, and tube formation, respectively. Nitric oxide (NO) levels were measured using an NO assay kit.Results: Kyoto encyclopedia of genes and genomes (KEGG) enrichment analysis showed that differentially expressed genes were enriched in cancer signaling, PI3K-Akt signaling, and Rap1 signaling pathways. We selected differentially expressed genes in the PI3K-Akt signaling pathway and verified them using a series of experiments. The results showed that ECSW therapy (500 shots at 0.09 mJ/mm2) significantly improved proliferation, adhesion, migration, and tube formation abilities of EPCs following hypoxic injury, accompanied by upregulation of p-PI3K, p-Akt, p-eNOS, Bcl-2 protein and NO, PI3K, and Akt mRNA expression, and downregulation of Bax and Caspase3 protein expression. All these effects of ECSW were eliminated using inhibitors specific to PI3K (LY294002), Akt (MK-2206), and eNOS (L-NAME).Conclusion: ECSW exerted a strong repaired effect on EPCs suffering inhibited hypoxia injury by inhibiting cell apoptosis and promoting angiogenesis, mainly through activating the PI3K/Akt/eNOS signaling pathway, which provide new evidence for ECSW therapy in CHD.

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Section: Introductionmentioning

confidence: 99%

Extracorporeal Cardiac Shock Waves Therapy Improves the Function of Endothelial Progenitor Cells After Hypoxia Injury via Activating PI3K/Akt/eNOS Signal Pathway

Wang

Yang

et al. 2021

Front. Cardiovasc. Med.

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“…CSWT delivers low-intensity shockwaves directly onto the myocardium, inducing the release of angiogenic factors, especially VEGF, to enhance neovascularization and reduce inflammatory response [ 9 , 10 , 11 , 12 , 13 , 20 ]. Recent clinical studies have demonstrated that CSWT increased biomarkers of angiogenesis and decreased those of inflammation in patients with coronary artery disease and HF [ 22 ]. As expected, two sessions of CSWT had no significant effect on BP and thus had none on LV structural changes, including LVH and myocardial fibrosis, which are associated with persistent elevated BP.…”

Section: Discussionmentioning

confidence: 99%

Attenuation of Myocardial Dysfunction in Hypertensive Cardiomyopathy Using Non-R-Wave-Synchronized Cardiac Shock Wave Therapy

Zhen

Sun

et al. 2022

IJMS

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Cardiac shock wave therapy (CSWT) is a novel therapeutic procedure for patients with angina that is refractory to conventional therapy. We investigated the potential mechanism and therapeutic efficacy of non-R-wave-triggered CSWT to attenuate myocardial dysfunction in a large animal model of hypertensive cardiomyopathy. Sustained elevated blood pressure (BP) was induced in adult pigs using a combination of angiotensin-II and deoxycorticosterone acetate (DOCA). Two sessions of non-R-wave-triggered CSWT were performed at 11 and 16 weeks. At 10 weeks, systolic and diastolic blood pressure, LV posterior wall thickness and intraventricular septum thickness significantly increased in both the hypertension and CSWT groups. At 20 weeks, +dP/dt and end-systolic pressure-volume relationship (ESPVR) decreased significantly in the hypertension group but not the CSWT group, as compared with week 10. A significant improvement in end-diastolic pressure-volume relationship (EDPVR) was observed in the CSWT group. The CSWT group exhibited significantly increased microvascular density and vascular endothelial growth factor (VEGF) expression in the myocardium. Cytokine array demonstrated that the CSWT group had significantly reduced inflammation compared with the hypertension group. Our results demonstrate that non-R-wave-triggered CSWT is safe and can attenuate LV systolic and diastolic dysfunction via enhancement of myocardial neovascularization and anti-inflammatory effect in a large animal model of hypertensive cardiomyopathy.

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“…Cardiac shock wave therapy plus OMT can potentially reduce the rate of rehospitalization in patients with severe CAD. The treatment of severe CAD is challenging, as patients with severe CAD experience angina even with minimal activity or at rest ( 41 , 42 ). Therefore, these individuals suffer a severely increased rate of rehospitalization for frequent angina, although the risk of mortality is similar to that for stable CAD ( 4 ).…”

Section: Discussionmentioning

confidence: 99%

Effect of cardiac shock wave therapy plus optimal medical therapy on rehospitalization in patients with severe coronary artery disease: A meta-analysis and trial sequential analysis

Jia

Liu

2022

Front. Cardiovasc. Med.

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ObjectiveSeveral small sample-sized clinical studies have demonstrated that cardiac shock wave therapy (CSWT) might reduce the risk of rehospitalization in patients with severe coronary artery disease (CAD). However, other observational studies did not reported that clinical benefit of CSWT. Therefore, the effect of CSWT plus optimal medical therapy (OMT) on rehospitalization is still controversial.MethodsWe performed an updated meta-analysis and systematic review of randomized clinical trials (RCTs) and prospective cohort studies identified in systematic searches of Pubmed, Embase, the Cochrane library, the ClinicalTrials.gov website and Chinese SinoMed Database (up to December 2021). Primary endpoint was the rate of major adverse cardiac events (MACEs, the composite outcome of mortality, coronary artery revascularization, and rehospitalization). Meta-regression and subgroup analyses were used to identify possible contributors to between-study variances in the HDRS. Required information size (RIS) was calculated with trial sequential analysis (TSA).ResultsA total of 11 RCTs and 5 prospective cohort studies involving 1,149 patients with a mean follow-up of 10.3 months (range 3–72) months were included. Overall, CSWT plus OMT significantly decreased the rate of MACEs compared with the OMT group (RR, 0.39; 95% CI, 0.29–0.53), which was mainly attributed to markedly lower risk of rehospitalization (RR, 0.37; 95% CI, 0.27–0.51). Subgroup analysis showed that the pooled RRs for MACEs was significantly lower in studies enrolling patients with higher baseline Canadian Cardiovascular Society angina class (≥2.2) (RR, 0.36; 95% CI, 0.26–0.50) or studies with short follow-up period (followed ≤ 6 months, RR, 0.39; 95% CI, 0.24–0.64; followed 7–12 months, RR, 0.38; 95% CI, 0.26–0.54) or studies with HF with reduced ejection fraction (RR, 0.31; 95% CI, 0.13–0.72) or with preserved ejection fraction (RR, 0.40; 95% CI, 0.29–0.56). TSA showed that The RIS for MACE was 935, and the accrued information size was 577.ConclusionCardiac shock wave therapy plus OMT could decrease the rate of rehospitalization among patients with severe CAD. However, this result must be interpreted with caution, for the evidence supporting the use of CSWT for severe CAD is limited by the small sample size and short follow-up period of previous studies. Larger RCTs with longer follow-up are warranted to confirm these findings.Systematic review registration[https://inplasy.com/], identifier [INPLASY202210103].

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Effectiveness and Safety of Extracorporeal Shockwave Myocardial Revascularization in Patients With Refractory Angina Pectoris and Heart Failure

Cited by 9 publications

References 30 publications

Extracorporeal Cardiac Shock Waves Therapy Improves the Function of Endothelial Progenitor Cells After Hypoxia Injury via Activating PI3K/Akt/eNOS Signal Pathway

Extracorporeal Cardiac Shock Waves Therapy Improves the Function of Endothelial Progenitor Cells After Hypoxia Injury via Activating PI3K/Akt/eNOS Signal Pathway

Attenuation of Myocardial Dysfunction in Hypertensive Cardiomyopathy Using Non-R-Wave-Synchronized Cardiac Shock Wave Therapy

Effect of cardiac shock wave therapy plus optimal medical therapy on rehospitalization in patients with severe coronary artery disease: A meta-analysis and trial sequential analysis

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