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Coronary artery disease (CAD), due to poor blood circulation, has been deliberated as one of the leading cause of death in the United
States.
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The common mechanisms for treating CAD include stable medications, percutaneous coronary intervention (PCI) and coronary artery bypass graft surgery (CABG).
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Comparing traditional medications with a new type of therapy called
researches examine how
ESWT is effective among adult patients in improving the symptoms of CAD.
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ESWT, in contrast to ultrasound, is a single acoustic pulse that creates high peak pressure with short duration and propagates energy to the target area without burning or tearing tissues in front of that.
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The mechanisms of ESWT are considered as practicable to prevent inflammation occurring in blood vessels and increase blood flow to myocardium.
Clinical Studies
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MRI
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Six-minute walk test
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Canadian Cardiovascular Society (CCS) grading of angina
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New York Heart Association (NYHA) functional classification
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Seattle angina questionnaire (SAQ)
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Record the nitroglycerin dosage
Vivo & Animal Studies
 Rodent epigastric flap model
 Transgenic mouse model
 Quantitative immunohistochemical analysis
 Western blot analysis
 Microscopic evaluation
 Myocardial cytokine analysis
 Real-time polymerase chain reaction
(PCR)
Enhance development of vascular endothelial growth factor .
Increase capillary density.
Suppress macrophage and neutrophil infiltration, therefore reduce inflammatory responses.
Enhance
Nitric Oxide activities.
Delay the expression of
TGF-
-positive cells.
Increase SAQ scale and 6 – minute walk distances.
Decrease patients’ nitroglycerin intake
.
Negative
Troponin T level.
Increase left ventricle ejection and end-diastolic dimension.
Decrease patients’
NYHA class and
CCS grading.
Figure 1. Extracorporeal shock wave was applied in pig in vivo
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ESWT was defined by
International Society for Medical
Shock Wave Therapy (ISMST).
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It is a single sequence of sonic pulse that generates a sudden and high peak pressure up to one hundred MPa within a very short duration of 10 µsecond, and a frequency spectrum ranging from 16-20 MHz.
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ESWT propagates energy directly into target tissues without burning or tearing tissues in front of that.
Figure 2. Neutrophil infiltration
Extracorporeal shock wave therapy ,a new therapeutic strategy has been examined for its effectiveness for treating coronary artery diseases
Studies suggest that ESWT at a low energy level (0.03 – 0.11 mJ/mm*2) can significantly suppress myocardium inflammation and improve revascularization to the heart.
Different regimens wouldn’t influence the efficacy of ESWT.
Also, there is no evidence showing ESWT is invasive.
Overall, ECSWT is a noninvasive and effective therapy for coronary artery disease.
[1].Vasyuk, Y. A., Hadzegova, A. B., Shkolnik, E. L., Kopeleva,
M. V., Krikunova, O. V., Iouchtchouk, E. N., Aronova, E. M.,
Ivanova, S. V. (2010). Initial clinical experience with extracorporeal shock wave therapy in treatment of ischemic heart failure.
.
[2].Wang, Y., Guo, T., Ma, T., Cail, H., Tao, S., Peng, Y., Yang,
P., Chen, M., & Gu, Y. (2012). Modified regimen of extracorporeal cardiac shock wave therapy for treatment of coronary artery disease.
[3].Abe,Y., Ito, K., Hao K., Shindo, T., Ogata, T., Kagaya, T.,
Kurosawa R., Nishimiya, K., Satoh, K., Miyata, S., Kawakami,
K., Shimokawa, H. (2014). Extracorporeal low-energy shock-wave therapy exerts anti-inflammatory effects in a rat model of acute myocardial infarction.
[4].Mittermayr, R., Hartinger, J., Antonic, V., Meinl, A.,
Pfeifer, S., Stojadinovic, Schaden, W., Redl, H. (2011).
Extracorporeal shock wave therapy (ESWT) minimizes ischemic tissue necrosis irrespective of application time and promotes tissue revascularization by stimulating angiogenesi.
[5].Yang, P., Guo T., Wang W., Peng Y., Wang, Y., Zhou, P.,
Luo, Z., Cai, H., Zhao, L., Yang, H. (2013). Randomized and double-blind controlled clinical trial of extracorporeal cardiac shock wave therapy for coronary heart disease.