Clinical effectiveness and safety of shock wave therapy in patients with stable angina

Abstract

Aim. To study the effects of cardiologic shock wave therapy (SWT) on the clinical manifestations of effort angina (EF) and left ventricular (LV) myocardial contractility, as well as to investigate the safety of SWT, as a part of combined therapy, in patients with coronary heart disease (CHD). Material and methods. The study included 40 patients, aged 44-75 years, with the diagnosis of CHD, Functional Class (FC) II-III stable EF (Canadian Cardiovascular Society classification). The participants were randomised into two groups. The main group (MG; n=20) received standard pharmaceutical therapy (PT) and SWT, while the control group (CG; n=20) received PT only. Before and after the SWT course, questionnaire survey, clinical examination, electrocardiography (ECG) at rest, treadmill stress test, echocardiography (EchoCG), stressEchoCG, and measurement of creatine phosphokinase (CPK) and MB-CPK levels were performed. Quality of life (QoL) was assessed by the SF-36 scale. All patients were given self-control diaries, to record blood pressure (BP) levels, angina attack incidence, and any adverse effects. The SWT course included 9 procedures (3 procedures with one-day intervals in Weeks 1, 5, and 9), using the “Cardiospec” system. Results. The SWT therapy was associated with an 8-fold reduction in nitrate doses (a significant difference with the CG). The angina attack incidence significantly reduced, from 7 to 1 per week. In the stress test, the exercise capacity and test time increased by 28% and 20%, respectively, in MG patients with CHD, FC II-III EA. The mean FC changed from II to I. There was a two-fold reduction in the size of hypokinetic myocardial zones, and a significant decrease in local dyskinesia index (-7%). In the MG, QoL substantially improved. The SWT course did not affect impulse generation and conduction in myocardium, as well as CPK and CPK-MB levels. Conclusion. SWT is a safe therapeutic method, improving myocardial perfusion, physical stress tolerability, QoL, and reducing angina attack incidence.