Clinical Info



Shock-Wave Therapy Improves Myocardial
Blood Flow Reserve in Patients with
Refractory Angina: Evaluation by Real-Time
Myocardial Perfusion Echocardiography

Conrado L. Ceccon, MD, Anderson S. Duque, MD, Luis H. Gowdak, MD, Wilson Mathias, Jr., MD,Hsu Po Chiang, MD, Joao C. N. Sbano, MD, Marta F. Lima, MD, Luis Antonio Machado Cesar, MD,Cecilia B. B. V. Cruz, MD, Paulo M. M. Dourado, MD, Claudio Meneghetti, MD, and Jeane M. Tsutsui, MD, S~ao Paulo, Brazil

J Am Soc Echocardiogr. 2019 Sep;32(9):1075-1085. Epub 2019 Jun 22

Cardiac shock-wave therapy (CSWT) has been demonstrated as an option for the treatment of patients with refractory angina (RA), promoting immediate vasodilatory effects and, in the long-term, neoangiogenic effects that would be responsible for reducing the myocardial ischemic load. The aim of this study was to determine the effects of CSWT on myocardial blood flow reserve (MBFR) assessed by quantitative real-time myocardial perfusion echocardiography in patients with RA.

Cardiac shock wave therapy improves myocardial perfusion and preserves left ventricular mechanics in patients with refractory angina: A study with speckle tracking echocardiography

Anderson S. Duque MD, Conrado L. Ceccon MD, Wilson Mathias Jr MD,
Joana Diniz Majesky MD, Luis H. Gowdak MD, João C. N. Sbano MD, Luis Antonio
Machado Cesar MD, Maria Cristina Abduch PhD, Márcio S. M. Lima MD,
Paulo M. M. Dourado MD, Cecilia B. B. V. Cruz MD, Jeane M. Tsutsui MD

Volume35, Issue10, October 2018, Pages 1564-1570.

Cardiac shockwave therapy (CSWT) is a new potential option for the treatment of patients with chronic coronary disease and refractory angina (RA). We aimed to study the effects of CSWT on left ventricular myocardial perfusion and mechanics in patients with RA…

Feasibility of Extracorporeal Shock Wave Myocardial Revascularization Therapy for Post-Acute Myocardial Infarction Patients and Refractory Angina Pectoris Patients

Masahiro Myojo MD, Jiro Ando MD, Masae Uehara MD, Masao Daimon MD,
Masafumi Watanabe MD, and Issei Komuro MD

Int Heart J. 2017 Apr 6;58(2):185-190. doi: 10.1536/ihj.16-289. Epub 2017 Mar 21.

Extracorporeal shockwave myocardial revascularization (ESMR) is one of the new treatment options for refractory angina pectoris (RAP), and some studies have indicated its effectiveness. A single-arm prospective trial to assess the feasibility of ESMR using Cardiospec for patients with post-acute myocardial infarction (AMI) and RAP was designed and performed. The patients were treated with 9 sessions of ESMR to the ischemic areas for 9 weeks..

Multimodality Imaging of Myocardial Revascuarization Using Cardiac Shockwave Therapy

G. Zuoziene, D. Leibowitz, J. Celutkiene, G. Burneikaite, L. Ivaskeviciene, G. Kalinauskas, V.V. Maneikiene, D. Palionis, V. Janusauskas, N. aleviciene, A. Laucevicius

International journal of cardiology. Mar 20 2015;187:229-230

Ischemic heart disease remains a leading cause of morbidity and mortality worldwide. Despite modern therapies, many patients still suffer from refractory angina pectoris (RAP) therefore, alternative non-invasive revascularization methods are under development. One of the methods stimulating angiogenesis is cardiac shock wave therapy (CSWT), a new treatmentmethod offering an alternative to…

Cardiac Shock Wave Therapy and Myocardial Perfusion in Severe Coronary Artery Disease

M. Kaller, L. Faber, N. Bogunovic, D. Horstkotte, W. Burchert, Oliver Lindner

Clinical research in cardiology: official journal of the German Cardiac Society. Apr 17 2015

Ultrasound guided cardiac shock wave therapy (CSWT) is a noninvasive therapeutic option in the treatment of chronic-refractory angina. Clinical trials have shown that CSWT reduces angina symptoms, improves regional systolic function, LV ejection fraction, myocardial perfusion and quality of life parameters. Absolute measurements of myocardial perfusion before and after CSWT have not been performed so far…

ESMR Therapy is Efficacious in Improving Symptoms in Patients with Refractory Angina Pectoris – A Multicenter Study

M. Prasad, W.A. Wan Ahmad, R. Sukmawan, Edward-Bengie L. Magsombol, A. Cassar, Y. Vinshtok, M. Dzafir Ismail, A. Syadi M. Zuhdi, S.A. Locnen, R. Jimenez, H. Callleja, A. Lerman

Coronary artery disease. May 2015;26(3):194-200

LI ESWT was applied to 10 patients with CAD associated with RAP. folloeing LI ESWT, nitroglycerin use was significantly reduced and imptovement  in the total Seattle Angina Questionnaire score was demonstrated in 86% of patients (p<0.001). Exercise tolerance was significantly enhanced by Extracorporeal Shockwave for Myocardial Revascularization (ESMR) (p<0.002) and a mild improvement of myocardial…

The Beneficial Effect of Extracorporeal Shockwave Myocardial Revascularization in Patients with Refractory Angina

Gianluca Alunni, Sebastiano Marra, Ilaria Meynet, Maurizio D’amico, Pelloni Elisa, Annalaura Fanelli, Stefano Molinaro, Paolo Garrone, Armando Deberardinis, Mario Campana, Amir Lerman

Cardiovascular revascularization medicine: including molecular interventions. Jan-Feb 2015;16(1):6-11

Refractory Angina in patients without revascularization option (RA) is a growing clinical concern. The prognosis and the quality of life in these patients is reduced and conventional medical therpy is frequently inadeguate for symptom relief. According to the last ACC/AHA guidelines on the manafement of chronic stable angina, the goal og the treatment should be the elimination of chest pain reduce hospitatlizations…

The Beneficial Effect of Extracorporeal Shockwave Myocardial Revascularization: Two Years of Follow-Up

Alunni G., Barbero U., Vairo A., D’Amico S., Pianelli M., Zema D., Bongiovanni F., Gaita F.

Cardiovasc Revasc Med. 2017 Dec;18(8):572-576. doi: 10.1016/j.carrev.2017.05.006. Epub 2017 May 10

Objectives: Despite the advancements achieved by revascularization technique and pharmacological therapies, the number of patients with refractory angina (RA) is still high, carrying together a poor prognosis. Experimental data and small clinical studies suggest that the use of extracorporeal shockwave myocardial revascularization (ESMR) might improve symptoms of angina in patients with RA…..

Safety and Efficacy of Extracorporeal Shock Wave Myocardial Revascularization Therapy for Refractory Angina Pectoris

Andrew Cassar, MD, MRCP; Megha Prasad, MD; Martin Rodriguez-Porcel, MD, FAHA; Guy S. Reeder, MD, FACC; Darshak Karia, MD; Anthony N. DeMaria, MD, MACC; and Amir Lerman, MD, FACC

Mayo Clinic proceedings Mayo Clinic. Mar 2014;89(3):346-354.

Objective: To assess the safety and afficacy of extracorporeal shockwave myocardial revascularization (ESMR) therapy in treating patients with refractory angina pectoris.
Patients and Methods: A single-arm multicenter prospective trial to assess safety and efficacy of the ESMR therapy in patients with refractory angina (class III/IV angina) was performed. Screening exercise treadmill tests and pharmacological…

Extracorporeal Shock Wave Myocardial Revascularization Improves Clinical Symptoms and Left Ventricular Function in Patients with Refractory Angina

Gitana Zuoziene, Aleksandras Laucevicius, David Leibowitz

Coronary artery disease. Jan 2012;23(1):62-67

Background: Medical therapy for refractory angina is limited and the prognosis is poor. Experimental data suggest that the use of extracorporeal shockwave myocardial revascularization (ESMR) can contribute to angiogenesis and improve symptoms of angina and left ventricular (LV) function. The objective of this study was to examine the effects of ESMR on clinical symptoms as well as LV function as assessed…

The Efficacy of Cardiac Shock Wave Therapy in the Treatment of Refractory Angina: A Pilot Prospective, Randomized, Double-blind Trial

David Leibowitz A. Teddy Weiss, David Rott, Ronen Durst, Chaim Lotan

Int J Cardiol. 2013 Sep 10;167(6):3033-4. doi: 10.1016/j.ijcard.2012.11.099. Epub 2012 Nov 30

Refractory angina pectoris (RAP) is a growing clinical problem. Prognosis in these patients is poor and conventional medical therapy is frequently inadequate for symptom relief. The aim of this pilot prospective, double-blind, placebo-controlled study was to test the hypothesis that low-energy extracorporeal shockwave myocardial revascularization (ESMR) can reduce clinical symptoms and improve…

Non-Invasive Therapy for the Management of Patient with Advanced Coronary Artery Disease

Kazmi W.H., Rasheed S.Z., Ahmad S., Saadat M., Altaf S., Samad A.

Coronary artery disease. Dec 2012;23(8):549-554

Objective: To determine the efficacy of cardiac shock wave therapy (CSWT) in the management of patients with end-stage coronary disease (CAD).
Introduction: Patients with end-stage CAD have symptoms such as recurrent angina, breathlessness, and other debilitating conditions. End-stage CAD patients are usually those who have angina pectoris following a coronary artery bypass…

Cardiac Shock-Wave Therapy in the Treatment of Refractive Angina Pectoris

Juan Ruiz-Garcia, Amir Lerman

Interv Cardiol 2011;3(2):191-201

An increasing number of patients are being diagnosed with severe coronary artery disease not amenable to traditional revascularization. Most of them remain symptomatic despite optimal medical therapy, so the resulting qualiy of life is poor. Thus, there is a need for the development of novel therapies. Shock waves (SWs) have been used in medicine for 30 years, but the recent discovery of their potential…

Cardiac Shock-Wave Therapy in the Treatment of Coronary Artery Disease: Systematic Review and Meta-Analysis

Burneikaitė G., Shkolnik E., Čelutkienė J., Zuozienė G., Butkuvienė I., Petrauskienė B., Šerpytis P., Laucevičius A., Lerman A.

Cardiovasc Ultrasound. 2017 Apr 12;15(1):11. doi: 10.1186/s12947-017-0102-y. Review

Aim: To systematically review currently available cardiac shock-wave therapy (CSWT) studies in humans and perform meta-analysis regarding anti-anginal efficacy of CSWT.
Methods: The Cochrane Controlled Trials Register, Medline, Medscape, Research Gate, Science Direct, and Web of Science databases were explored. In total 39 studies evaluating the efficacy of CSWT in patients with stable angina….

Extracorporeal Shock Wave Therapy Reverses Ischemia-related Left Ventricular Dysfunction and Remodeling: Molecular-Cellular and Functional Assessment

M. Fu, J.J. Sheu, S. Chua, Y.L. Chen, S.Y. Chung,T.H. Tsai, H.K. Yip

PloS one. 2011;6(9):e24342

Objectives: An optimal treatment for patients with diffuse obstructive arterial disease unsuitable for catheter-based or surgical intervention is still pending. This study tested the hypothesis that extracorporeal shock wave (ECSW) therapy may be a therapeutic alternative under such clinical situation.
Methods: Myocardial ischemia was induced in male mini-pigs through applying…

Initial Clinical Experience with Extracorporeal Shock Wave Therapy in Treatment of Ischemic Heart Failure

Y.A. Vasyuk; A.B. Hadzegova; E.L. Shkolnik; M.V. Kopeleva; O.V. Krikunova; E.N. Iouchtchouk; E.M. Aronova; S.V. Ivanova

Congest Heart Fail. Sep-Oct 2010;16(5):226-230

Previous experimental studies have suggested a beneficial effect of extracorporeal shock wave therapy (ESWT) in patients with ischemic heart failure. Twenty-four patients with ischemic heart failure and left ventricular ejection fraction (LVEF) <40% received ESWT in addition to their stable treatment. ESWT was performed in 9 sessions with 100 shocks per spot in viable segments detected by dobutamine…

Cardiac Shockwave Therapy in Patients with Chronic Refractory Angina Pectoris

Vainer J., Habets JH., Schalla S., Lousberg AH., de Pont CD., Vöö SA., Brans BT., Hoorntje JC., Waltenberger J.

Netherlands heart journal: monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation. May 2016;24(5):343-349.

Background: Cardiac shockwave therapy (CSWT) might improve symptoms and decrease ischaemia burden by stimulating collateral growth in chronic ischaemic myocardium. This prospective study was performed to evaluate the feasibility and safety of CSWT.
Methods: We included 33 patients (mean age 70 ± 7 years, mean left…

Extracorporeal Shockwave Myocardial Revascularization Therapy in Refractory Angina Patients

Slavich Massimo MD, Ancona Francesco MD, Margonato Alberto MD

International Journal of Cardiology, 2015. 194: p. 93.

LI-ESWT was applied to 10 patients with CAD associated with RAP. folloeing LI-ESWT, nitroglycerin use was significantly reduced and imptovement  in the total Seattle Angina Questionnaire score was demonstrated in 86% of patients (p<0.001). Exercise tolerance was significantly enhanced by Extracorporeal Shockwave for Myocardial Revascularization (ESMR) (p<0.002) and a mild improvement of myocardial…

Extracorporeal Shock Wave Myocardial Revascularization (ESMR) Therapy: A Novel Therapy for Refractory Angina

M.D. Ismail, A.S.M. Zuhdi, Z. Yaakob, W.H.A.W. Harun, C.K. Han, A. Loch, M.A. Saddiq, S.R.M.Sathasivam, N .Ashikin Md Sari, W.A.W. Ahmad

World Congress of Cardiology (WCC) 2012

Introduction: With improvement in cardiovascular care, there is a rapidly growing group of patients who remain severely disabled by symptoms of myocardial ischemia but yet not amenable to conventional revascularization therapy. ESMR is a shockwave therapy given to the area of ischemic myocardium which theoretically induces angiogenesis and hence improvement in myocardial perfusion and clinical…

Extracorporeal Shock Wave Myocardial Reperfusion (ESMR) Therapy Improves Left Ventricular Dyssynchrony

A.S.M. Zuhdi, M.D. Ismail, A.W. Undok, I.Z. Abidin, M.N.M. Naser, Z.H. Yaakob, R.Singh, R. Singh, A.J. Nordin, W.A.W. Ahmad

World Congress of Cardiology (WCC) 2012

Introduction: Left ventricular (LV) dyssynchrony is frequently observed in patients with ischemic myocardium and is recognized as an adverse predictor of clinical outcome. ESMR on the other hand, is a novel therapy for refractory angina in patients with severe coronary artery disease not amenable for conventional revascularization therapy (CABG or PCI)…

Extracorporeal Cardiac Shock Wave Therapy in Severe Coronary Artery Disease Unsuitable for Percutaneous Coronary Intervention (PCI) and Coronary Artery Bypass Surgery (CABG): A Single Center Experience

Morgan Mao-Young Fu, Ching-Jen Wang, Hon-Kan Yip, Chiung-Jen Wu, Chu-Yuan Fang, Sarah Chua, Chun-Jen Chen, Su-Ming Chen, Wen-Hou Leu

ISMST congress 2010

Introduction: To test the effectiveness and feasibility of extracorporeal cardiac shockwave (SW) therapy in patients with severe coronary artery disease (CAD) unsuitable for revascularization.
Methods: Extracorporeal SW is performed with the application of 100 shocks/spot at 0.09mJ/mm2 energy flux density for 3-6 spots each time, with three times per…

Investigation Into the Effectiveness of Shock Wave Treatment for Angina Pectoris Patients Post-Bypass Surgery

T. Takayama, S. Saito, A. Hirayama, J. Honye, M. Chiku, T. Yoda, I. Watanabe

European Heart Journal, 2008

Background: The effectiveness of shock wave based, angiogenesis therapy for patients with ischemic disease has been confirmed in basic experimentation, yet effectiveness in a clinical setting is yet to be fully clarified. Therefore, an investigation was undertaken to determine the effectiveness of shock wave treatment for post-bypass ischemic patients, given that patients that are no longer suitable for coronary…

Safety and Efficacy of Extracorporeal Low Energy Shock Wave Application for the Treatment of Refractory Angina Pectoris and Myocardial Ischemia in Patients with End-Stage Coronary Artery Disease

Christoph K Naber, Sara Lammers, Tinatin Lind, Stefan Müller, Gil Hakim, Raimund Erbel

European Cardiology Society Congress (ESC), 2008

Background: The number of patients with end stage coronary artery disease increases rapidly due to improved techniques in bypass surgery and interventional cardiology.
Myocardial ischemia in these patients often leads to refractory angina, a status of disease which can be treated clinically only with limited success so far. Experimental data indicates, that the application of low energy shockwaves may stimulate the…

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