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Figure 1. Extracorporeal cardiac shock-wave therapy. (A) The patient under electrocardiographic monitoring (B) receives, in the ischemic zones localized with ultrasound guidance, the shock waves produced by the generator that is attached to the chest wall. (C) At each session, cardiac shock-wave therapy is applied to the border of the ischemic area to potentially induce neovascularization from the healthy region to the ischemic area.
(Figure omitted. See article PDF.)
Figure 2. Shock-wave effects. SW treatment increased the mRNA expression of VEGF and its receptor Flt-1 in human umbilical vein endothelial cells, with a maximum effect at 0.09 mJ/mm2 . (A) Normalization of the LVEF was only observed in the group of pigs treated with the SW therapy (B) . The regional myocardial blood flow evaluated with colored microspheres in both the endocardium and the epicardium also improved significantly in the SW group (C) . LVEF: Left ventricular ejection fraction; RMBF: Regional myocardial blood flow; SW: Shock wave. Reproduced with permission from [60].
(Figure omitted. See article PDF.)
Figure 3. Proposed mechanism for the beneficial effects of cardiac shock-wave therapy. The observed clinical effects are believed to be related to different angiogenic pathways, including NO, VEGF, PGF, (SDF-1) and recruitment of EPCs. EPC: Endothelial progenitor cell; NO: Nitric oxide; SDF-1: Stromal-derived factor-1.
(Figure omitted. See article PDF.)
As a result of the improvements in both pharmacologic and revascularization therapies life expectancy for patients with coronary artery disease (CAD) has greatly increased. This means that patients with more extensive CAD are now living longer, so many of them will develop myocardial ischemia and clinical angina that are not amenable to traditional revascularization therapy [1-4].
Patients with severe, symptomatic, chronic CAD have been described as having intractable angina, end-stage CAD or have been called 'no option' patients. However, despite being considered a therapy-resistant condition, refractory angina is a more appropriate term because a considerable number of new therapeutic methods are now available. The Canadian Cardiovascular Society (CCS) has recently defined refractory angina as a persistent (more than 3 months), painful condition, characterized by chest pain caused by coronary insufficiency in the presence of CAD, which cannot be controlled by a combination of medical therapy, angioplasty and coronary bypass surgery [5]. It is necessary to ensure that...