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Abstract

Background

Growing evidence have shown cardiac extracorporeal shock wave therapy (ESWT) improve clinical symptoms and left ventricular ejection fraction (LVEF) for patients with end-stage diffuse coronary artery disease (EnD-CAD) unsuitable for coronary interventions. However, little is known whether cardiac ESWT remains effective on symptomatic relief and improvement of LVEF for the EnD-CAD patients with end-stage renal disease (ESRD).

Methods

This was a small-scale prospective study. Between August 2016 and January 2019, a total of 16 subjects received cardiac ESWT for their EnD-CAD. They were divided into two groups according to ESRD or not, i.e., EnD-CAD group (n = 8) and EnD-CAD/ESRD group (n = 8). Clinical symptoms including angina and dyspnea, levels of circulating endothelial progenitor cells (EPC), LVEF, and adverse events were regularly followed up for one year to compare safety and efficacy of cardiac ESWT between the EnD-CAD patients with or without ESRD.

Results

All participants tolerated cardiac ESWT without any relevant side effects such as skin allergic reaction, local redness/tenderness or cardiac arrhythmia. There were similar baseline comorbidities and clinical features between two groups, but the EnD-CAD/ESRD group had significantly higher serum potassium level as well as lower renal function and lipid profile (all p-values <0.03). After cardiac ESWT, the patients in both groups had significant improvement in angina and dyspnea at 1 year (all p-values <0.03). However, the EnD-CAD/ESRD group did not have increase in either circulating EPC levels or LVEF at 6 months (mean change in LVEF: −4.00% ± 8.32%, p = 1.000). In contrast, the EnD-CAD group had gradually improving levels of circulating EPC surface markers and increased LV systolic function (mean change in LVEF: +4.87% ± 8.76%, p = 0.092). Notably, patients in the EnD-CAD/ESRD group suffered from high incidental clinical adverse events before and after enrollment into the ESWT study (75% vs. 25%, p = 0.132).

Conclusion

Although cardiac ESWT provided improvement of clinical symptoms in the EnD-CAD patients, its long-term effects on the angiogenesis and LVEF were reduced for those high-risk patients with concomitant EnD-CAD and ESRD.

Trial registration

none.

Details

Title
Reduced effects of cardiac extracorporeal shock wave therapy on angiogenesis and myocardial function recovery in patients with end-stage coronary artery and renal diseases
Author
Pei-Hsun Sung 1   VIAFID ORCID Logo  ; Fu, Morgan 2 ; Hsin-Ju Chiang 3 ; Huang, Chi-Ruei 4 ; Chi-Hsiang Chu 4 ; Lee, Mel S 5 ; Hon-Kan Yip 6   VIAFID ORCID Logo 

 Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan; Center for Shockwave Medicine and Tissue Engineering, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan; Institute for Translational Research in Biomedicine, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan; College of Medicine, Changu Gung University, Taoyuan, Taiwan 
 Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan 
 Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan; Chung Shan Medical University School of Medicine, Taichung, Taiwan; College of Medicine, Changu Gung University, Taoyuan, Taiwan 
 Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan; College of Medicine, Changu Gung University, Taoyuan, Taiwan 
 Department of Orthopedics, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan; College of Medicine, Changu Gung University, Taoyuan, Taiwan; Paochien Hospital, Pintung, Taiwan 
 Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan; Center for Shockwave Medicine and Tissue Engineering, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan; Institute for Translational Research in Biomedicine, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan; Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan; Division of Cardiology, Department of Internal Medicine, Xiamen Chang Gung Memorial Hospital, Fujian, China; College of Medicine, Changu Gung University, Taoyuan, Taiwan 
Pages
S201-S209
Section
Original Article
Publication year
2021
Publication date
Dec 2021
Publisher
Elsevier Limited
ISSN
23194170
e-ISSN
23202890
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
3205381568
Copyright
©2020. Chang Gung University