| Part 1 Experiment of AnimalThe Experimental Study about The Changes of BrainNatriuretic Peptide in Pigs Treated by Extracorporeal Cardiac Shock Wave Therapy after Acute Myocardial InfarctionObjective We analysed the change of Brain Natriuretic Peptide(BNP) in pigs treated by extracorporeal cardiac shock wave therapy after acute myocardial infarction to explore the possible mechanism of extracorporeal cardiac shock wave therapy improved ventricular remodeling after acute myocardial infarction in pig.Methods 30 pigs were selected randomly in our institution,20 of them were selected randomly to establish model of acute myocardial infarction by blocking distal of left anterior descending with balloon.Among the models,15 pigs were divided to treatment group which underwent shock wave therapy,meanwhile 5 pigs were divided to positive control group which didn't undergo shock wave therapy.Another 10 pigs,5 pigs of them were divided to negative control group which underwent shock wave therapy,menwhile 5 pigs of them were divided to blank control group which didn't receive any treatment.Blood samples of peripheral venous was collected before surgery and 1th day,2th day,3th day,5th day,7th day,11th day,14th day and 28th day of postoperate in all pigs.Concentration of BNP were measured through enzyme-linked immunosorbent assay. Results BNP began to increase in the positive control group on the first day after acute myocardial infarction.It reached a peak on the third day,then had a little down, but still higher than the level of preoperative.BNP was still higher than before surgery on 28th day of after myocardial infarction(2399.00±71.67pg/ml vs 2732.20±13.01 pg/ml p＜0.01).BNP began to increase on the first day after myocardial infarction in treated group.It reached the peak on the second day,then decrease on the third day after shock wave therapy were accepted.It can be maintained at a low level and has no significant difference compared to preoperative(2421.20±432.80pg/ml vs 2408.90±451.50pg/ml p=0.95＞0.05).The levels of BNP were relatively stable in negative control group and blank group and statistical difference were not found during the period of observation.Positive control group,treatment group,negative control group and blank control group to carry on the One-Way ANOVA.The positive control group compared to treatment group,negative control group and blank control group the significant statistical differences were showned.Treatment group compared to negative control group and blank control group significant difference were not found. Between treatment group and positive control group the significant statistically differences were found(p=0.003＜0.05).Negative control group compared to blank control group significant difference were not found.Conclusions The level of BNP was elevated significantly after acute myocardial infarction in pig.Extracorporeal cardiac shock wave therapy can improve the level of BNP significantly after acute myocardial infarction in pig.The improving of BNP may be related with the improving of left ventricular remodeling. Part 2 Research of Human一,The Safety of Extracorporeal Cardiac Shock Wave Therapy for Treatment of Coronary Artery Disease in PatientsObjective To investigate the security of extracorporeal cardiac shock wave therapy for treatment of coronary artery disease.Methods 35 patients were enrolled for CSWT in our institution.All patients were diagnosed as coronary heart disease with severe angina pectoris without indications for coronary artery bypass grafting(CABG) or percutaneous coronary intervention(PCI) or their prognosis still remains poor.All patients were treatmented by instrument of extracorporeal cardiac shock therapy which made in Switzerland and named STORZ MEDICAL.The whole process was monitored by real-time ECG, blood pressure,oxygen saturation.Meanwhile,we observed condition of local skin of patients and asked them whether have any discomfort during the treatment.Myocardial enzyme,function of liver and ECG were exampled before and after treatment.Results There were not significant changes in heart rate,rhythm,blood pressure and oxygen saturation during the treatment.Damage of skin and myocardium were not found.Patients don't have bvious discomfort.Embolism and polypnea also were not found.For those whose ECG trigger was not underwent,shock pulse will released per one second.Hemodynamics and heat rhythm also were not found.Conclusions Study have shown that CSWT didn't have any side effect on heart rate,rhythm,blood pressure and oxygen saturation and didn't have any damage to skin and myocardium.Patients didn't have bvious discomfort.It is a safe and non-invasive way for treatment coronary artery disease. 二,The Effectiveness of Extracorporeal Cardiac Shock Wave Therapy for Treatment of Coronary Artery Disease in PatientsObjective To evaluate effectiveness of extracorporeal cardiac shock wave therapy for treatment of coronary artery disease.Methods 9 patients were enrolled for CSWT in our institution.All patients were diagnosed as coronary artery disease and treatmented by instrument of extracorporeal cardiac shock therapy which made in Switzerland and named STORZ MEDICAL. Beforeand after the treatment,myocardial perfusion and cardiac function of MRI were examined,meanwhile 6-minute walk distance,nitrate intake per week,angina frequency per week and seattle angina questionnaire(SAQ) were compared to evaluat the effectiveness of extracorporeal cardic shock wave therapy for treatment coronary artery disease.Results Before and after treatment,the time of myocardial perfusion to peak was different(0.39±7.27s vs 0.30±4.85s,p=0.02)。Meanwhile,The signal intensity of myocardial perfusion to peak also were different significantly(23.6±5.15 vs 27.4±5.42,p＜0.01).The time of Perfusion to peak in chamber of left ventricular has no significant difference(0.23±9.03s vs 0.21±7.80s,p=0.31).Meanwhile,the intensity of Perfusion to peak in chamber of left ventricular also has no significant difference (72.75±29.68 vs 68.12±25.88,p=0.14).Before and after treatment,the changes of wall thickness of ischemic myocardium were different significantly in diastolic (8.11±1.58mm vs 8.91±1.83mm,p＜0.01),the changes of wall thickness of ischemic myocardium also were different significantly in systolic(10.08±2.68mm vs 12.24±2.58mm,p＜0.01),The extent of wall thickness increased were different (1.17±1.64mm vs 3.27±2.37mm,P＜0.01),The percent of wall thickness increased also were different significantly(12.08±17.50%vs 39.56±31.43%,p=0.01).Before and after treatment,left ventricular end diastolic diameter has no significant difference (103.22±92.20mm vs 110.37±84.96 ram,p=0.71).Left ventricular ejection fraction has no significant difference(46.94±23.90%vs 44.71±20.25%,p=0.29)before and after treatment.But some patients with ejection fraction greater than 50%before treatment.For patients whose ejection fraction less 50%before treatment(3 cases), ejection fraction were different significantly(23.16±12.59%vs25.73±13.41%, p=0.04).Before and after treatment,6-minute walking distance(357.00±93.31m vs 454.22±70.92m,p＜0.01),frequency of use nitroglycerin per week(1.77±0.97 vs 0.22±0.44,p＜0.01),angina of frequency per week(2.72±2.72 vs 0.31±0.4,p=0.02)and seattle angina questionaire(74.11±8.56 vs 82.77±9.78,p=0.001＜0.01) significant differences were found.Conclusions extracorporeal cardiac shock wave therapy can improve perfusion of ischemic myocardium.It can improve movement of regional wall.It can increase 6 -minutes walking distance and reduce frequency of use nitroglycerin and reduce angina and improve the quality of life.It is an effective new method to treatment of coronary artery disease. 三,The Analyse about the Changes of Brain Natriuretic Peptide in Patients with End Stage Coronary Artery Disease Treated by ExtracorporealCardic Shock Wave TherapyObjective To observe the change of brain natriuretic peptide(BNP) in patients with end stage coronary artery disease treated by extracorporeal cardic shock wave therapy(CSWT).To explore the possible mechanism of extracorporeal cardic shock wave therapy for improvement of ventricular remodeling of end stage coronary artery disease.Methods 35 patients were enrolled for CSWT in our institution.All patients were diagnosed as coronary heart disease and treated by instrument of extracorporeal cardiac shock therapy which made in Switzerland and named STORZ MEDICAL. Blood samples of peripheral venous were collected before treatment and before 3th, 6th,10th of treatment.The BNP were measured through enzyme-linked immunosorbent assay.Meanwhile,BNP of 10 patients without coronary artery disease also were measured.Results Concentrations of brain natriuretic peptide have no significant difference before and after treatved by CSWT.The leavl of BNP in patients with coronary artery disease on end stage were higher significantly than peoples without coronary artery disease.Conclusions Study demonstrated that the level of BNP was not significant difference before and after extracorporeal cardiac shock wave therapy for treatment end stage coronary artery disease.Concentrations of BNP in patients with end stage coronary artery disease were higher significantly than peoples without. |
PDF Full Text Request