Research On The Effect And Mechanism Of Cardiac Shock Wave Therapy For Patients With Ischemic Cardiomyopathy

Background: At present,ischemic heart disease has become a major cause of death worldwidely.Current methods of treating ischemic cardiomyopathy include drug therapy、percutaneous transluminal coronary angioplasty surgery and stenting、coronary artery bypass grafting、stem cell transplantation、heart transplantation and so on.Many patients with ischemic cardiomyopathy who have undergone standard drug therapy or revascularization are still recurrent with angina,heart failure and / or arrhythmia.Stem cell transplantation、cardiac transplantation and other methods are expensive and limited efficacy.Therefore,there is an urgent need to find a safer、more effective and simple way to treat ischemic cardiomyopathy.In vitro cardiac shock wave therapy(CSWT)works by positioning the ischemic myocardial target by airborne ultrasound,relying on body surface electrocardiogram R wave to trigger,and going into the target myocardium in the absolutely refractory period of ECG activity.CSWT can promote angiogenesis and increase blood flow of the target myocardium,so as to improve angina and cardiac function.Objective : To research the effect of Cardiac Shock Wave Therapy in patients with ischemic cardiomyopathy and to explore the underlying mechanisms.Methods:Sixty patients with ischemic cardiomyopathy were randomized to CSWT or control group.We took New York Heart Association(NYHA)class 、 Seattle Angina Questionnaire(SAQ)、 Canadian CardiovascularSociety(CCS)classification and 6 minutes walking distance to estimate severity of angina and health-related quality of life.Cardiac function was estimated by Left ventricular ejection fraction(LVEF)、left ventricular end systolic volume(LVESV)and left ventricular end-diastolic volume(LVEDV).Myocardial blood flow perfusion and metabolism were assessed by Single Photon Emission Computed Tomography(SPECT)images.Realtime reverse transcription polymerase chain reaction(RT-PCR)was used to dected the m RNA levels of genes on peripheral blood mononuclear cells(PBMC)from patients before and after CSWT treatment,in order to investigate the potential mechanisms of CSWT amelorate myocardial ischemia.Result : The NYHA 、 SAQ score 、 CCS class 、 summed stress score(SSS)、 summed rest score(SRS)of patients in CSWT were significantly improved(P<0.05).The levels of vascular endothelial growth factor-B(VEGFB)、 tumor necrosis factor receptor superfamily member 12A(TNFRSF12A)and chemokine(C-X-C motif)ligand 1(CXCL1)、 2(CXCL2)、3(CXCL3)m RNA of patients in CSWT were notably upregulated(P<0.05),mitogen-activated protein kinase 9(MAPK9)m RNA of patients in CSWT was down-regulated(P<0.05).However,the 6 minutes walking distance、LVEF、LVESV、LVEDV of patients in CSWT have no statistical significance.All these parameters changed little in control group.Conclusion:CSWT could amelorate myocardial ischemia、 reduce angina grading and improve blood perfusion for patients with ischemic cardiomyopathy.The mechanism may be that CSWT resulted in a significantly increase in the expression of promoters of neovascularization(VEGFB,TNFRSF12 A and CXCL1、CXCL2、CXCL3)and a notable decrease in the expression of a mediator of cell apoptosis(MAPK9).