田春梅,郑京京,贾娜,张琳,刘保逸,刘君萌,蓝明,刘兵

• 1:北京医院心内科国家老年医学中心中国医学科学院老年医学研究院

摘要(Abstract)：

目的 探讨心脏体外震波治疗（CSWT）对冠心病患者负荷心肌灌注扫描及心电图结果的影响。方法 纳入2016年12月至2022年8月因冠心病在北京医院住院诊治并行CSWT的患者。CSWT为3个月方案，共9次治疗。收集冠心病患者行CSWT前后的临床基本资料、心肌灌注扫描数据和心电图数据。比较CSWT前后心肌灌注扫描结果和心电图参数的变化。结果 共有55例冠心病患者，其中男43例，平均年龄为（67.45±8.96）岁。CSWT前后12导联心电图ST段最大位移均无明显变化，心肌灌注扫描显示左心室整体负荷灌注总分（P=0.031）和整体可逆灌注总分（P=0.024）显著改善，静息左心室整体缺血面积显著缩小（P=0.034），差异均有统计学意义。靶节段负荷灌注评分（P=0.002）、靶节段可逆灌注评分（P=0.002）、靶节段负荷缺血面积（P=0.001）明显改善，差异均有统计学意义。结论 CSWT对冠心病难治性心绞痛患者心电图ST段最大位移无影响，有助于改善心肌血流灌注，缩小缺血范围。

关键词(KeyWords)： 冠心病;心脏体外震波治疗;心肌缺血;心电图

Abstract:

Keywords:

基金项目(Foundation): 北京医院院内课题项目（BJ-2019-159）

作者(Author): 田春梅,郑京京,贾娜,张琳,刘保逸,刘君萌,蓝明,刘兵

参考文献(References)：

• [1]马丽媛，王增武，樊静，等.《中国心血管健康与疾病报告2021》概要[J].中国介入心脏病学杂志，2022,30(7):481-496. DOI:10.3969/j.issn.1004-8812.2022.07.001.
• [2] Kaller M, Faber L, Bogunovic N, et al. Cardiac shock wave therapy and myocardial perfusion in severe coronary artery disease[J]. Clin Res Cardiol, 2015, 104(10):843-849. DOI:10.1007/s00392-015-0853-0.
• [3] Ceccon CL, Duque AS, Gowdak LH, et al. Shock-wave therapy improves myocardial blood flow reserve in patients with refractory angina:evaluation by real-time myocardial perfusion echocardiography[J]. J Am Soc Echocardiogr, 2019, 32(9):1075-1085. DOI:10.1016/j.echo.2019.04.420.
• [4] Schmid JP, Capoferri M, Wahl A, et al. Cardiac shock wave therapy for chronic refractory angina pectoris. A prospective placebocontrolled randomized trial[J]. Cardiovasc Ther, 2013, 31(3):e1-e6. DOI:10.1111/j.1755-5922.2012.00313.x.
• [5]刘保逸，陈聪霞，张瑞生，等.体外心脏震波系统治疗顽固性心绞痛的临床探讨[J].中国心血管杂志，2015,20(1):23-28. DOI:10.3969/j.issn.1007-5410.2015.01.006.
• [6] Tilkemeier PL, Bourque J, Doukky R, et al. ASNC imaging guidelines for nuclear cardiology procedures:Standardized reporting of nuclear cardiology procedures[J]. J Nucl Cardiol,2017, 24(6):2064-2128. DOI:10.1007/s12350-017-1057-y.
• [7]田春梅，郑京京，贾娜，等.冠心病患者心脏体外震波治疗护理流程及其安全性分析[J].中国医学前沿杂志（电子版），2023, 15(3):53-58.DOI:10.12037/YXQY.2023.03-10.
• [8] Di Meglio F, Nurzynska D, Castaldo C, et al. Cardiac shock wave therapy:assessment of safety and new insights into mechanisms of tissue regeneration[J]. J Cell Mol Med, 2012, 16(4):936-942. DOI:10.1111/j.1582-4934.2011.01393.x
• [9]刘保逸，李文婵，张瑞生，等.体外心脏震波治疗老年冠心病患者的疗效和安全性分析[J].中华老年医学杂志，2015, 34(7):736-740.
• [10] Zhao L, Yang P, Tang Y, et al. Effect of cardiac shock wave therapy on the microvolt T wave alternans of patients with coronary artery disease[J]. Int J Clin Exp Med, 2015, 8(9):16463-16471.
• [11] Kereiakes DJ, Virmani R, Hokama JY, et al. Principles of intravascular lithotripsy for calcific plaque modification[J].JACC Cardiovasc Interv, 2021, 14(12):1275-1292.DOI:10.1016/j.jcin.2021.03.036.
• [12]王燕庆，白文楼，苏晗琪，等.血管内冲击波碎石术在冠状动脉钙化病变中的研究进展[J].中国介入心脏病学杂志，2023, 31(5):367-372. DOI:10.3969/j.issn.1004-8812.2023.05.008.
• [13]王菁，马墩亮，钟志安，等.评价血管内冲击波碎石术在小型猪冠状动脉中应用的安全性[J].中国介入心脏病学杂志，2022, 30(8):606-612. DOI:10.3969/j.issn.1004-8812.2022.08.008.
• [14] Jia N, Zhang R, Liu B, et al. Efficacy and safety of cardiac shock wave therapy for patients with severe coronary artery disease:a randomized, double-blind control study[J]. J Nucl Cardiol, 2022, 29(5):2404-2419. DOI:10.1007/s12350-021-02768-7.
• [15] Weijing L, Ximin F, Jianying S, et al. Cardiac shock wave therapy ameliorates myocardial ischemia in patients with chronic refractory angina pectoris:a randomized trial[J].Front Cardiovasc Med, 2021, 8:664433. DOI:10.3389/fcvm.2021.664433.
• [16] Yang P, Guo T, Wang W, et al. Randomized and doubleblind controlled clinical trial of extracorporeal cardiac shock wave therapy for coronary heart disease[J]. Heart Vessels, 2013,28(3):284-291. DOI:10.1007/s00380-012-0244-7.
• [17] Kikuchi Y, Ito K, Shindo T, et al. A multicenter trial of extracorporeal cardiac shock wave therapy for refractory angina pectoris:report of the highly advanced medical treatment in Japan[J]. Heart Vessels, 2019, 34(1):104-113.DOI:10.1007/s00380-018-1215-4.
• [18] Shkolnik E, Burneikaite G, Jakutis G, et al. A randomized,triple-blind trial of cardiac shock-wave therapy on exercise tolerance and symptoms in patients with stable angina pectoris[J]. Coron Artery Dis, 2018, 29(7):579-586. DOI:10.1097/mca.0000000000000648.
• [19]?elutkien?J, Burneikaite G, Shkolnik E, et al. The effect of cardiac shock wave therapy on myocardial function and perfusion in the randomized, triple-blind, sham-procedure controlled study[J]. Cardiovasc Ultrasound, 2019, 17(1):13.DOI:10.1186/s12947-019-0163-1.
• [20] Wang J, Jia N, Liu B, et al. Clinical outcomes of cardiac shockwave therapy in severe coronary artery disease patients after coronary artery bypass grafting[J]. Int Heart J, 2023, 64(2):137-144. DOI:10.1536/ihj.22-481.
• [21] Wang W, Liu H, Song M, et al. Clinical effect of cardiac shock wave therapy on myocardial ischemia in patients with ischemic heart failure[J]. J Cardiovasc Pharmacol Ther,2016, 21(4):381-387. DOI:10.1177/1074248415616189.
• [22] Zhang Y, Shen T, Liu B, et al. Cardiac shock wave therapy attenuates cardiomyocyte apoptosis after acute myocardial infarction in rats[J]. Cell Physiol Biochem, 2018, 49(5):1734-1746. DOI:10.1159/000493616.
• [23] Cai HY, Li L, Guo T, et al. Cardiac shockwave therapy improves myocardial function in patients with refractory coronary artery disease by promoting VEGF and IL-8 secretion to mediate the proliferation of endothelial progenitor cells[J]. Exp Ther Med, 2015, 10(6):2410-2416. DOI:10.3892/etm.2015.2820.
• [24] Li H, Liu ML. Cardiac shock wave therapy:an alternative non-invasive therapy for refractory angina[J]. Eur Rev Med Pharmacol Sci, 2018, 22(16):5402-5410. DOI:10.26355/eurrev_201808_15743.
• [25] Yu W, Shen T, Liu B, et al. Cardiac shock wave therapy attenuates H9c2 myoblast apoptosis by activating the AKT signal pathway[J]. Cell Physiol Biochem, 2014, 33(5):1293-1303. DOI:10.1159/000358697.
• [26] Du L, Shen T, Liu B, et al. Shock wave therapy promotes cardiomyocyte autophagy and survival during hypoxia[J].Cell Physiol Biochem, 2017, 42(2):673-684. DOI:10.1159/000477885.
• [27] Wang L, Tian X, Cao Y, et al. Cardiac shock wave therapy improves ventricular function by relieving fibrosis through PI3K/Akt signaling pathway:evidence from a rat model of postinfarction heart failure[J]. Front Cardiovasc Med, 2021,8:693875. DOI:10.3389/fcvm.2021.693875.
• [28] Qiu Q, Shen T, Yu X, et al. Cardiac shock wave therapy alleviates hypoxia/reoxygenation-induced myocardial necroptosis by modulating autophagy[J]. Biomed Res Int, 2021,2021:8880179. DOI:10.1155/2021/8880179.