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a:2:{s:4:"TEXT";s:162:"The effect of cardiac shock wave therapy on the clinical and functional state of patients with coronary heart disease after myocardial revascularization surgery";s:4:"TYPE";s:4:"HTML";}


Authors: Borbodoeva B.M.1, Asymbekova E.U.1, Matskeplishvili S.T.1.2, Akhmedyarova N.K.1, Sherstyannikova O.M.1, Tugeeva E.F.1, Buziashvili V.Yu.1, Buziashvili Yu.I.1

Company:
1 Clinical and Diagnostic Department, Bakоulev National Medical Research Center of Cardiovascular Surgery, Rublevskoe shosse, 135, Moscow, 121552, Russian Federation;
2 Lomonosov Moscow State University Medical Center, Lomonosovskiy prospekt, 27/2, Moscow, 119192, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

Heading: Original Research

UDC: 616.12-005.4:616.127-089.844:615.8

Link: Clinical Physiology of Blood Circulaiton. 2019; 3 (2): 94-102

Quote as: Borbodoeva B.M., Matskeplishvili S.T., Asymbekova E.U., Akhmediarova N.K., Sherstyannikova O.M., Tugeeva E.F., Buziashvili V.Yu., Buziashvili Yu.I. The effect of cardiac shock wave therapy on the clinical and functional state of patients with coronary heart disease after myocardial revascularization surgery. Cardiovascular Surgery News. 2019; 3 (2): 94–102 (in Russ.). DOI: 10.24022/2588-0284-2019-3-2-94-102

Received / Accepted:  31.05.2019/24.06.2019

Full text:
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Abstract

Summary. A significant number of patients with ischemic heart disease (CAD) after myocardial revascularization persist withsymptoms of angina, which causes a deterioration in the prognosis and quality of life of patients. In many cases, the features of CAD do not allow repeated myocardial revascularization, and the presence of comorbidity is associated with an unacceptably high risk of perioperative complications. Such problems dictate the use of alternative therapeutic approaches, including cardiac shock wave therapy (CSWT) – one of the new methods that allow non-invasive stimulation of angiogenesis in the area of myocardial ischemia.

Objective. To study the possibility of using shock-wave therapy in patients with coronary heart disease after myocardial revascularization, as well as to assess its safety and effectiveness.

Material and Methods. 50 patients with CAD with reversible left ventricular myocardial dysfunction according to stress echocardiography were examined. Aorto-coronary bypass surgery (CABG) was performed in 71% of patients, 12% underwent percutaneous coronary intervention, 17% of patients did not tolerate myocardial revascularization. The CSWT was conducted according to the standard method. All patients when included in the study, immediately after the end and a month after the course of CSWT, were carried out a comprehensive clinical and instrumental examination and laboratory examination. To assess the safety of CSWT, the levels of troponin I, a cardiac protein, binding aliphatic acids, C-reactive protein (CRP) were determined; For evaluation of angiogenesis, vascular endothelial growth factor A (VEGF-A), hepatocyte growth factor (HGF), fibroblast growth factor (FGF basic), transforming growth factor alpha (TGF-α).

Results. After the completed course of CSWT according to the standard scheme, patients had a significant decrease in the average functional class of angina, improved longitudinal systolic function and diastolic function of the myocardium. There was an increase in EF from 53.9±1.0% to 56.4±0.8%, according to the stress-Echo, a significant increase in load time was observed from 5.5±0.1 minutes to 6.8±0.1 and 7.7±0.2 minutes, respectively. The increase in EF in response to the load was 10.3±1.5% at baseline, after CSWT – 14.4±1.1%, and after 1 month – 17.1±1.3%. According to tissue Doppler, there was a significant improvement in the longitudinal systolic and diastolic functions of the myocardium. The dynamics of laboratory examinations before and after CSWT showed a significant increase in the content of all growth factors after the 3rd session and the preservation of the achieved gain 1 month after the end of therapy. When comparing the degree of change in the concentration of growth factors, the minimum increase in the level of angiogenesis factors was 1.6, the maximum – 2.2. When studying the dynamics of troponin I, cardiac protein, binding aliphatic acids, C-reactive protein, no negative dynamics were observed in any case.

Conclusion. The use of shock-wave therapy in patients with coronary artery disease is accompanied by an improvement in functional status, which is manifested in an increase in the tolerance threshold and duration of the load, an increase in EF in response to the load. CSWT leads to improvement of longitudinal systolic function, improvement of diastolic function. The basis for improving the clinical and functional state is the mechanism of angiogenesis, confirmed by an increase in the content of angiogenic factors. In no case was there any worsening of the condition of the patients, no negative dynamics of the diastolic and systolic functions of the ventricles was observed, which characterizes the CSWT as a safe method. Additionally, safety is confirmed by the determination of troponin I, cardiac protein, binding aliphatic acids, and CRP.

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About Authors

  • Borbodoeva Bаktygul' Matikanovna, Cardiologist, orcid.org/0000-0001-8139-5742;
  • Asymbekova El'mira Umetovna, Dr. Med. Sc., Leading Researcher, orcid.org/0000-0002-5422-2069;
  • Matskeplishvili Simon Teymurazovich, Dr. Med. Sc., Corresponding Member of RAS, Chief Researcher, orcid.org/0000-0002-5670-167Х;
  • Akhmedyarova Nazli Kerimovna, Cand. Med. Sc., Researcher, orcid.org/0000-0001-7157-6312;
  • Sherstyannikova Ol'ga Mikhailovna, Cand. Med. Sc., Researcher, orcid.org/0000-0002-0340-695Х;
  • Tugeeva El'vira Faatovna, Dr. Med. Sc., Senior Researcher, orcid.org/0000-0003-1751-4924;
  • Buziashvili Victoriya Yur'evna, Cand. Med. Sc., Junior Researcher, orcid.org/0000-0001-6589-9246;
  • Buziashvili Yuriy Iosifovich, Dr. Med. Sc., Academician of RAS, Professor, orcid.org/000-0001-7016-7541

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