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Cardiac Shock Wave Therapy in Coronary Artery Disease: A Systematic Review and Meta-Analysis
Quan Qiu1, Shenjie Chen1, Yuangang Qiu1
1Department of Cardiology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.
Insights
Cardiac shock wave therapy (CSWT) offers a promising non-invasive treatment for coronary artery disease (CAD). This meta-analysis confirms CSWT moderately improves cardiac function and myocardial perfusion in CAD patients.
Area of Science:
- Cardiology
- Non-invasive therapies
- Medical technology
Background:
- Coronary artery disease (CAD) is a major global health concern, leading to significant morbidity and mortality.
- Cardiac shock wave therapy (CSWT) presents a novel, non-invasive therapeutic approach for managing CAD.
Approach:
- A systematic review and meta-analysis were conducted, searching major electronic databases.
- Included 10 studies (8 RCTs, 2 prospective cohort) with 643 patients (336 CSWT, 307 control).
- Evaluated efficacy using weighted mean difference (WMD) with 95% confidence intervals (CI).
Key Points:
- CSWT significantly improved rest left ventricular ejection fraction (LVEF) (WMD 3.88, 95% CI 1.53-6.23).
- Left ventricular internal diameter in diastole (LVIDd) was significantly reduced with CSWT (WMD -1.81, 95% CI -3.23 to -0.39).
- Summed stress score favored CSWT (WMD -3.76, 95% CI -6.15 to -1.37), indicating improved myocardial perfusion.
Conclusions:
- CSWT demonstrates moderate efficacy in improving myocardial perfusion and cardiac function in patients with CAD.
- This therapy offers a valuable and meaningful treatment option for clinicians managing CAD.
- The findings are based on studies with a low risk of bias, suggesting reliable results.
Objective:
Coronary artery disease (CAD) has been one of the leading causes of morbidity and mortality worldwide. Cardiac shock wave therapy (CSWT) is a novel and non-invasive therapy for CAD. Therefore, we conducted a systematic review and meta-analysis to evaluate the efficacy of CSWT on CAD.
Methods And Results:
We performed a comprehensive search of electronic databases such as PubMed, Embase, the Cochrane Library, and Wanfang Data in October 2021. The results were reported as weighted mean difference (WMD) with a 95% confidence interval (CI). Statistical heterogeneity scores were assessed with the standard Cochran's Q test and the I 2 statistic. A total of 8 randomized trials and 2 prospective cohort studies, together involving 643 patients (n = 336 CSWT and n = 307 control), were included in our study. Eight studies with 371 patients showed significantly improved rest left ventricular ejection fraction (LVEF) with CSWT as compared to that of the control group (WMD 3.88, 95% CI 1.53-6.23, p = 0.001, I 2 = 51.2%). Seven studies with 312 patients reported left ventricular internal diameter in diastole (LVIDd) were markedly decreased in the CSWT group compared to the control group (WMD -1.81, 95% CI -3.23 to -0.39, p = 0.012, I 2 = 20.3%). The summed stress score significantly favored the CSWT group (WMD -3.76, 95% CI -6.15 to -1.37, p = 0.002, I 2 = 56.8%), but there was no significant difference for the summed rest score. Our data were acquired from studies without a perceived high risk of bias, so plausible bias is unlikely to seriously affect the main findings of the current study.
Conclusion:
Based on data from our present meta-analysis, CSWT was shown to moderately improve myocardial perfusion and cardiac function among patients with CAD, which would provide the clinicians with a meaningful and valuable option.
Systematic Review Registration:
The meta-analysis was registered on the Open Science Framework (OSF) (https://osf.io/r2xf9).
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