体外冲击波治疗缺血性心肌病心力衰竭的初步疗效

Extracorporeal cardiac shock wave therapy ameliorates ischemia-induced heart failure

目的评估体外心脏冲击波治疗(ESWT)在缺血性心肌病心力衰竭治疗中的初步疗效。方法 8例因缺血性心肌病导致的心力衰竭患者接受ESWT,指定治疗仪(100击/点,能量为0.09 mJ/mm^2,每次3～6点,3次/周),3次治疗为1组,间隔3周进行1组治疗,共治疗9周。观察治疗前及治疗后6个月纽约心脏学会(NYHA)心功能水平、6 min步行距离、血氨基末端脑钠肽前体(NT-proBNP)水平,采用^(99m)锝-甲氧异腈(^(99m)Tc-MIBI)静息/负荷单光子发射计算机断层成像术(SPECT)评价左心室射血分数(LVEF)及节段性心肌灌注和室壁运动。结果经ESWT治疗后,NYHA心功能分级为(2.1±0.3)级,显著低于治疗前的(2.5±0.5)级(P<0.05);LVEF为0.285±0.046,显著高于治疗前的0.238±0.054(P<0.05);治疗节段的舒张末期心肌灌注、收缩末期心肌灌注分别为(49.0±6.3)%、(59.6±8.6)%,均显著高于治疗前的(46.3±7.7)%、(55.4±9.1)%(P值均<0.05);治疗节段的室壁运动为(3.11±0.96) mm,显著高于治疗前的(2.75±1.03)mm(P<0.05)。结论 ESWT在改善缺血性心肌病心力衰竭患者的心功能方面具有潜在应用价值。

Objective To evaluate the effect of extracorporeal shock wave therapy（ESWT） in treatment of patients with ischemia-induced heart failure.Methods ESWT was applied for the reversible ischemic regions in eight patients with ischemia-induced heart failure.Patients were treated at 3-6 cardiac spots,100 shots/spot, at the intensity of 0.09 mJ/mm^2,3 times a week for 3 weeks（week 1,week 5,and week 9）.The cardiac function（NYHA class）,6-minute walking distance,and serum NT-proBNP level were observed before and 6 months after treatment.The LVEF and segmental myocardial perfusion were evaluated by stress ^（99m）Tc sestamibi single-photon emission computed tomography（SPECT）.Results The cardiac function was significantly improved after ESWT（NYHA class from 2.5±0.5 to 2.1±0.3,P0.05,LVEF from 0.238±0.054 to 0.285±0.046, P0.05）.During the treatment period,myocardial perfusion and wall motion were also significantly improved than that before treatment（end-diastolic myocardial perfusion from[46.3±7.7]%to[49.0±6.3]%,end-systolic myocardial perfusion from[55.4±9.1]%to[59.6±8.6]%,and wall motion from[2.75±1.03]mm to[3.11±0.96]mm,all P0.05）.Conclusion ESWT has a potential in improving the heart function of patients with ischemia-induced heart failure.