体外心脏震波治疗缺血性心力衰竭的初步观察

Effects of extracorporeal cardiac shock wave therapy in patients with ischemic heart failure

目的 探讨体外心脏震波（CSWT）治疗缺血性心力衰竭（心衰）的可行性、安全性及疗效.方法 选取2009年8月至2011年8月诊断为冠心病缺血性心衰、左室射血分数＜50％的患者50例.随机将患者分人：试验组,予震波能量（0.09 mJ/mm2）治疗；对照组,相同程序不予震波能量治疗；各25例.治疗程序为：3个月一疗程,共9次震波治疗.治疗前后行99锝m-甲氧基异丁基异腈（99Tcm-MIBI）/18氟-脱氧葡萄糖（18 F-FDG）双核素单光子发射型计算机心肌断层显像或者99Tcm-MIBI-单核素单光子发射型计算机心肌断层显像定位并评价存活/缺血心肌,同时行彩色心脏超声、肌钙蛋白Ⅰ、6 min步行距离等检查,治疗前后评价西雅图心绞痛量表、加拿大心绞痛分级、纽约心脏功能分级,临床随访不少于4个月.结果 所有患者均依方案完成研究.两组患者均无心绞痛加剧、无心肌损伤、出血、栓塞、无恶性心律失常等并发症.试验组震波治疗后的纽约心脏功能分级、加拿大心绞痛分级、硝酸甘油用量、左室舒张末期内径、左室灌注总分和左室代谢总分较治疗前减低（均为P＜0.05）,西雅图心绞痛量表评分、左室射血分数以及6 min步行距离较治疗前增高（均为P＜0.05）；对照组上述指标差异均改变不明显（均为P ＞0.05）.多重线性回归分析显示,CSWT是以上各临床指标、超声指标、左室灌注指标改变的影响因素（均为P ＜0.05）.结论 CSWT治疗是对冠心病缺血性心衰的一项无创、安全、有效的新疗法,可缓解患者心绞痛、改善心功能,提高生活质量及运动耐量.

Objective To evaluate the feasibility,safety and efficiency of extracorporeal cardiac shock wave therapy （CSWT）in patients with ischemic heart failure.Methods Fifty patients with ischemic heart failure and left ventricular ejection fraction （LVEF） 〈 50% were randomized to CSWT （shots/spot at 0.09 mJ/mm2 for 9 spots,9 times within 3 month） or control group.Dual isotope simultaneous acquisition single-photon emission computed tomography with 99 18Tcm -sestamibi/ F-fluorodeoxyglucose （99 Tcm-MIBI/18F-FDG） was performed before randomization and at 1 month after CSWT/control to locate and evaluate viable myocardium region.Canadian cardiovascular society （CCS） class sores,NYHA,Seattle Angina Questionnaire（ SAQ）,6-min walk test（6 MWT）,left ventricular ejection fraction （LVEF）,left ventricular end-diastolic dimension （LVEDD）and the dosage of nitroglycerin use were compared between two groups at each time point.Results All patients completed the study protocol without procedural complications.At 1 month,patients in CSWT group experienced improvement in NYHA （P 〈 0.01 ）,CCS（P 〈 0.01 ）,SAQ （P =0.021 ）,6 MWT（ P =0.012） and dosage of nitroglycerin use（P 〈 0.01 ） compared to baseline.LVEF [45.0（39.0,48.0） vs.47.0（42.0,50.0） P=0.001],LVEDD[58.0（56.0,59.0） vs.56.0（55.0,58.0） P=0.002],summed perfused score[23.0（20.5,24.5） vs.20.0（18.0,22.0） P〈0.01] and metabolic score[25.0（23.0,26.0） vs.24.0（21.5,25.0） P =0.028] were also improved in CSWT group.All these parameters remained unchanged in control group between baseline and at 1 month. CSWT was independent factor for improved cardiac function,quality of life and echocardiography parameters after adjusting for known factors which might affect outcome.Conclusion CSWT could improve symptom,cardiac function,quality of life and exercise tolerance in patients with ischemic heart failure,CSWT might serve as a new,non-invasive,safe and efficient therapy for these patients.