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Shock wave therapy of ischemic heart disease in the light of general pathology

2009; Elsevier BV; Volume: 144; Issue: 1 Linguagem: Inglês

10.1016/j.ijcard.2008.12.198

1874-1754

Sergei V. Jargin,

Elasticity and Material Modeling

A device on the basis of a modified lithotripter is currently applied in Russia for the treatment of coronary heart disease. Long-term benefit from shock wave therapy (SWT) is discussed in this letter to the Editor from the viewpoint of general pathology. The shock wave is an unselective damaging factor, it can injure cell membranes, cytoskeleton and small vessels. Cardiac muscle cells are incapable of mitosis; their vulnerability under ischemic conditions is enhanced. Additional damage by SWT can cause irreversible loss of muscle cells. Benefit from SWT is attributed to improvement of myocardial blood flow and enhanced angiogenesis. Mechanism of hyperemia after SWT is explained by release of nitric oxide, a vasodilator with a short duration effect. Angiogenesis is attributed to upregulation of VEGF growth factors. The role of VEGF in atherosclerosis is controversial: it can induce proliferation of mesenchymal cells and accelerate atherogenesis. VEGFR-1 receptors are present on the macrophages, and their participation in atherogenesis cannot be excluded. VEGF can promote vascularization of atherosclerotic plaques contributing to their instability. Benefit from angiogenesis is questionable because coronary arteries, whose compromise gives rise to ischemia, are located proximally in the epicardium. SWT induces in the myocardium an injury-and-repair process, which can be expected to end up with some fibrosis and function loss. Therefore, animal experiments with follow-up for late complications should be performed before broad introduction of the method into clinical practice.