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Multimodality imaging of myocardial revascularization using cardiac shock wave therapy

      Ischemic heart disease remains a leading cause of morbidity and mortality worldwide. Despite modern therapies, many patients still suffer from refractory angina pectoris (RAP) therefore, alternative non-invasive revascularization methods are under development. One of the methods stimulating angiogenesis is cardiac shock wave therapy (CSWT), a new treatment method offering an alternative to revascularization. Recent studies have demonstrated that the extracorporeal application of low-intensity shockwaves to the myocardium may induce the release of angiogenesis-mediating growth factors such as endothelial nitric oxide synthase (eNOS) and vascular endothelial growth factor (VEGF), as well as induce the recruitment of endothelial progenitor cells [
      • Gotte G.
      • Amelio E.
      • Russo S.
      • Marlinghaus E.
      • Musci G.
      • Suzuki H.
      Short-time non-enzymatic nitric oxide synthesis from l-arginine and hydrogen peroxide induced by shock waves treatment.
      ,
      • Mariotto S.
      • Cavalieri E.
      • Amelio E.
      • Ciampa A.R.
      • de Prati A.C.
      • Marlinghaus E.
      • et al.
      Extracorporeal shock waves: from lithotripsy to anti-inflammatory action by NO production.
      ,
      • Ciampa A.R.
      • de Prati A.C.
      • Amelio E.
      • Cavalieri E.
      • Persichini T.
      • Colasanti M.
      • et al.
      Nitric oxide mediates anti-inflammatory action of extracorporeal shock waves.
      ,
      • Aicher A.
      • Heeschen C.
      • Sasaki K.
      • Urbich C.
      • Zeiher A.H.
      • Dimmeler S.
      Low-energy shock wave for enhancing recruitment of endothelial progenitor cells.
      ]. This non-invasive treatment method has been used clinically and been shown to improve symptoms and improve perfusion, however, limited data are available on the use of multimodality imaging in patients undergoing this therapy [
      • Leibowitz D.
      • Weiss A.T.
      • Rott D.
      • Durst R.
      • Lotan C.
      The efficacy of cardiac shock wave therapy in the treatment of refractory angina: a pilot prospective, randomized, double-blind trial.
      ,
      • Ito K.
      • Fukumoto Y.
      • Shimokawa H.
      Extracorporeal shock wave therapy as a new and non-invasive angiogenic therapy.
      ,
      • Zuozienė G.
      • Laucevičius A.
      • Leibowitz D.
      Extracorporeal shockwave myocardial revascularization improves clinical symptoms and left ventricular function in patients with refractory angina.
      ]. The objective of the current study was to utilize multimodality imaging including cardiac MRI for the selection of patients and evaluation of dynamic changes of LV function during CSWT therapy.

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