Scientific studies on
Cardiac Shock Wave Therapy (CSWT)
Clinical research
on the efficacy and safety of CSWT
Cardiac shock wave therapy (CSWT) has been extensively researched in recent years and tested in numerous clinical studies with heart patients, including with regard to its safety. Clinical research consistently shows positive effects on blood circulation, vascular regeneration, and heart function.
Below you will find a selection of important studies, investigations, and meta-analyses on cardiac shock wave therapy (CSWT), each with a brief summary and a direct link to the corresponding work.
Overview of studies
In this prospective clinical study, patients with refractory angina pectoris showed a significant reduction in angina symptoms and nitrate requirements after CSWT, as well as a significant improvement in exercise capacity, myocardial perfusion, and cardiac function. The treatment was well tolerated, with no relevant side effects.
In this placebo-controlled study, patients with severe angina pectoris showed a significant improvement in chest pain and cardiac function after CSWT – without side effects.
In an animal model, CSWT was able to significantly improve left ventricular function after myocardial infarction. The treated animals showed a higher ejection fraction and increased capillary density.
Randomized study of 32 patients with ischemic heart failure: After 3 months, CSWT showed significant improvements in cardiac output (LVEF ↑) and quality of life – without relevant side effects.
In this clinical study with 26 patients, CSWT led to a significant increase in endothelial progenitor cells as well as the growth factors VEGF and IL-8 – an indication of increased angiogenesis.
Link: https://www.spandidos-publications.com/10.3892/etm.2015.2820
23 patients with ischemic heart failure received 3 weeks of CSWT. The therapy significantly improved blood flow, quality of life, and NYHA classification and activated genes involved in angiogenesis.
An early animal experimental study that demonstrated the angiogenesis and regeneration effects of shock waves on the heart muscle. This study laid the foundation for later clinical research.
In the animal model, CSWT promoted angiogenesis and blood flow in critical limb ischemia – evidence for the principle of mechanotransduced angiogenesis.
Also an early clinical study showing that shock waves improved microcirculation and pain in patients with circulatory disorders of the legs. This study is also a basis for later cardiac applications.
Low-energy shock waves reduced inflammation and fibrosis and promoted capillary formation in rats after myocardial infarction.
The review shows: Shock waves activate VEGF (vascular endothelial growth factors), promote angiogenesis, and improve myocardial perfusion. This work is the basis of many clinical applications in cardiology.
Human study with angina pectoris patients: CSWT improved angina symptoms (CCS class) and showed a tendency towards better myocardial perfusion in scintigraphy.
Meta-analysis (10 studies, 643 patients): CSWT significantly improved ejection fraction, LV diameter, and perfusion; no serious side effects.
Link: https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.932193/full
Animal experiment: CSWT reduced fibrosis and the number of circulating fibrocytes after AMI; functional cardiac parameters improved accordingly.
Animal study: Shock waves activate VEGF-C and bFGF, promote lymphangiogenesis – evidence for tissue-wide regeneration effects.
Basic research: Shock waves generate NO non-enzymatically – this is a key mechanism for vasodilatory and regenerative effects.
Link: https://febs.onlinelibrary.wiley.com/doi/10.1016/S0014-5793%2802%2902807-7
Overview: Mechanotransduction as a central principle of action – shock waves stimulate healing, angiogenesis, and pain relief processes.
Prospective randomized double-blind study: Patients with CHD showed significant improvements in angina symptoms, quality of life, resilience, and ejection fraction after 9 CSWT sessions – with excellent tolerability.
Randomized study (87 patients): CSWT reduced pathological T-wave alternans, improved heart rate variability and resilience – a clear indication of stabilizing effects on electrical heart function.
Meta-analysis (26 studies, 855 patients): CSWT significantly improved 6-minute walk distance, NYHA class, angina symptoms, LVEF, and quality of life. No relevant side effects.
Link: https://cdn.publisher.gn1.link/bjcvs.org/pdf/v35n5a21.pdf
Most publicly known clinical study of the University of Innsbruck (European Heart Journal 2024): 63 patients, randomized, sham-controlled. CSWT in addition to bypass surgery significantly increased LVEF (+11.3% vs. +6.3%) and walking distance – without complications.
Link: https://academic.oup.com/eurheartj/article/45/29/2634/7695522
Pioneering basic research: Shock waves activate NO- and NF-κB-dependent signaling pathways and reduce inflammatory cytokines – a key mechanism for cardiac regeneration as well.
In vitro study (University of Verona): Shock waves lead to the release of nitric oxide (NO) – this is crucial for vasodilation and anti-inflammation.
Link: https://febs.onlinelibrary.wiley.com/doi/10.1016/j.febslet.2005.11.023
Another key study (Circulation 2004): This work provided the first evidence of angiogenesis in the heart muscle through CSWT – achieving complete functional recovery in the animal model after chronic ischemia with the shock waves.
Link: https://www.ahajournals.org/doi/10.1161/01.CIR.0000148849.51177.97
This experimental study shows that shock waves accelerate the regeneration of nerve fibers and muscle function – a clear indication of systemic regeneration beyond the heart muscle.
In vitro study on human heart tissue: Shock waves stimulated cardiac progenitor cells to proliferate and differentiate – this is an important evidence for regenerative processes in the heart muscle.
This is a very early vascular study on the human aorta: Shock waves did not lead to any structural or histological damage even at high energy densities – thus providing the first evidence of tissue safety.
Link: https://journals.sagepub.com/doi/10.1177/000331979804900901
Clinical study in PAD: CSWT improved walking distance, helped to reduce pain and improve oxygen supply to the muscles in PAD patients – and this without any side effects.
Link: https://www.jstage.jst.go.jp/article/circj/76/6/76_CJ-11-1216/_article
An early review article on the therapeutic use of ultrasound in cardiology – this work describes the basics of mechanical effects (mechanotransduction), including shear forces and microcirculation improvement, as they were and are later used in CSWT.
Clinical study (23 patients, Shanghai): CSWT significantly improved angina symptoms, NYHA class, and quality of life. Gene expression analyses showed activation of angiogenic and anti-inflammatory signaling pathways (VEGF, CXCL).
Link:
Note: This list of studies on CSWT does not claim to be exhaustive. Further studies and scientific papers will be added to this section on an ongoing basis.