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 randomized clinical trial involving 259 patients with coronary heart disease, cardiac shock wave therapy (CSWT) showed a significant improvement in the Gensini score, left ventricular ejection fraction, and relevant laboratory parameters after 12 months compared to drug therapy alone. The combination of CSWT and EECP achieved the strongest effects in terms of coronary stenosis, heart function, and reduction of cardiovascular events. The therapy proved to be safe and well tolerated.
Link: https://www.sciencedirect.com/science/article/pii/S2772487526000048
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.
A recent review study shows that shockwave–based therapies, particularly extracorporeal cardiac shockwave therapy (CSWT), are increasingly being viewed as an innovative adjunct in the treatment of cardiovascular diseases. Positive effects on blood flow and symptoms were observed, particularly in cases of chronic angina pectoris. Overall, these procedures are considered promising and safe.
This study shows that cardiac shock wave therapy (CSWT) specifically activates repair processes in heart tissue by converting fibroblasts into angiogenic cells. Activation of the TLR3 receptor triggers genetic programs that improve blood flow and reduce scar tissue. At the same time, an improvement in heart function was demonstrated. The results provide important evidence that CSWT can trigger regenerative processes directly in the heart muscle.
A randomized controlled trial investigated the combination of cardiac shock wave therapy (CSWT) and exercise training in patients following stent implantation (PCI). The results show significant improvements in physical capacity (including VO₂max) and cardiac function, as well as beneficial effects on inflammatory and vascular parameters. Additionally, myocardial ischemia was reduced. The study underscores that CSWT can be a promising component of modern cardiac rehabilitation.
A recent experimental study shows that cardiac shock wave therapy (CSWT) specifically activates so-called exosomes—tiny messenger molecules that travel between cells. Among other things, these exosomes transport the microRNA miR-98-5p, which has been shown to promote the formation of new blood vessels (angiogenesis). At the same time, cellular damage was reduced and cell viability was improved. The results provide an important mechanistic explanation for how CSWT can support the regeneration of damaged heart tissue.
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
Overview: Mechanotransduction as a central principle of action – shock waves stimulate healing, angiogenesis, and pain relief processes.
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
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
Human study with angina pectoris patients: CSWT improved angina symptoms (CCS class) and showed a tendency towards better myocardial perfusion in scintigraphy.
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.
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
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.
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: https://journals.sagepub.com/doi/10.1177/1074248415616189
Low-energy shock waves reduced inflammation and fibrosis and promoted capillary formation in rats after myocardial infarction.
Animal experiment: CSWT reduced fibrosis and the number of circulating fibrocytes after AMI; functional cardiac parameters improved accordingly.
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.
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.
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
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.
Animal study: Shock waves activate VEGF-C and bFGF, promote lymphangiogenesis – evidence for tissue-wide regeneration 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.
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.
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 the animal model, CSWT promoted angiogenesis and blood flow in critical limb ischemia – evidence for the principle of mechanotransduced angiogenesis.
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.
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
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.
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
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
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.
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.
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
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.