Cardiac Shockwave Therapy: Commentary

Jargin SV

Published on: 2025-12-24

Abstract

The evidence supporting efficacy of cardiac shockwave therapy (CST) comes mostly from small, observational studies. Clinical benefits from CST are attributed to enhanced myocardial perfusion and angiogenesis explained among others by the up-regulation of vascular endothelial growth factors of the VEGF family. The role of VEGF in coronary artery disease and atherosclerosis is ambiguous; details are discussed here. A shockwave induces tissue cavitation leading to shear stress on cell membranes. The vulnerability of cardiomy ischemia is increased. Additional impact might contribute to the cell loss. Reported effects of CST may transient and reactive. Clinical improvements in humans are caused, at least in part, by the placebo effect. Placebo treatments are beneficial for some patients; however, placebo by definition must be harmless. Animal experiments with a longer follow-up are needed. However, some potential late consequences e.g. angiogenesis within plaques and their instability are hardly reproducible in experiments. The most reliable way to evaluate the net harm or benefit could be lifelong animal experiments with comparisons of average life duration between test and control groups.