***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: Background Cardiac shock wave therapy ( CSWT ) improves cardiac function in patients with severe coronary artery disease ( CAD ) . We aim ed to evaluate the clinical outcomes of a new CSWT treatment regimen . Methods The 55 patients with severe CAD were r and omly divided into 3 treatment groups . The control group ( n = 14 ) received only medical therapy . In group A ( n = 20 ) , CSWT was performed 3 times within 3 months . In group B ( n = 21 ) , patients underwent 3 CSWT sessions/week , and 9 treatment sessions were completed within 1 month . Primary outcome measurement was 6-minute walk test ( 6MWT ) . Other measurements were also evaluated . Results The 6MWT , CCS grading of angina , dosage of nitroglycerin , NYHA classification , and SAQ scores were improved in group A and B compared to control group . Conclusions A CSWT protocol with 1 month treatment duration showed similar therapeutic efficacy compared to a protocol of 3 months duration . Clinical trial registryWe have registered on Clinical Trials.gov , the protocol ID is CSWT IN CHINA OBJECTIVE The aim of this study was to evaluate the effect of cardiac shock wave therapy ( CSWT ) on microvolt T wave alternans ( MTWA ) in patients with coronary artery disease ( CAD ) . METHODS 87 patients with old myocardial infa rct ion ( OMI ) were enrolled in this study . Sixty-two patients were r and omized into the CSWT group , 32 patients into the regular treatment group ( Group A ) according to different shock wave procedure , and 30 into the exp and ing scope treatment group ( Group B ) , and 25 patients were r and omized into the control group ( Group C ) . But the shock wave ( SW ) energy was only applied to the patients in the CSWT group and not to the patients in the control group . Three months was a treatment course , thus patients received a total of 9 CSWT treatment sessions . RESULTS Technetium-99 m sestamibi myocardial perfusion , fluorine-18 fluorodeoxyglucose myocardial metabolism single-photon emission computed tomography ( SPECT ) were performed to identify segments of myocardial ischemia , myocardial viability , and microvolt T wave alternans ( MTWA ) before and after CSWT . After CSWT , the rehospitalization rates of CSWT group were lower than control group ( P<0.05 ) . The myocardial ischemic segments , metabolism abnormal segments , total radioactive score of perfusion imaging and metabolism imaging , MTWA , and MTWA/HR in CSWT group were reduced significantly ( P<0.05 ) . And the heart rate of maximum MTWA , exercise time were increased significantly ( P<0.05 ) . All of the parameters in the control group did not change significantly even worsen after the treatment ( P>0.05 ) . CONCLUSIONS CSWT can reduce the MTWA value , improve the heart chronotropic function and increase the threshold of frequency which causes MTWA Background Ultrasound guided cardiac shock wave therapy ( CSWT ) is a noninvasive therapeutic option in the treatment of chronic-refractory angina . Clinical trials have shown that CSWT reduces angina symptoms , improves regional systolic function , LV ejection fraction , myocardial perfusion and quality of life parameters . Absolute measurements of myocardial perfusion before and after CSWT have not been performed so far . Methods and results We studied a total of 21 CCS III patients with history of CAD and multiple interventions who suffered from disabling angina despite individually optimized medical therapy . An N-13 NH3 PET perfusion scan under adenosine was performed before and after CSWT treatment . CSWT was well tolerated in all patients . Absolute perfusion under adenosine of the global left-ventricular myocardium did not change under therapy or minimal coronary resistance . The treated segments , however , showed in terms of both perfusion and resistance a mild but significant improvement , by 11 and 15 % , respectively , whereas no change could be observed in the remote segments . Considering a threshold of increased perfusion of 5 % , 10 ( 77 % ) out of 13 patients with a better target perfusion improved in their CCS class , whereas 3 ( 43 % ) out of 7 patients without improved target perfusion improved in their CCS class too . ConclusionS t and ard CSWT has the potential to improve myocardial perfusion of the therapy zone and clinical CAD symptomatology without affecting global myocardial perfusion . As a noninvasive and well tolerated therapeutic option , these data suggest the use of CSWT in patients with end-stage CAD Our aim was to evaluate the safety and effectiveness of extracorporeal cardiac shock wave therapy ( CSWT ) for the patients with coronary heart disease ( CHD ) using a r and omized , double-blind , controlled clinical trial design . Twenty-five patients with CHD were enrolled in this study . Fourteen of the patients were r and omized into the CSWT group and 11 into the control group . We applied the CSWT procedure to each patient by using nine shock treatments during 3 months , but the shock wave ( SW ) energy was only applied to the patients in the CSWT group and not to the patients in the control group . Technetium-99 m sestamibi myocardial perfusion , fluorine-18 fluorodeoxyglucose myocardial metabolism single-photon emission computed tomography ( SPECT ) , and two-dimensional echocardiography were performed to identify segments of myocardial ischemia , myocardial viability , and ejection fraction before and after CSWT . We also followed the patients to evaluate adverse effects . After CSWT , the New York Heart Association class , the Canadian Cardiovascular Society angina scale , nitroglycerin dosage , myocardial perfusion and myocardial metabolic imaging scores of dual-isotope SPECT in the CSWT group were reduced significantly ( P = 0.019 , 0.027 , 0.039 , 0.000 , 0.001 , respectively ) , and the Seattle Angina Question naire scale , 6-min walking test , and left ventricular ejection fraction were increased significantly ( P = 0.021 , 0.024 , 0.016 , respectively ) compared with those before the SW treatment . All of the parameters in the control group did not change significantly after the treatment ( all P > 0.05 ) . No serious adverse effects of CSWT were observed . Cardiac shock wave therapy is a safe and effective treatment for CHD patients Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more AIMS An increasing number of patients with severe coronary artery disease ( CAD ) are not c and i date s for traditional revascularization and experience angina in spite of excellent medical therapy . Despite limited data regarding the natural history and predictors of adverse outcome , these patients have been considered at high risk for early mortality . METHODS AND RESULTS The OPtions In Myocardial Ischemic Syndrome Therapy ( OPTIMIST ) program at the Minneapolis Heart Institute offers traditional and investigational therapies for patients with refractory angina . A prospect i ve clinical data base includes detailed baseline and yearly follow-up information . Death status and cause were determined using the Social Security Death Index , clinical data , and death certificates . Time to death was analysed using survival analysis methods . For 1200 patients , the mean age was 63.5 years ( 77.5 % male ) with 72.4 % having prior coronary artery bypass grafting , 74.4 % prior percutaneous coronary intervention , 72.6 % prior myocardial infa rct ion , 78.3 % 3-vessel CAD , 23.0 % moderate-to-severe left-ventricular ( LV ) dysfunction , and 32.6 % congestive heart failure ( CHF ) . Overall , 241 patients died  ( 20.1 % : 71.8 % cardiovascular ) during a median follow-up 5.1 years ( range 0 - 16 , 14.7 % over 9 ) . By Kaplan-Meier analysis , mortality was 3.9 % ( 95 % CI 2.8 - 5.0 ) at 1 year and 28.4 % ( 95 % CI 24.9 - 32.0 ) at 9 years . Multivariate predictors of all-cause mortality were baseline age , diabetes , angina class , chronic kidney disease , LV dysfunction , and CHF . CONCLUSION Long-term mortality in patients with refractory angina is lower than previously reported . Therapeutic options for this distinct and growing group of patients should focus on angina relief and improved quality of life Background Cardiac shockwave therapy ( CSWT ) might improve symptoms and decrease ischaemia burden by stimulating collateral growth in chronic ischaemic myocardium . This prospect i ve study was performed to evaluate the feasibility and safety of CSWT . Methods We included 33 patients ( mean age 70 ± 7 years , mean left ventricular ejection fraction 55 ± 12 % ) with end-stage coronary artery disease , chronic angina pectoris and reversible ischaemia on myocardial scintigraphy . CSWT was applied to the ischaemic zones ( 3–7 spots/session , 100 impulses/spot , 0.09 mJ/mm2 ) in an echocardiography-guided and ECG-triggered fashion . The protocol included a total of 9 treatment sessions ( 3 treatment sessions within 1 week at baseline , and after 1 and 2 months ) . Clinical assessment was performed using exercise testing , angina score ( CCS class ) , nitrate use , myocardial scintigraphy , and cardiac magnetic resonance ( CMR ) 1 and 4 months after the last treatment session . Results One and 4 months after  CSWT , sublingual nitrate use decreased from 10/week to 2/week ( p < 0.01 ) and the angina symptoms diminished from CCS class III to CCS class II ( p < 0.01 ) . This clinical improvement was accompanied by an improved myocardial uptake on stress myocardial scintigraphy ( 54.2 ± 7.7 % to 56.4 ± 9.4 % , p = 0.016 ) and by increased exercise tolerance at 4-month follow-up ( from 7.4 ± 2.8 to 8.8 ± 3.6 min p = 0.015 ) . No clinical ly relevant side effects were observed . Conclusion CSWT  improved symptoms and reduced ischaemia burden in patients with end-stage coronary artery disease without relevant side effects . The study provides a solid basis for a r and omised multicentre trial to establish CSWT as a new treatment option in end-stage coronary artery disease Objectives The usefulness and safety of percutaneous myocardial laser therapy in selected patients have been identified in previous 1-year r and omized trial reports , including that from a double-blind , sham-controlled trial we independently conducted . We aim ed to determine whether the 1-year effects are maintained through a long-term , longitudinal follow-up . Methods Patients ( n=77 ) with chronic , stable , medically refractory angina ( class III or IV ) not amenable to conventional revascularization and with evidence of reversible ischemia , ejection fraction ≥25 % , and myocardial wall thickness ≥8 mm were treated with percutaneous myocardial laser . After the 1-year follow-up and disclosure of all r and omized assignments as prespecified in the respective study protocol , patients were followed up longitudinally for a mean of 3 years for angina class , left ventricular ejection fraction , medication usage , and adverse events . Results No procedural mortality , myocardial infa rct ion , or cerebral embolism occurred . Pericardiocentesis was required in two patients ( 2.6 % ) . Cardiac event-free survival was 88 % at 1 year and 66 % at late follow-up . Mean Canadian Cardiovascular Society angina class was significantly improved from baseline ( 3.2±0.4 ) at 1 year ( 2.2±1.1 , P<0.001 ) and at a mean of 3 years ( 1.9±1.2 , P<0.001 ) . Nitrate usage was significantly reduced at late follow-up ; however , ejection fraction did not change over time . In a multivariate analysis , angina improvement at 1 year was found to be a significant independent predictor of both survival and angina improvement at late follow-up . Conclusion We conclude that percutaneous myocardial laser therapy in selected patients with severe , medically refractory angina not treatable with conventional revascularization induces significant and sustained symptomatic benefit Objectives . To investigate the effectiveness of extracorporeal shock wave therapy ( ESWT ) for symptoms alleviation in chronic pelvic pain syndrome ( CPPS ) . Material s and Methods . 40 patients with CPPS were r and omly allocated into either the treatment or sham group . In the first group , patients were treated by ESWT once a week for 4 weeks by a defined protocol . In the sham group , the same protocol was applied but with the probe being turned off . The follow-up assessment s were done at 1 , 2 , 3 , and 12 weeks by Visual Analogue Scale ( VAS ) for pain and NIH-developed Chronic Prostatitis Symptom Index ( NIH-CPSI ) . Results . Pain domain scores at follow-up points in both treatment and sham groups were reduced , more so in the treatment group , which were significant at weeks 2 , 3 , and 12 . Urinary scores became significantly different at weeks 3 and 12 . Also , quality of life ( QOL ) and total NIH-CPSI scores at all four 
    Output:
    
All selected studies demonstrated significant improvement in subjective measures of angina symptoms and /or quality of life , in the majority of studies left ventricular function and myocardial perfusion improved .
Conclusions Systematic review of CSWT studies in stable coronary artery disease ( CAD ) demonstrated consistent improvement of clinical variables .
Meta- analysis showed a moderate improvement of exercise capacity .
Overall , CSWT is a promising non-invasive option for patients with end-stage CAD , but evidence is limited to small sample single-center studies .