Acupuncture Continuing Education

Acupuncture Heart Disease Blood And Oxygen Benefit

BL15 Xinshu

Researchers find acupuncture effective for the treatment of coronary heart disease (CHD). Using Single Photon Emission Computed Tomography (SPECT) scans, researchers from the Department of Nuclear Medicine at Peking University Shenzhen Hospital document that acupuncture produces a 70.1% blood perfusion improvement in ischemic myocardium CHD patients, while sublingual administration of nitroglycerine produces a 77.4% improvement. [1] The SPECT scans indicate that acupuncture produces clinically significant results. 

Single Photon Emission Computed Tomography (SPECT) is a nuclear imaging test used to diagnose coronary artery disease and other heart problems. [2] It uses venous injection of radioactive materials to produce images of the heart. On the images, the areas where the heart's blood circulation is healthy appear light. Areas with poor blood circulation are dark. The imaging results indicate that acupuncture benefits blood circulation to the heart.

CHD, also known as coronary artery disease, occurs when the coronary arteries are either damaged or diseased. CHD is typically due to plaque buildups within the coronary arteries and inflammation. This causes a lack of blood and oxygen supply to the myocardium (heart muscular tissue). Initially, the condition may be asymptomatic but angina, shortness of breath, or even a heart attack may ensue in later stages of the illness. It is imperative that the blood and oxygen supply is restored to the heart. Now, advanced imaging finds acupuncture a helpful tool in restoration of blood flow.

The researchers observe, “Many studies have proven that acupuncture is effective for the treatment of coronary heart disease (CHD) through increasing myocardial blood perfusion. However, the current studies are mainly based on clinical symptoms and laboratory tests. There is a lack of a direct, visible, and quantifiable method to measure acupuncture’s effectiveness for the treatment of CHD.” They add that “SPECT provides a new research method for the study of coronary heart disease. It is a non-invasive and effective tool for macroscopically observing blood perfusion and cell function in human organs.”

 

Group Selection Process
Inclusion criteria were as follows. All participants had a diagnosis of coronary heart disease, according to the Nomenclature and Criteria for Diagnosis of Ischemic Heart Disease established by the World Health Organization. In addition, all patients met the following inclusion criteria:

  • Positive myocardial SPECT perfusion imaging results
  • Between 36–68 years of age
  • Signed consent form

Exclusion criteria were applied to assure that patients did not experience interference from other conditions. Patients with the following conditions did not participate in the clinical trial:

  • Cardiac neurosis
  • Menopausal syndrome
  • Cervical spondylosis

 

Design
The research team (Gao et al.) used the following study design. A total of 59 patients were treated and evaluated. All patients admitted to the study were diagnosed with coronary heart disease (CHD). They were randomly divided into an acupuncture group (n=32) and a nitroglycerine group (n=27).

The acupuncture group was comprised of 25 males and 8 females. The average age in the acupuncture group was 50.0 (±7.1) years. The average course of disease in the acupuncture group was 14.6 (±3.1) months. The nitroglycerine group was comprised of 21 males and 6 females. The average age in the nitroglycerine group was 58.1 (±11.9) years. The average course of disease in the acupuncture group was 12.5 (±4.2) months. There were no significant statistical differences in gender, age, and course of disease relevant to patient outcome measures for the patients when admitted to the study. Careful attention to inclusion criteria and randomness assured the validity of the results.

 

Nitroglycerin and Acupuncture
For both groups, the myocardial perfusion imaging was performed 5 minutes after intravenous injection of 99mTc-methoxyisobutylisonitrile (99mTc-MIBI) during normal exercise (Bruce’s protocol) or drug (dipyridamole) load. After the myocardial perfusion imaging was completed, the nitroglycerine group patients received 1 mg of nitroglycerin sublingually. After 5 minutes, 99mTc-MIBI was intravenously injected. A second myocardial perfusion imaging scan was performed 5 minutes after injection.

After the myocardial perfusion imaging was completed, patients in the acupuncture group received electroacupuncture at bilateral Neiguan (PC6) and Xinshu (BL15) for 30 min, with the frequency alternating between 2 and 15 Hz. The current strength ranged from 9 to 18 mA. Next, 99mTc-MIBI was injected 15 minutes after needling. A second myocardial imaging scan was obtained 15 minutes after needling. Only experienced licensed acupuncturists were chosen to implement acupuncture treatment.

 

Evaluations
Patients were evaluated before and after the treatment course. The muscle and cavity of the left ventricle were divided into 9 segments for the regional analysis of myocardial perfusion. First, all patients underwent myocardial perfusion qualitative assessments, wherein the number of the heart’s light and dark areas were compared before and after acupuncture treatments.

Next, a quantitative comparison of myocardial perfusion imaging results before and after treatment were evaluated by measuring the radioactive uptake rate (RUR) increase of each myocardial segment. If RUR increased by more than 15% after treatment, myocardial perfusion improvement is labeled “obvious”; if less than 15%, the improvement is “not obvious”. Third, a quantitative comparison of RUR increased, specifically in ischemic myocardial segments in the two groups, was performed before and after treatment.

 

Results
From a total of 288 myocardial segments from the 32 acupuncture group patients, there were 127 dark segments before treatment. After acupuncture treatment, 89 of the dark segments became light, indicating an improvement (70.1%, 89/127) in myocardial segment perfusion. From a total of 243 myocardial segments in the 27 nitroglycerin group patients, there were 93 dark segments before treatment. After nitroglycerin administration, 72 of the dark segments became light, indicating an improvement (77.4%, 72/93) in myocardial segment perfusion. Comparing the results of the above two groups, acupuncture produced statistically significant clinical outcomes.

The RUR of the acupuncture group before treatment was 33.1% (±7.5). After acupuncture treatment, RUR was increased to 47.1% (±11.9), showing “obvious” myocardial perfusion improvement. The RUR of the nitroglycerin group before treatment was 30.8% (±7.6). After nitroglycerin administration, RUR was increased to 49.0% (±12.2), showing “obvious” myocardial perfusion improvement. There was no statistically significant difference between the two groups after treatment (P>0.05).

The RUR in the 89 ischemic myocardial segments of the acupuncture group was significantly increased by 17.6% (±7.8). The RUR in the 72 ischemic myocardial segments of the nitroglycerin group was significantly increased by 20.3%(±9.9). There was no statistically significant difference between the two groups (P>0.05).

 

Summary
The focus of this study was to scientifically verify acupuncture’s effectiveness for the treatment of CHD. SPECT imaging results indicate that acupuncture is effective for myocardial perfusion improvements in CHD patients. According to the research covered in this article, common protocols involve the application of acupoints Neiguan (PC6) and Xinshu (BL15). Patients interested in learning more about CHD treatment are recommended to contact local licensed acupuncturists.

 

References:
[1] Gao Z, Hu S, Wang ZJ, Chen Q, Jia SW. Treating Coronary Heart Disease by Acupuncture at Neiguan (PC6) and Xinshu (BL15): An Efficacy Assessment by SPECT [J] Chinese Journal of Integrated Traditional and Western Medicine, 2013, 33(9):1196-1198.
[2] heart.org/en/health-topics/heart-attack/diagnosing-a-heart-attack/single-photon-emission-computed-tomography-spect

 

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