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Abstract: Purpose: We evaluated whether right ventricular (RV) diastolic dysfunction assessed by pulsed tissue Doppler imaging (TDI) predicts cardiac events in patients with chronic pulmonary thromboembolism (CPTE). Materials and methods: In 63 consecutive patients with CPTE, early diastolic myocardial velocity (Ea) at the tricuspid annulus by TDI and early diastolic tricuspid inflow (E) by conventional pulsed Doppler were obtained, and E/Ea was calculated as an indicator of RV diastolic dysfunction. Brain natriuretic peptide (BNP) and other echo parameters were also obtained. A cardiac event (rehospitalization caused by congestive heart failure or cardiac death) was the study endpoint. Incidence of cardiac events was determined over a 374±451 day follow-up period. Results: In the follow-up period twelve patients had cardiac events. We divided patients into group A with cardiac events and group B without events. E/Ea was significantly increased in group A as compared with group B (8.3±4.1 vs. 5.7±2.6, p <0.01). BNP was higher in group A than group B (221±191 vs. 121±140 mg/dl, p <0.05), and in addition E/Ea was significantly positively correlated with BNP (r=0.48, p <0.001). A logistic regression model for predicting cardiac events was constructed and E/Ea was associated with an increased incidence of cardiac events (relative risk=1.33, 95% CI 1.00–1.75). Conclusion: Elevated values of E/Ea obtained by TDI may predict cardiac events in patients with CPTE. BNP may also be a significant predictor. [Copyright &y& Elsevier]

Abstract: Purpose: To assess the effects of the oral intake of flavonoid-rich dark chocolate on coronary circulation, we measured coronary flow velocity reserve (CFVR) by noninvasive transthoracic Doppler echocardiography (TTDE) in healthy adult subjects. Materials and methods: The study was a randomized, single-blind design conducted for 2 weeks in 39 healthy men (mean age 29.7±3.9 years, range 23–40 years). Subjects were randomly assigned a daily intake of either flavonoid-rich dark chocolate (Meiji Black Chocolate 45 g, Meiji Seika kaisya Ltd, including cacao polyphenol 550 mg/day, 200 kcal) or non-flavonoid white chocolate (Meiji White Chocolate 35 g, Meiji Seika kaisya Ltd, including cacao polyphenol 0 mg/day, 140 kcal) as a control. CFVR was recorded by TTDE, and assessed before and after 2 weeks of intake. At the same time, we also assessed serum asymmetric dimethylarginine, 8-isoprostanes, and malondialdehyde-modified low-density lipoprotein (MDA-LDL) as markers of oxidative stress. Results: Flavonoid-rich dark chocolate consumption significantly improved CFVR (3.38±0.49 before intake, 4.28±0.85 after intake; p <0.01), whereas non-flavonoid white chocolate consumption did not (3.28±0.49 before intake, 3.16±0.49 after intake; p =0.44). All predictor variables were used as dependent variables in a multiple regression model of the incremental change in CFVR after 2 weeks of chocolate intake. Intake of dark (but not white) chocolate, MDA-LDL, triglyceride (TG) and heart rate (HR) significantly influenced the change of CFVR after 2 weeks of intake (p <0.01) according to the multiple regression formula: Y =1.01X 1 −0.005X 2 −0.003X 3 −0.017X 4 (Y =change in CFVR after 2 weeks of chocolate intake, X 1 =intake of dark (but not white) chocolate, X 2 =MDA-LDL, X 3 =TG, X 4 =HR). Conclusion: Flavonoid-rich dark chocolate intake significantly improved coronary circulation in healthy adults, independent of changes in oxidative stress parameters, blood pressure and lipid profile, whereas non-flavonoid white chocolate had no such effects. [Copyright &y& Elsevier]

Abstract: Purpose: It has been reported that mental stress is an independent risk factor for cardiovascular events and impairs coronary circulation. Lavender aromatherapy, one of the most popular complementary treatments, is recognized as a beneficial mental relaxation therapy. However, no study has examined the effect of this therapy on coronary circulation. We aimed to assess the effect of lavender aromatherapy on coronary circulation by measuring coronary flow velocity reserve (CFVR) with noninvasive transthoracic Doppler echocardiography (TTDE). Material and methods: We enrolled 30 young healthy men (mean age 34±4.7 years, range 24–40 years). Coronary flow velocities in the left anterior descending coronary artery were recorded by TTDE at rest and during hyperemia induced with an intravenous infusion of adenosine triphosphate (ATP). CFVR was calculated as the ratio of hyperemic to basal mean diastolic flow velocity. CFVR was assessed at baseline and immediately after lavender aromatherapy (four drops of essential oil diluted with 20 ml of hot water and inhaled for 30 min). Simultaneously, serum cortisol was measured as a marker of stress hormones. To exclude the relaxation effects of rest, the same measurements were repeated in the same volunteers without aromatherapy as a control study. Results: CFVR measurements were obtained in all volunteers (100%). Blood pressure and heart rate responses to ATP infusion were not affected by lavender aromatherapy. Serum cortisol significantly decreased after lavender aromatherapy (8.4±3.6 to 6.3±3.3, p <0.05), but remained unchanged in controls (9.1±3.5 to 8.1±3.9, p =ns). In addition, CFVR significantly increased after lavender aromatherapy (3.8±0.87 to 4.7±0.90, p <0.001), but not in controls (3.9±0.8 to 3.9±0.8, p =ns). Conclusions: Lavender aromatherapy reduced serum cortisol and improved CFVR in healthy men. These findings suggest that lavender aromatherapy has relaxation effects and may have beneficial acute effects on coronary circulation. [Copyright &y& Elsevier]

Abstract: Purpose: Chronic pulmonary arterial thromboembolism (CPATE) often causes right ventricular (RV) pressure overload but the relationship between the degrees of CPATE and RV pressure overload is not clear. To quantify the degrees of CPATE and RV pressure overload, we performed multislice computed tomography (CT) and Tissue Doppler Imaging (TDI) and compared the two modalities. Materials and methods: Sixteen consecutive subjects (4 men, 12 women; age 27–72 with proven CPATE underwent CT. The right vascular obstruction index (VOI), the left VOI, and the total VOI (TVOI) were determined using the scoring system of Qanadli. The early systolic myocardial velocity (Sw) and diastole myocardial velocity (Ew) at the tricuspid annulus and the early diastolic tricuspid inflow (E) were obtained by TDI in the apical four chamber view; RV systolic pressure (RVSP) was estimated by pressure gradient of tricuspid valve regurgitation. E/Ew was calculated as the parameter of RV diastolic function. Results: The right VOI was 23±10%, the left VOI was 18±10%, and TVOI was 41±14%. The means with ranges of Sw, Ew, E/Ew, RVSP, and brain natriuretic peptide (BNP) were 10.7 (range 7.7–14.6) cm/s, 7.7 (range 4.2–10.6) cm/s, 5.0 (range 2.2–8.1), 55 (range 26–90) mm Hg, and 50.3 (range 12.2–165) pg/ml, respectively. The correlation coefficients between Sw, Ew, E/Ew, RVSP, and BNP and either larger of right or left side (LVOI) and TVOI were 0.041, −0.163 (Sw vs. LVOI, TVOI), −0.153, −0.232 (Ew vs. LVOI, TVOI), 0.145, 0.241 (E/Ew vs. LVOI, TVOI), 0.255, 0.401 (RVSP vs. LVOI, TVOI), and 0.192, 0.170 (BNP vs. LVOI, TVOI), respectively. The correlation coefficient between RVSP and BNP was 0.390. Conclusions: TVOI was better correlated with RVSP (R =0.401) than the other parameters (Sw, Ew, E/Ew, and BNP), and this was similar to the degree that BNP was correlated with RVSP (R =0.390). TVOI can be a better indicator of RVSP than LVOI. CT VOI may be a useful parameter to assess CPATE morphologically. [Copyright &y& Elsevier]