Abstract. Adamsson V, Reumark A, Fredriksson I-B, Hammarström E, Vessby B, Johansson G, Risérus U (Uppsala University, Uppsala; Lantmännen R&D, Stockholm; Bollnäs Heart Clinic, Mitt Hjärta, Bollnäs; Halmstad University, Halmstad, Sweden). Effects of a healthy Nordic diet on cardiovascular risk factors in hypercholesterolaemic subjects: a randomized controlled trial (NORDIET). J Intern Med 2011; 269: 150-159.Objective. The aim of this study was to investigate the effects of a healthy Nordic diet (ND) on cardiovascular risk factors.Design and subjects. In a randomized controlled trial (NORDIET) conducted in Sweden, 88 mildly hypercholesterolaemic subjects were randomly assigned to an ad libitum ND or control diet (subjects' usual Western diet) for 6 weeks. Participants in the ND group were provided with all meals and foods. Primary outcome measurements were low-density lipoprotein (LDL) cholesterol, and secondary outcomes were blood pressure (BP) and insulin sensitivity (fasting insulin and homeostatic model assessment-insulin resistance). The ND was rich in high-fibre plant foods, fruits, berries, vegetables, whole grains, rapeseed oil, nuts, fish and low-fat milk products, but low in salt, added sugars and saturated fats.Results. The ND contained 27%, 52%, 19% and 2% of energy from fat, carbohydrate, protein and alcohol, respectively. In total, 86 of 88 subjects randomly assigned to diet completed the study. Compared with controls, there was a decrease in plasma cholesterol ()16%, P < 0.001), LDL cholesterol ()21%, P < 0.001), high-density lipoprotein (HDL) cholesterol ()5%, P < 0.01), LDL ⁄ HDL ()14%, P < 0.01) and apolipoprotein (apo)B ⁄ apoA1 ()1%, P < 0.05) in the ND group. The ND reduced insulin ()9%, P = 0.01) and systolic BP by )6.6 ± 13.2 mmHg ()5%, P < 0.05) compared with the control diet. Despite the ad libitum nature of the ND, body weight decreased after 6 weeks in the ND compared with the control group ()4%, P < 0.001). After adjustment for weight change, the significant differences between groups remained for blood lipids, but not for insulin sensitivity or BP. There were no significant differences in diastolic BP or triglyceride or glucose concentrations.Conclusions. A healthy ND improves blood lipid profile and insulin sensitivity and lowers blood pressure at clinically relevant levels in hypercholesterolaemic subjects.

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Objective-To study the time course and underlying mechanisms of right heart filling after cardiac surgery.Design-A prospective observational study of adult patients undergoing cardiac surgery.Setting-Echocardiography laboratory of the Stanford University Medical Center.Patients-Twenty six patients (mean age 54-9) undergoing cardiac surgery were studied before and two days, one week, six weeks, and six months after cardiac surgery.Main outcome measures-Flow in the hepatic veins and superior vena cava, tricuspid and mitral annulus motion, signs of tricuspid regurgitation, and right ventricular size were assessed by echocardiography.Results-Right heart filling, expressed as the ratio of systolic to diastolic forward flow Doppler velocity integrals in the superior vena cava and by tricuspid annulus motion, decreased in parallel from before surgery baseline values of 3*5 (SD 3-1) and 21-9 (3-4) mm, respectively to 02 (01) and 8-1 (2-3) mm two days after operation. A gradual increase towards baseline values was noted after six months, to 1-4 (1-3) and 15.1 (2 3) mm respectively; however, these values were still significantly less than those before operation. Similar changes were seen in the hepatic venous flow pattern. The decrease in total tricuspid annulus motion was most pronounced in its lateral segment and the atrial component of the tricuspid annulus motion showed similar changes.Conclusions-The pronounced decrease in tricuspid annulus motion during the early postoperative period suggests right atrial and right ventricular dysfunction as mechanisms responsible for the early changes-seen. The progressive return to a normal venous filling pattern and the partial recovery of annular motion six months after operation further support the influence ofthe above mechanisms, as well as their resolution with time. The persistent flow abnormalities and compromised motion of the free aspects of the tricuspid annulus, however, suggest long-term tethering of the right heart walL Right heart filling, reflected in the pattern of systemic venous return, becomes abnormal in patients who undergo cardiac surgery supported by cardiopulmonary bypass.'-' These changes were first described as an alteration in jugular venous pulse contours and flow velocities from the normal dominant systolic flow to an equal or dominant diastolic flow.45 Recently we have shown, using intraoperative transoesophageal echocardiography, that the venous flow pattern is normal before cardiopulmonary bypass even with the pericardium fully opened, but becomes abnormal immediately after termination of cardiopulmonary bypass.6 A mechanical impediment to cardiac motion and a combination of abnormalities in right heart function were suggested as possible mechanisms for these changes immediately after cardiopulmonary bypass. The present study was undertaken to further elucidate the time course and underlying mechanisms of these changes through repeated observations before and during a six month period after operation. Patients and methods PATIENT POPULATION...

Echocardiography was used to assess normal values in the right and left ventricular cavity and wall in 127 male elite endurance athletes. M-mode and two dimensional measurements of left ventricle and left and right atria were also obtained. All subjects were high-performance orienteers, cross-country skiers and middle-distance runners. They all had a normal electrocardiogram at rest and no echocardiographic evidence of heart disease. With the use of multiple right ventricular cross-sections and two-dimensional measurements, we found a significantly greater right ventricular inflow tract and right and left atrial measurements in endurance athletes compared with earlier studies of normal, active subjects. The right ventricular free wall was slightly thicker than reported in normal active subjects but the differences were small. Left ventricular diastolic diameter was consistent with previous reports of endurance athletes. Of the 127 subjects, 13% had left ventricular wall thickness above 13 mm but none of the athletes had wall thickness above 15 mm. These data suggest that cardiac enlargement occurs symmetrically in both right and left cavities, probably reflecting increased haemodynamic loading, a mechanism by which athletes sustain a high cardiac output during exercise.

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