The change in heart rate and HRV between resting and post-TC suggested that TC exercise could enhance vagal modulation. The potential beneficial effect of long-term regular TC exercise in patients with CAD merits further investigation.

The objective of the present study was to evaluate the effect of a six-month Tai Chi (TC) exercise cardiac rehabilitation program on two prognostic factors of cardiac events, rate-pressure product and rate-pressure product reserve, in patients with coronary artery disease (CAD). Patients (N = 54) with CAD were recruited from the clinics of cardiology and cardiovascular surgery at a regional hospital in Taiwan. Twenty-two of them enrolled in the TC rehabilitation program which consisted of weekly 90-min sessions of Yang's style TC for six months in addition to receiving usual care. The remaining 32 patients received usual care only. Modified Bruce treadmill exercise test was performed to evaluate their exercise test responses at baseline and at six months. The change over time was significantly different between the TC and control group in peak rate-pressure product (RPP) (interaction between group and time, p = 0.029) and in RPP reserve (interaction between group and time p = 0.009) over the six-month period, there was a decrease in peak RPP of 32.0 mmHg x bpm x 10(-2) and in RPP reserve of 37.4 mmHg x bpm x 10(-2) in the TC group. In conclusion, participating in a six-month TC exercise-based cardiac rehabilitation program was associated with improved peak RPP and RPP reserve during exercise testing in patients with CAD. TC exercise program may lead to a better prognosis for cardiac events in patients with CAD.

Intramural hematoma (IMH) of the aorta is a well-known variant of aortic dissection; however, the optimal initial treatment strategy for type A IMH remains controversial. An English language search of Medline for manuscripts on the treatments and outcomes of IMH with the keywords 'intramural hematoma', 'ascending aorta or type A', 'aortic disease' with cross-references was performed for articles dating from January 1986 to September 2006. Primary outcomes of interest were initial treatment strategies as well as the early and overall mortality rates. Earlier publications studying overlapping patient groups from the same institutions were excluded. Case reports and small series of less than 10 patients were not enrolled. Data from 328 reported cases in 12 studies were extracted. Initial surgery and medical treatment were performed for 168 (51.2%) and 160 (48.8%) patients, respectively. Nine out of 12 studies (75%) came from Asia. The early mortality rate was 10.1% (17/168) and 14.4% (23/160) in patients who received initial surgery and medical treatment, respectively (p=0.37). The optimal initial treatment strategy for type A IMH may still be individualized. Initial medical treatment and timed surgical therapy seems to be associated with higher early mortality rates in patients with type A IMH, even in a primarily Asian cohort. The impact of either initial treatment strategy on long-term survival must be evaluated in further study.