Altered mitral flow pattern in patients with hypertrophic obstructive cardiomyopathy.

Editor must not exceed 400 words in length and may be subject to editing or abridgment. Letters must be limited to three authors and five references. They should not have tables or figures and should relate solely to an article published in Circulation within the preceding 12 weeks. Only some letters will be published. Authors of those selected for publication will receive prepublication proofs, and authors of the article cited in the letter will be invited to reply. Replies must be signed by all authors listed in the original publication. To the Editor: The statement on " Phytochemicals and Cardiovascular Disease " published in the June 3, 1997, issue of Circulation 1 focuses attention on the vast therapeutic possibilities found in plants. One of the 3 groups of substances mentioned, the flavonoids, is found in great abundance in standardized special extracts of Hawthorn leaves with flowers. This extract has been studied extensively in Germany and is currently being used as a treatment modality in NYHA class II heart failure. Clinical studies (double-blind and placebo controlled) have been published in German and other languages 2,3 along with pharmacological and chemical studies. In a recent article, 4 136 patients (NYHA class II heart failure) were randomized (double-blind) to either 160 mg Hawthorn special extract WS 1442 per day or placebo. The difference between the pressure/heart rate product (PHRP) at a 50-W load versus rest was measured before and after treatment, and the change in this parameter was defined as the primary target parameter. The group receiving active medication showed a significant improvement in the PHRP, whereas, in the placebo group, this parameter tended to deteriorate. Other surrogate parameters (patients' subjective assessment of symptoms and quality of life) also improved. The medication was excellently tolerated. The cardioprotective qualities of Hawthorn extract WS 1442 have been demonstrated by Krzeminski and Chatterjee. 5 They used the ischemia/reperfusion model in 2 groups of rats, 1 receiving 100 mg ⅐ kg Ϫ1 ⅐ d Ϫ1 of the standardized Hawthorn extract WS 1442 orally for 6 days before induction of ischemia and the other serving as a control group. Active treatment effectively protected the animals from reperfusion-induced ar-rhythmia, mortality, and hypotensive crisis, as observed in the control animals after 7 minutes of coronary occlusion. A better understanding of the pharmacological working principles of WS 1442 is offered by Chatterjee et al. 6 They fractionated the Hawthorn extract and …