Flow-induced dilation of blood vessel is the result of a series of bioreaction in vascular endothelial cells(VEC). Shear stress change by blood flow in human artery or vein is sensed by the mechanoreceptor and responsible for such a chain reaction. The inositol(1,4,5)-triphophate($IP_3$) is produced in the first stage to elevate permeability of the intercellular membrane to calcium ions by which the cytosolic calcium concentration is consequently increased. This intracellular calcium transient triggers synthesis of EDRF and prostacyclin. The mathematical model of this VEC calcium dynamics is reproduced from the literature. We then use the Computational Fluid Dynamics(CFD) technique to investigate the blood stream dictating the VEC calcium dynamics. The pulsatile blood flow in a stenosed blood vessel is considered here as a part of study on thrombogenesis. We calculate the pulsating shear stress (thus its temporal change) distributed over the stenosed artery that is implemented to the VEC calcium dynamics model. It has been found that the pulsatile shear stress induces larger intracellular $Ca^{2+}$ transient plus much higher amount of EDRF and prostacyclin release in comparison with the steady shear stress case. It is concluded that pulsatility of the physiological shear stress is important to keep the vasodilation function in the stenosed part of the blood vessel.

Because patients with coronary artery disease (CAD) have depressed vagal modulation and the mortality risk from acute myocardial infarction is lower in patients with higher vagal modulation, methods that can increase vagal modulation are desirable in patients with CAD. We intended to inspect the effect of recumbent posture on vagal modulation. By using angiography, 33 patients with abnormal (CAD group) and 33 patients with normal coronary arteries (control group) were studied. The nonlinear as well as the linear characteristics of heart rate variability (HRV) were analyzed on these patients in three recumbent postures: namely, the supine, right lateral decubitus, and left lateral decubitus postures. The lower the normalized high-frequency power (nHF) in the supine or left lateral decubitus posture, the higher the increase in the nHF when the posture was changed from supine or left lateral decubitus to right lateral decubitus in both groups of patients. Right lateral decubitus posture can lead to the highest vagal modulation and the lowest sympathetic modulation among the three recumbent postures in both normal and patients with CAD. Therefore, the right lateral decubitus posture can be used as an effective physiologic vagal enhancer in patients with CAD.

The main purpose of our study is to propose a new methodology to develop the multi-parametric measure including linear and nonlinear measures of heart rate variability diagnosing cardiovascular disease. We recorded electrocardiogram for three recumbent postures; the supine, left lateral, and right lateral postures. Twenty control subjects (age: $56.70{\pm}9.23$ years), 51 patients with angina pectoris (age: $59.98{\pm}8.41$ years) and 13 patients with acute coronary syndrome (age: $59.08{\pm}9.86$ years) participated in this study. To develop the multi-parametric measure of HRV, we used the multiple discriminant analysis method among statistical techniques. As a result, the multiple discriminant analysis gave 75.0% of goodness of fit. When the linear and nonlinear measures of HRV are individually used as a clinical tool to diagnose cardiac autonomic function, there is quite a possibility that the wrong results will be obtained due to each measure has different characteristics. Although our study is a preliminary one, we suggest that the multi-parametric measure, which takes into consideration the whole possible linear and nonlinear measures of HRV, may be helpful to diagnose the cardiovascular disease as a diagnostic supplementary tool.