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Biomedical subjects

H Feigenbaum

Publications and source records attributed to H Feigenbaum.

At least 37 records · Page 2Linked to original sources
PubMed1989

Exercise echocardiographic detection of coronary artery disease in women.

The utility of exercise echocardiography for the diagnosis of coronary artery disease has been demonstrated in populations consisting largely of men with a high prevalence of disease. To determine the diagnostic value of exercise echocardiography in women, 57 women who presented with chest pain were studied with coronary cineangiography and echocardiography combined with either treadmill (n = 38) or bicycle exercise (n = 19). Significant coronary artery disease (greater than or equal to 50% reduction in luminal diameter) was present in 28 (49%) of 57 patients, including 16 (84%) of 19 who had typical angina, and 12 (32%) of 38 who had atypical chest pain. The overall sensitivity and specificity of echocardiography were both 86%. Exercise echocardiography correctly determined the presence or absence of coronary artery disease in 32 (84%) of 38 patients who had atypical chest pain and in 17 (89%) of 19 who had typical angina (p = NS). The exercise electrocardiogram (ECG) was nondiagnostic in 17 patients (30%) who had rest ST segment depression or ST depression with exercise that could also be induced by hyperventilation or changes in position. The correct diagnosis was made by echocardiography in 14 (82%) of 17 patients with a nondiagnostic exercise ECG. In conclusion, exercise echocardiography has a clinically useful level of sensitivity and specificity for the detection of coronary artery disease in women. The technique provides diagnostic information in women presenting with atypical chest pain and in those who have a nondiagnostic exercise ECG.

Adult↗
PubMed1989

Early recovery of regional left ventricular function after reperfusion in acute myocardial infarction assessed by serial two-dimensional echocardiography.

Although global and regional left ventricular (LV) function has been demonstrated to improve after reperfusion in acute myocardial infarction (AMI), the timing of these changes has not been well established. In this study, serial 2-dimensional echocardiography was used to assess regional LV function in 23 patients with AMI in whom reperfusion was accomplished by thrombolysis alone, by coronary angioplasty alone or by both interventions within 6 hours after onset of chest pain. Echocardiograms were performed before or within 6 hours after reperfusion (n = 23) and at 1 (n = 19), 3 (n = 21) and 7 (n = 20) days after reperfusion. Wall motion index and percentage of normally functioning muscle were calculated using a 16-segment scoring system analyzed in blinded fashion without knowledge of patient identity, therapy or time of study. The mean wall motion index improved from 1.78 +/- 0.48 to 1.56 +/- 0.38 at 1 day (n = 19, p less than 0.01), and to 1.48 +/- 0.37 at 3-7 days (p less than 0.01), with no significant difference between 3 days (1.49 +/- 0.39) and 7 days (1.42 +/- 0.30). There was a corresponding improvement in the percentage of normally functioning muscle, from 53 +/- 24% at 6 hours to 62 +/- 20% at 1 day (p less than 0.05) and to 67 +/- 18% at 3-7 days (p less than 0.01), again with no significant difference between 3 days (67 +/- 21) and 7 days (70 +/- 20).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Non-invasive diagnosis of ischemic heart disease using stress thallium scintigraphy and digital exercise 2-dimensional echocardiography.

The introduction of computer technology has overcome many of the technical difficulties in performing and interpreting echocardiograms obtained from exercising individuals and has made stress echocardiography a potentially practical examination. Additional data, however, are necessary to establish the accuracy of exercise echocardiography. The purpose of this study is to compare exercise echocardiography and planar thallium studies for accuracy in detecting coronary artery disease. The study was performed on 50 patients, 41 of whom underwent coronary angiography. For the remaining 9 patients accuracy was defined as concordance of clinical information, treadmill ECG results, thallium data and the exercise echocardiogram. If there was any discrepancy among these tests, the patient was not included in the analysis. The sensitivity of exercise 2D digital echocardiography was comparable to stress thallium (0.86 vs 0.85) and was better than treadmill test alone (0.66). There were no false positive tests with echocardiographic study, while 1 false positive thallium examination was detected. The diagnostic accuracy of stress echocardiography was 0.90, stress thallium 0.85 and treadmill test only 0.75. In conclusion, exercise echocardiography appears to give results comparable to stress planar thallium studies. In addition, the ultrasonic procedure has several advantages: it is totally non-invasive, does not require a reperfusion study 4 hours later, avoids radiation and is less expensive.

Adult↗
PubMed1988

Improvement in regional wall motion after percutaneous transluminal coronary angioplasty during acute myocardial infarction: utility of two-dimensional echocardiography.

In the setting of acute myocardial infarction, 16 patients undergoing successful coronary angioplasty (PTCA) within 6 hours of presentation (group I) and eight patients receiving conventional medical therapy (group II) were studied by serial two-dimensional (2D) echocardiography to assess the functional recovery of myocardium. All patients underwent 2D echocardiograms within 24 hours of presentation and at a minimum of 6 days after admission. Wall motion analysis was quantified with a wall motion score index based on 16 left ventricular wall segments. Wall motion score index improved significantly from early to late echocardiographic study in the patients undergoing PTCA (1.65 +/- 0.29 to 1.40 +/- 0.30; p less than 0.001), whereas the index did not improve in the conventionally treated group (1.54 +/- 0.26 to 1.58 +/- 0.25; p = NS). One patient in group II had a greater than or equal to 10% improvement in wall motion score index compared to 11 of 16 in group I (p less than 0.01). In all cases improvement in wall motion score index was due to improvement in regional wall motion in the area of infarction. In group I, 40 of 77 (52%) infarct zone segments showed improvement of at least one grade, versus 4 of 28 (14%) segments in group II (p less than 0.001). These data indicate that regional myocardial function improves in the majority of patients undergoing successful PTCA as emergency therapy for acute myocardial infarction and that serial 2D echocardiography is an excellent means to quantify this improvement.

Adult↗
PubMed1988

Exercise echocardiography: detection of coronary artery disease in patients with normal left ventricular wall motion at rest.

Most studies investigating the ability of exercise two-dimensional echocardiography to identify patients with coronary artery disease have included patients with left ventricular wall motion abnormalities at rest. This has the effect of increasing sensitivity because patients with only abnormalities at rest are detected. To determine the diagnostic utility of exercise echocardiography in patients with normal wall motion at rest, 64 patients were studied with exercise echocardiography in conjunction with routine treadmill exercise testing before coronary cineangiography. All 24 patients who had no angiographic evidence of coronary artery disease had a negative exercise echocardiogram (100% specificity). Nine of 40 patients with coronary artery disease (defined as greater than or equal to 50% narrowing of at least one major vessel) also had a negative exercise echocardiogram (78% sensitivity). Of the nine patients with a false negative exercise echocardiographic study, six had single vessel disease. Among 25 patients with single vessel disease, exercise echocardiography was significantly more sensitive (p = 0.01) than treadmill exercise testing alone (76 versus 36%, respectively). Among 15 patients with multivessel disease, the two tests demonstrated similar sensitivity (80%). In conclusion, exercise echocardiography is highly specific and moderately sensitive for the detection of coronary artery disease in patients with normal wall motion at rest. Although exercise echocardiography is significantly more sensitive than treadmill exercise electrocardiographic testing alone in patients with single vessel disease, the two tests are similar in their ability to detect coronary artery disease in patients with multivessel disease and normal wall motion at rest.

Adult↗
PubMed1987

Digital two-dimensional echocardiographic imaging of the proximal left anterior descending coronary artery.

The use of 2-dimensional echocardiography to evaluate coronary artery anatomy noninvasively and directly has been primarily limited to the evaluation of the left main coronary artery. To determine the feasibility of visualization of the proximal left anterior descending coronary artery (LAD) and assessment for atherosclerotic disease in this location, 128 consecutive patients undergoing coronary arteriography were evaluated with digital 2-dimensional echocardiography. Visualization of the proximal LAD was possible in 90 (70%) of the 128 patients. Of 45 patients with proximal LAD narrowing by angiography, digital echocardiography correctly identified 44 (98% sensitivity). In 27 patients with angiographically normal coronary arteries, digital echocardiography was normal in 18 (67% specificity). In the 18 patients with an angiographically normal proximal LAD but narrowing elsewhere in the coronary system, digital echocardiographic evaluation of the proximal LAD was abnormal in 15. This initial study suggests that 2-dimensional echocardiography is a feasible technique to image the proximal LAD noninvasively in patients undergoing coronary arteriography.

Adult↗
PubMed1987

Risk stratification after acute myocardial infarction by means of exercise two-dimensional echocardiography.

To determine whether exercise two-dimensional echocardiography contributes to the prognostic information provided by exercise testing in patients recovering from acute myocardial infarction, 40 patients were prospectively studied by means of pre- and postexercise echocardiography 10 to 21 days after myocardial infarction. Patients were followed for 6 to 10 months or until one of the following clinical end points occurred: death, recurrent myocardial infarction, unstable angina, or coronary artery bypass grafting. Results of treadmill exercise tests were negative in 13 of 20 patients with good clinical outcome (65% specificity) and positive in 11 of 20 patients with poor clinical outcome (55% sensitivity). The resting echocardiogram was abnormal in 37 of 40 patients. The exercise echocardiogram was negative in 19 of 20 patients with good clinical outcome (95% specificity) and positive in 16 of 20 patients with poor clinical outcome (80% sensitivity). We conclude that exercise echocardiography is more sensitive and specific than treadmill exercise testing for predicting the occurrence of subsequent cardiac events after acute myocardial infarction.

Adult↗
PubMed1987

Effect of prior myocardial infarction and extent and location of coronary disease on accuracy of exercise echocardiography.

Exercise echocardiography is an emerging technique for the evaluation of patients with suspected coronary artery disease. In this study, rest and immediate postexercise echocardiograms were performed in 123 patients who were stratified on the basis of prior myocardial infarction and the number and location of coronary artery stenoses at cardiac catheterization. The location of wall motion abnormalities on rest and postexercise studies was correlated with the location of coronary artery stenoses. The sensitivity of exercise echocardiography for detecting coronary artery disease in patients with multivessel disease was 97% in those with and 86% in those without prior infarction. The corresponding sensitivity for patients with single vessel disease was 100% and 72%, respectively. Multivessel disease was present in 59 patients, but specifically identified as such in only 32 (54%). Normal rest and exercise echocardiograms were seen in 12 patients with coronary artery disease, 8 of whom had single vessel disease. It is concluded that the subjective analysis of the exercise echocardiogram accurately identifies the majority of patients with coronary artery disease. Its sensitivity is greatest in those with multivessel coronary disease. It is limited in those with single vessel coronary disease and in accurately identifying the subset of patients with multivessel disease.

Angiography↗
PubMed1986

Digital averaging to facilitate two-dimensional echocardiographic measurements.

A problem in quantitative two-dimensional echocardiography is myocardial dropout of still frame images. This study was designed to evaluate the ability of digital averaging to overcome myocardial dropout without distorting quantitative measurements. Forty-one percent of 80 digitally averaged images were thought to be improved by five independent observers, whereas 7% showed some deterioration. Measurements obtained from processed images were statistically identical (r greater than or equal to 0.9) to those from three arithmetically averaged, unprocessed images in 60 patients. Digital averaging can improve image quality without measurement distortion and should facilitate two-dimensional echocardiographic quantitation.

Analog-Digital Conversion↗
PubMed1986

Failure of fluosol DA to enhance the ultrasonic image of infarcted myocardium.

The perfluorocarbon Fluosol DA has been reported to increase the subjective echogenicity of infarcted myocardium. To investigate this phenomenon, two-dimensional echocardiograms were recorded in 20 closed-chest dogs before and 24,48,72, and 96 h following permanent coronary artery occlusion. Low-dose Fluosol, 10 ml/kg (LDF) (four dogs), high-dose Fluosol, 25 ml/kg (HDF) (eight dogs), or lactated Ringers 25 ml/kg (LR) (eight dogs) was administered 48 h after occlusion. Left ventricular sections corresponding to the short-axis echocardiographic examination plane were stained with nitroblue tetrazolium 48 h after Fluosol administration. Short-axis echocardiographic studies were evaluated by two blinded observers who found no consistent increase in the echogenicity of the infarcted area in any group. Videodensitometry of the infarcted area, normalized to the average value of two remote areas, confirmed mean post-Fluosol increases of 66% in LR dogs, 65% in LDF dogs, and 107% in HDF animals (p less than 0.001 for all dogs; all intergroup comparisons NS). The increase in videodensity observed in all groups may have occurred as a consequence of volume administration, although changes in infarct intensity occurring over time cannot be excluded.

Animals↗
PubMed1986

Determination of the earliest site of ventricular activation in Wolff-Parkinson-White syndrome: application of digital continuous loop two-dimensional echocardiography.

Surgical and transcatheter ablation of accessory atrioventricular (AV) connections (Wolff-Parkinson-White syndrome) requires accurate localization of the accessory pathway. In a canine model of endocardial pacing, a continuous loop two-dimensional echocardiographic technique was developed for determining the earliest site of ventricular activation. This technique was then used to localize accessory AV connections in patients. Echocardiographic images were acquired on videotape and converted to a digital continuous loop format, from which the earliest site of systolic motion was determined. In six dogs, using six distinct endocardial sites, two blinded observers accurately identified the earliest site of ventricular activation in 31 (86%) of 36 and 32 (89%) of 36 locations. Determination of the earliest site of ventricular activation with the continuous loop digital technique was superior to standard analog analysis in overall accuracy (p less than 0.02) and in intraobserver variability (p less than 0.004). After validation of this technique, 21 patients with 22 accessory AV connections with anterograde conduction were studied. The earliest site of mechanical activity was determined during sinus (10 patients) or atrial paced (11 patients) rhythms by two blinded observers and compared with electrophysiologic mapping and surface electrocardiograms. Digitally processed echocardiograms correctly localized the earliest site of ventricular activation in 18 of 22 connections and predicted an adjacent location in the remaining 4.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

Complementary value of two-dimensional exercise echocardiography to routine treadmill exercise testing.

Two-dimensional echocardiograms were done during rest and after exercise in 95 patients who subsequently had coronary arteriography. Prior myocardial infarction was present in 36 patients, 35 of whom had wall motion abnormalities. There was no evidence of prior infarction in 59 patients, 44 of whom had coronary disease. In these 44 patients, the exercise electrocardiogram showed ischemia in 19, was normal in 13, and was nondiagnostic in 12. Exercise echocardiograms were abnormal in 35 of these 44 patients. In 15 patients without coronary disease, the treadmill response was nondiagnostic in 6, ischemic in 1, and normal in 8. Exercise echocardiograms were normal in 13 of these 15 patients. We conclude that exercise echocardiography is a valuable addition to routine treadmill testing. It may be of special value in patients with an abnormal resting electrocardiogram or a nondiagnostic response to treadmill testing or when a false-negative treadmill test is suspected.

Adult↗
PubMed1979

Serial echocardiographic appearance of healing bacterial vegetations.

Serial M mode and cross-sectional echocardiograms were obtained from six patients who had been treated with antibiotic drugs for infectious endocarditis. Three to six M mode echocardiograms and one to six cross-sectional echocardiograms were obtained from each patient over a follow-up period averaging 50 weeks (range 10 to 108 weeks). On echocardiography, vegetations were observed to have become smaller and more echo-reflective with healing. A dramatic change was seen in two patients after peripheral embolization. M mode echocardiography was particularly helpful in determining the quality of echo reflection by vegetations; cross-sectional echocardiography was more helpful in judging the size and shape of a vegetation. Echocardiography is ideally suited for the serial visualization of healing vegetations in patients who do not require early valve replacement. It may prove helpful to examine serially valve vegetations with both M mode and cross-sectional echocardiography when following up patients with infectious endocarditis treated with antibiotic agents.

Adult↗
PubMed1979

Mid systolic notching of the pulmonary valve in the absence of pulmonary hypertension.

In a patient with idiopathic dilatation of the pulmonary artery the pulmonary valve echogram showed a prominent mid systolic closing motion or notching indistinguishable from that seen in pulmonary hypertension. Normal right ventricular and pulmonary arterial pressures were recorded simultaneously with echocardiograms of the pulmonary valve.

Adult↗
PubMed1979

Right ventricular outflow tract assessment by cross-sectional echocardiography in tetralogy of Fallot.

Cross-sectional echocardiographic (CSE) studies were obtained in 29 children with tetralogy of Fallot. In this study we evaluated the capability of CSE to record the right ventricular outflow tract (RVOT) and compared the severity of infundibular obstruction determined by CSE with cineangiographic (cine) determinations. In addition, we examined capabilities of CSE and M-mode echocardiography (M-mode) to record the diagnostic features of tetralogy of Fallot, including RVOT obstruction, aortic overriding, ventricular septal defect, and presence of the pulmonary valve. An excellent correlation (r = 0.925) was found for the combined pre- and post-repair patients studied by CSE vs cine, while the correlation (r = 0.805) for M-mode was not as good. The difference was even more striking for the unrepaired patients, in which the correlation (r = 0.746) for CSE was much better than for M-mode (r = 0.374). In the unrepaired patients, CSE allowed easier detection of the ventricular septal defect than M-mode (95% for CSE vs 76% for M-mode). The pulmonary valve was recorded in 90% by CSE, but in only 26% by M-mode. Aortic overriding was recorded in all unrepaired patients both by CSE and M-mode. These data indicate that CSE is better than M-mode for recording the RVOT dimensions, ventricular septal defect, and the pulmonary valve in unrepaired patients with tetralogy of Fallot.

Aorta↗
PubMed1979

Long-term changes in mitral valve area after successful mitral commissurotomy.

We examined the long-term effects of closed instrumental mitral commissurotomy on mitral valve area (MVA) in 18 patients, followed for as long as 14 years after successful operation. Each patient had preoperative and early postoperative cardiac catheterization; late postoperative determination of MVA was obtained 10-14 years (mean 12.2 years) after commissurotomy. In 17 patients, the MVA was determined by cross-sectional echocardiography and in one patient by repeat cardiac catheterization. Thirteen of 18 patients had no change in MVA between early postoperative study (mean MVA = 2.7 cm2) and late postoperative study (mean MVA = 2.9 CM2). MVA in five patients decreased 0.7-2.2 cm2 (mean 1.4 cm2) during the follow-up period. In these five patients, the mean MVA at early postoperative study was 2.7 cm2 and at late postoperative study was 1.3 cm2 (p less than 0.001). At late postoperative evaluation, cardiac symptoms were associated with severity of mitral stenosis but did not predict restenosis. A successful, closed, instrumental mitral commisurotomy can provide substantial long-term improvement in MVA.

Cardiac Catheterization↗