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Biomedical subjects

Harvey Feigenbaum

Publications and source records attributed to Harvey Feigenbaum.

14 recordsLinked to original sources
PubMed2006

Prognostic importance of wall motion abnormalities in patients with ischemic cardiomyopathy and an implantable cardioverter-defibrillator.

Patients with extensive regional wall motion abnormalities are predisposed to development of ventricular tachyarrhythmia. The prognostic effect of this in patients with an implantable cardioverter-defibrillator (ICD) and coronary artery disease (CAD) is not known. Echocardiographic left ventricular systolic indexes, wall motion score index (WMSI), and extent of regional akinesia in 140 patients (65 +/- 10 years old; 92% men) with an ICD and CAD were studied. Arrhythmic events requiring ICD therapy and causing death (n = 41, 29%) were recorded over a mean follow-up of 1.4 +/- 0.8 years. Left ventricular basal fractional shortening, ejection fraction, global WMSI, and extent of akinesia, especially in the inferoposterior regions of a right coronary artery territory, were univariate predictors (all p values <0.05). Global WMSI (hazard ratio 2.18, 95% confidence interval 1.03 to 4.65, p = 0.04) and fractional shortening (hazard ratio 0.93, 95% confidence interval 0.88 to 1.00, p = 0.04) were multivariate predictors. Global WMSI (p = 0.04) and > or =2 right coronary region akinetic segments (p = 0.05) provided incremental risk prediction to left ventricular ejection fraction in a global risk-assessment model (chi-square p = 0.001). Presence of right coronary region akinesia better identified those at increased risk of events (p = 0.02) compared with the presence of left anterior descending region akinesia (p = 0.2), independent of systolic function. In conclusion, global WMSI and left ventricular basal fractional shortening were important additional risk predictors of ICD events in CAD. Global WMSI and right coronary region inferoposterior akinesia provided independent and incremental risk assessment to left ventricular ejection fraction and improved identification of those at increased risk of ICD-related events in patients with ischemic cardiomyopathy.

Aged↗
PubMed2005

Comparison of tissue Doppler dynamics to Doppler flow in evaluating left atrial appendage function by transesophageal echocardiography.

Tissue Doppler imaging (TDI) patterns from the left atrial appendage (LAA) were evaluated by transesophageal echocardiography. Reproducible, characteristic triphasic or biphasic tissue velocities similar to Doppler flow of the LAA were obtained. Patient peak TDI velocities correlated well with flow and were measurable in atrial fibrillation. Patients with an embolic cerebrovascular accident and in sinus rhythm had higher tissue TDI velocities from the LAA compared with patients without an event, and the groups had similar flow velocities. Hence, Doppler tissue contraction dynamics determined by TDI may complement flow velocities in evaluating LAA function for risk assessment of thromboembolism.

Adult↗
PubMed2003

Incremental value of myocardial viability for prediction of long-term prognosis in surgically revascularized patients with left ventricular dysfunction.

OBJECTIVES: We assessed the incremental long-term prognostic value of myocardial viability in surgically revascularized (CABG) patients with left ventricular (LV) dysfunction. BACKGROUND: Clinical factors, medical therapy, the degree of LV dysfunction, and stress-induced ischemia may affect the relative prognostic value of myocardial viability. METHODS: Patients with coronary disease and ventricular dysfunction (mean ejection fraction 33% by echocardiography, 25% by angiography) were studied with dobutamine echocardiography. Follow-up (mean -4.9 years) was obtained in 95 patients (85% triple-vessel disease) who underwent CABG. RESULTS: The use of angiotensin-converting enzyme inhibitors, advanced heart failure, rest, low- and peak-dose wall motion scores were univariate predictors of cardiac death. The extent of contractile reserve and ischemia were not predictive. Low-dose score was the strongest multivariate predictor of death (p < 0.001, hazard ratio 6.7). A biphasic response predicted better survival (p = 0.045, hazard ratio 0.5). Five-year survival was better in those with extensive (low-dose score <2.00) versus intermediate (score 2.00 to 2.49) amounts of viable myocardium (p = 0.019). Patients with the least viability (score > or =2.5) had the worst outcome (p = 0.0001 vs. those with low-dose score <2.00; p = 0.05 vs. those with score 2.00 to 2.49). In stepwise multivariate analysis, low-dose score added incremental prognostic value (p = 0.024) to clinical information and rest score. CONCLUSIONS: Low-dose score, representing the extent of viable myocardium, has incremental prognostic value as a predictor of long-term outcome in CABG patients with LV dysfunction.

Coronary Artery Bypass↗
PubMed2003

Comparison of usefulness of dipyridamole stress myocardial contrast echocardiography to technetium-99m sestamibi single-photon emission computed tomography for detection of coronary artery disease (PB127 Multicenter Phase 2 Trial results).

We hypothesized that assessment of hyperemic myocardial blood flow (MBF) velocity using myocardial contrast echocardiography (MCE) can detect coronary artery disease (CAD). We also postulated that only a single MCE study during stress is required for the detection of CAD in patients with normal function at rest. Patients with known or suspected CAD referred for dipyridamole stress technetium-99m sestamibi single-photon emission computed tomographic (SPECT) studies were enrolled. MCE was performed concurrently with SPECT using continuous infusions of PB127 during intermittent harmonic power Doppler imaging at multiple pulsing intervals. MCE and SPECT were compared in 43 of 54 patients who had adequate studies using both techniques. In 15 of the 43 patients, coronary angiography was performed within 30 days of the MCE/SPECT tests. Overall concordance for classification of patients as normal versus abnormal was 84% (kappa = 0.63) between the 2 tests. When false-negative SPECT scans were corrected for results of angiography, concordance increased to 93% (kappa = 0.82). For territorial analysis, concordance between MCE and SPECT for location of perfusion defects was 65% (kappa = 0.41) and 74% (kappa = 0.61) after SPECT was corrected by angiography. In patients with normal function at rest, a single stress MCE perfusion study allowed identification of CAD with the same concordance as rest/stress perfusion studies. In conclusion, visual assessment of regional differences in MBF velocity using PB127 allows detection of CAD with good concordance compared with technetium-99m sestamibi SPECT. In patients with normal left ventricular function at rest, a single stress PB127 MCE perfusion study is adequate for the detection of CAD.

Adult↗
PubMed2003

Left anterior descending coronary artery wall thickness measured by high-frequency transthoracic and epicardial echocardiography includes adventitia.

High-frequency, 2-dimensional transthoracic echocardiography (HR-2DTTE) measurements of the left anterior descending (LAD) coronary artery wall thickness are larger than measurements obtained by intravascular ultrasound. We hypothesize that this difference is due to inclusion of the third vascular layer, which may represent adventitia by HR-2DTTE, and that this layer must be increasing in thickness with the development of atherosclerosis. We evaluated the contribution of this third layer to the wall thickness of the normal and atherosclerotic LAD artery imaged by HR-2DTTE using high-frequency epicardial echocardiography (HFEE) as the reference standard. Eighteen patients (10 men, mean age 62 years), 13 with coronary atherosclerosis and 5 with normal coronary arteries, referred for open-heart surgery, underwent preoperative HR-2DTTE evaluation of the LAD artery (SONOS 5500; 3- to 8-MHz transducer) and intraoperative HFEE of the LAD artery (SONOS 5500; 6- to 15-MHz transducer). Wall thickness was greater in patients with coronary atherosclerosis than in those with normal coronary arteries by both HR-2DTTE (1.9 +/- 0.3 vs 1.0 +/- 0.1 mm, p = <0.001) and HFEE (1.8 +/- 0.2 vs 1.0 +/- 0.2 mm, p = <0.001). On HFEE, the average intima plus media thickness was greater in patients with coronary atherosclerosis than in those with normal coronary arteries (0.78 +/- 0.3 vs 0.34 +/- 0.1 mm, p = 0.005). The average thickness of adventitia was also greater in patients with coronary atherosclerosis than in those with normal coronary arteries (0.92 +/- 0.2 vs 0.54 +/- 0.2 mm, p = 0.0005). HR-2DTTE and HFEE measurements of the wall thickness correlated well (r = 0.83 [reader 1], p <0.001; r = 0.61 [reader 2], p <0.01). A third vascular layer, which likely included adventitia, represents a significant portion of the LAD wall thickness imaged by HR-2DTTE and HFEE, and it significantly increases in thickness with the development of atherosclerosis.

Adult↗
PubMed2003

Myocardial contrast echocardiography (MCE) with triggered ultrasound does not cause premature ventricular complexes: evidence from PB127 MCE studies.

Previous studies suggest that myocardial contrast echocardiography using high mechanical index triggered ultrasound can be associated with increased frequency of the premature ventricular complex (PVC). However, this association has not been systematically examined. PB127 (Point Biomedical Corp, San Carlos, Calif) is a novel microsphere designed for evaluation of myocardial perfusion with ultrasound. PB127 myocardial contrast echocardiography was performed with triggered harmonic power Doppler in early/mid diastole (mechanical index </= 1.0). A total of 71 patients (cohort A) were studied at rest and another 64 (cohort B, age 62 +/- 12.6 years) were allocated to stress. Continuous electrocardigraphy was recorded. The study evaluated premature ventricular complex frequency at baseline, during, and after infusion of PB127 (dose < 0.175 mg/kg, <60-minute duration). Proportions of triggered and nontriggered intervals associated with premature ventricular complex were determined. PVC frequency did not increase with PB127 infusion in either cohort (P =.572, P =.263). Proportion of triggered intervals after QRS associated with PVC was similar to proportion of untriggered intervals in cohort A (P >.999) and was lower than untriggered intervals (P =.001) in B, suggesting that triggers do not cause PVC. PB127 does not cause increase PVC frequency during or after imaging with triggered ultrasound at mechanical index of 1.

Adult↗
PubMed2003

Potential use of high-resolution two-dimensional transthoracic echocardiography for visualization of the left anterior descending coronary artery.

High-resolution, two-dimensional transthoracic echocardiography (HR-2DTTE) can detect the difference in the left anterior descending coronary artery (LAD) wall thickness between patients with coronary artery disease and patients with normal coronary arteries. However, HR-2DTTE measurements of the LAD wall thickness are larger than measurements obtained by intravascular ultrasound and histology. This difference may be due to the inclusion of adventitia by HR-2DTTE. We evaluated the contribution of adventitia to the wall thickness of the normal and atherosclerotic LAD by comparing HR-2DTTE with high-frequency epicardial echocardiography. The LAD wall thickness was significantly greater in patients with coronary artery disease by both HR-2DTTE and high-frequency epicardial echocardiography. Both an increase in the intima plus media thickness and an increase in the thickness of adventitia contributed to the increase in the LAD wall thickness in patients with coronary artery disease. Adventitia represents a significant portion of the LAD wall thickness imaged by HR-2DTTE and its thickness increases significantly with the development of atherosclerosis.

Adolescent↗
PubMed2002

Imaging of the left anterior descending coronary artery by high-frequency transthoracic and epicardial echocardiography.

Left anterior descending coronary artery (LAD) wall thickness and external diameter are significantly increased in patients with coronary artery disease compared with normal subjects. High-resolution, 2-dimensional transthoracic echocardiography (HR-2DTTE) can be used to measure LAD wall thickness and is sensitive enough to detect these differences. However, HR-2DTTE measurements of the LAD wall thickness are larger than measurements obtained by intravascular ultrasound and histology. We hypothesize that this difference is due to inclusion of the third vascular layer, which may represent adventitia, by HR-2DTTE, and that this layer must be increasing in thickness with the development of atherosclerosis. We evaluated the contribution of this third layer to the wall thickness of the normal and atherosclerotic LAD imaged by HR-2DTTE using high-frequency epicardial echocardiography (HFEE). Thirteen patients with coronary atherosclerosis and 5 patients with normal coronary arteries underwent preoperative HR-2DTTE and intraoperative HFEE. HR-2DTTE and HFEE measurements of the wall thickness correlated well. The wall thickness was significantly greater in patients with coronary atherosclerosis than in patients with normal coronary arteries by both HR-2DTTE and HFEE. With HFEE, the average intima plus media thickness and the average thickness of adventitia were greater in patients with coronary atherosclerosis than in patients with normal coronary arteries. A third vascular layer, which likely includes adventitia, represents a significant portion of the LAD wall thickness imaged by HR-2DTTE and HFEE, and its thickness increases significantly with the development of atherosclerosis.

Case-Control Studies↗
PubMed2002

Usefulness of rest and low-dose dobutamine wall motion scores in predicting survival and benefit from revascularization in patients with ischemic cardiomyopathy.

This study examined the value of wall motion scores at rest and with low- and high-dose dobutamine infusion for prediction of outcome and benefit from revascularization in patients with ischemic cardiomyopathy. Follow-up was obtained in 139 patients with ischemic cardiomyopathy who had echocardiography at rest, and during low- (10 microg/kg/min) and high-dose dobutamine (maximal dose 50 microg/kg/min) infusion. Both rest and low-dose wall motion scores were multivariate predictors of cardiac death, but ischemia and peak dose scores were not predictors. Rest scores risk stratified patients into 3 groups: score (1.00 to 1.99) with 11% cardiac death; score (2.00 to 2.49) with 30% death; and score > or =2.50 with 47% death. One third of patients with rest scores > or =2.50 had improvement in scores to < 2.50 with low-dose dobutamine. Their frequency of cardiac death was reduced to 23% compared with 60% (p = 0.04) in those who remained with low-dose scores > or =2.50. Low-dose scores also identified those who benefited from revascularization. In patients with low-dose scores (1.00 to 1.99), the frequency of cardiac death was marginally lower in revascularized than nonrevascularized patients (10% vs 21%, p = 0.28). In patients with scores (2.00 to 2.49), revascularized patients had a significantly lower frequency of cardiac death than nonrevascularized patients (15% vs 41%, p < 0.05). The frequency of death in those with low-dose scores > or =2.50 was very high in both revascularized (75%) and nonrevascularized (56%, p = 0.42) patients. Thus, rest and low-dose wall motion scores enable risk stratification of patients with ischemic cardiomyopathy and identify those who do and do not benefit from revascularization.

Adrenergic beta-Agonists↗
PubMed1997

Practical Approach to a Digital Echocardiographic Laboratory.

Routine digital storage of echocardiograms offers considerable advantages over video tape, including random access to images within a study, side-by-side comparison with prior studies, and duplication and transmission of images without degradation. The massive storage requirements for complete echo studies has discouraged many laboratories from adopting digital storage, but through judicious use of "clinical compression" routine digital echocardiography can be a reality today. By limiting storage to quad screen displays of images, it is possible to store the most relevant data from an examination in just a few megabytes.

Journal Article↗