Howard S Friedman, M.D.

Analysis of the electrocardiographic waveforms produced by right ventricular pacing: relation to the nonpaced patterns
Friedman, Howard S
2008 May;31(5):529-535, Pacing & clinical electrophysiology
BACKGROUND: Ventricular aberrant conduction has a confounding effect on the known relationships between the electrocardiogram (ECG) and left ventricular (LV) mass. By relating the ECG of right ventricular pacing to LV mass and to nonpaced recordings, clarification of these effects might emerge. METHODS AND RESULTS: In 30 patients (age, 81 +/- 7 years; 13 women) who had right ventricular paced ECGs and echocardiograms, 24 of who also had nonpaced ECGs, comparative analyses were performed. Although the nonpaced ECGs had strong correlations with various echocardiographic measurements, for paced ECGs, only QRS complex voltage and interventricular septal thickness (IVS) were significantly related. However, paced QRS complex voltage relationships correlated with those of nonpaced QRS complexes, ranging from an r = 0.54, P < 0.006, for the sum of the R in aVL and the S in V-3 to r = 0.78, P < 0.001, for the sum of the R in I and the S in III. Paced ECGs had a QRS complex with a greater spatial amplitude, a longer duration, and a more superior position, and had more deeply inverted T waves than nonpaced ECGs. The differences between the voltages of paced and nonpaced QRS complexes, moreover, diminished as LV mass and/or IVS increased. When compared with nonpaced ECGs, paced ECGs showed the most similarity to nonpaced ECGs having a left bundle branch block (LBBB) pattern. Except for the presence of more superiorly directed QRS complexes, paced impulses were not significantly different (P < 0.008) from nonpaced impulses having a LBBB pattern. Also, the nonpaced ECG pattern had no discernable effect on ECG produced by right ventricular (RV) pacing. CONCLUSIONS: Despite having weak relations with echocardiographic measurements, the QRS complex voltage of the paced ECG correlated with those of nonpaced ECGs, and the voltage differences between them were smaller as LV mass increased
— id: 79159, year: 2008, vol: 31, page: 529, stat: Journal Article,

Determinants of the total cosine of the spatial angle between the QRS complex and the T wave (TCRT): implications for distinguishing primary from secondary T-wave abnormalities
Friedman, Howard S
2007 Jan;40(1):12-17, Journal of electrocardiology
BACKGROUND: Contrary to intuitive expectations and dissimilar from that which occurs in the atria, left ventricular (LV) depolarization and repolarization proceed in opposite directions, creating a concordance of the spatial QRS complex and T-wave angles (QRS-T). By defining the determinants of QRS-T, it might be possible to distinguish a primary (caused by an abnormality of repolarization) from a secondary (caused by a delay in ventricular depolarization) T-wave abnormality. METHODS AND RESULTS: From a near-consecutive series of 154 patients (age, 60 +/- 16 years; 81 females) in sinus rhythm, Doppler echocardiographic and 12-lead electrocardiogram (ECG) findings were related to the total cosine of the angle subtended by the spatial QRS complex and T wave (TCRT). Using the QRS complex and T-wave angles in the frontal and horizontal planes, TCRT was obtained from the table cited in the article of Helm and Fowler (Am Heart J 1953;45:835). TCRT correlated negatively with age, QRS duration (QRS), interventricular septal thickness (IVS) and posterior wall thickness, LV mass, LV cross-sectional area (CSA), LV relative wall thickness (RWT), left atrial dimension, and atrial velocity time integral (all, P < .001), but it was not related to LV diastolic dimension or systolic function. In multivariate analyses of the entire cohort or of patients without a left bundle branch block, QRS, CSA, RWT, and atrial velocity time integral emerged as independent variables (all, P < .001). When patients with right bundle branch block were also excluded, IVS, instead of CSA and RWT, was significant (P < .001). Overall, TCRT distinguished normal patients from those with heart disease, and patients with diabetes mellitus and hypertension from those not having these conditions. However, residuals of regression, TCRT = (-1.6IVS [cm]) + (-0.01QRS [milliseconds]) + 3, distinguished patients with coronary disease, but not other disorders, from normals, and diabetics, but not patients with hypertension or hyperlipidemia, from those not having these conditions (the regression having adjusted for secondary QRS-T discordance). CONCLUSIONS: The determinants of TCRT can be quantified and expressed as a regression that may be used to distinguish primary from secondary T-wave abnormalities
— id: 70026, year: 2007, vol: 40, page: 12, stat: Journal Article,

Carotid-artery stenting versus endarterectomy
Friedman, Howard S
2005 Feb 10;352(6):624-627, New England journal of medicine
— id: 61907, year: 2005, vol: 352, page: 624, stat: Journal Article,

Conditions associated with ST-segment elevation
Friedman, Howard S
2004 Mar 11;350(11):1152-1155, New England journal of medicine
— id: 61908, year: 2004, vol: 350, page: 1152, stat: Journal Article,

Heart rate variability in atrial fibrillation related to left atrial size
Friedman, Howard S
2004 Mar 15;93(6):705-709, American journal of cardiology
The purpose of this investigation was to determine whether heart rate variability (HRV) in atrial fibrillation (AF) can be related to any echocardiographic-derived measurements of cardiac dimensions or function. AF is characterized by marked HRV. Although HRV in normal sinus rhythm has been studied and shown to have important clinical implications, there have been relatively few published reports dealing with the phenomenon in AF. This study examines HRV in AF taking into account the influence of heart rate. HRV measurements were obtained in 38 patients with persistent AF who had undergone 24-hour ambulatory electrocardiographic monitoring. Taking into account a strong heart rate dependence of the HRV measurements, regressions were calculated. The relations were then re-examined using the differences (diff) in HRV from the expected for the average RR intervals. No significant correlations were found between unadjusted HRV measurements and any clinical features or echocardiographic variables. However, taking into account heart rate relations, with negative HRVdiff signifying less HRV than expected, reduced HRV correlated with increasing left atrial and left ventricular dimensions. On multivariate regression analysis, left atrial dimension emerged as an independent determinant of HRV. Also, HRV was greater in patients with lone AF than in those with cardiac disorders. HRV in AF is highly rate dependent. Unless this influence is taken into account, important relations may be obscured. When HRVdiff are related to echocardiographic measurements, increasing left atrial dimensions correlate with less HRV
— id: 42580, year: 2004, vol: 93, page: 705, stat: Journal Article,

Serum homocysteine and stroke in atrial fibrillation
Friedman, HS
2001 FEB 6 ;134(3):253-254, Annals of internal medicine
— id: 55217, year: 2001, vol: 134, page: 253, stat: Journal Article,

Knowledge discovery from databases and data mining: new paradigms for statistics and data analysis
Friedman H; Goldberg JD
2000 ;8(2):1-12, Biopharmaceutical report
— id: 24760, year: 2000, vol: 8, page: 1, stat: Journal Article,

Observational studies and randomized trials
Friedman, HS
2000 OCT 19 ;343(16):1195-1196, New England journal of medicine
— id: 54501, year: 2000, vol: 343, page: 1195, stat: Journal Article,

Cardiovascular effects of alcohol
Friedman HS
1998 ;14:135-166, Recent developments in alcoholism
The ingestion of one or two alcoholic drinks can affect heart rate, blood pressure, cardiac output, myocardial contractility, and regional blood flow. These actions generally are not clinically important. In the presence of cardiovascular disease, however, even such small quantities of alcohol might result in transient unfavorable hemodynamic changes. Moreover, alcohol abuse can produce cardiac arrhythmias, hypertension, cardiomyopathy, stroke, and even sudden death. In contrast, moderate alcohol use produces changes that have an overall favorable effect on atherosclerotic-related vascular diseases. Because cardiovascular disease due to atherosclerosis is the leading cause of death in Western society, this desirable effect of alcohol use outweighs its detrimental actions, resulting in favorable findings in population studies. Nevertheless, the body of evidence argues against encouraging alcohol use for its cardiovascular effects
— id: 67023, year: 1998, vol: 14, page: 135, stat: Journal Article,

Streptokinase versus alteplase in acute myocardial infarction
Friedman HS
1996 Aug;89(8):427-430, Journal of the Royal Society of Medicine
— id: 67024, year: 1996, vol: 89, page: 427, stat: Journal Article,

Coronary bypass graft surgery: reexamining the assumptions
Friedman HS
1990 Jan-Feb;5(1):80-83, Journal of general internal medicine
— id: 67025, year: 1990, vol: 5, page: 80, stat: Journal Article,

Effects of acetyl strophanthidin on duration of atrial fibrillation in the neurally-intact and blockaded dog
Mokraoui AM; Friedman HS; Melniker LA; Nguyen TN
1988 Nov;2(4):569-577, Cardiovascular drugs & therapy
Although the inotropic and dromotropic effects of cardiac glycosides in atrial fibrillation (AF) are well recognized, their action on AF itself is not clear. Accordingly, to determine whether cardiac glycosides prolong AF, the duration of electrically induced AF, atrioventricular conduction, and left ventricular function were assessed for 30 minutes before and for 30 minutes following intravenous administration of acetyl strophanthidin (AS), 20 micrograms/kg, in neurally intact, beta-blocked, and beta-blocked and vagotomized dogs. In the intact dog, AS, 20 micrograms/kg, increased peak dp/dt by 132 +/- 35 mmHg.sec-1, p less than 0.05, and slowed ventricular response by 16 +/- 7 min-1, p less than 0.05, but had a variable effect on AF duration. While the increased left ventricular peak dp/dt persisted for 15 minutes after AS, an increased duration of AF was evident only at 20 minutes, when the effects of AS on left ventricular (LV) inotropy were no longer apparent. Moreover, the subset of dogs that did not demonstrate prolongation of average duration of AF after AS had a greater increment of peak dp/dt than those that showed prolongation, 237 +/- 52 versus 53 +/- 31 mmHg.sec-1, p less than 0.05. An additional 20 micrograms/kg, which produced ventricular extrasystoles, prolonged AF duration when compared to both control and 30-minute measurements. Acetyl strophanthidin, 20 micrograms/kg, had a variable effect on duration of AF with beta-blockade but prolonged duration by 114 +/- 34%, p less than 0.05, with both vagotomy and beta-blockade.(ABSTRACT TRUNCATED AT 250 WORDS)
— id: 67026, year: 1988, vol: 2, page: 569, stat: Journal Article,

MR imaging of neuronal migrational disorders
Osborn, R E; Byrd, S E; Naidich, T P; Bohan, T P; Friedman, H
1988 Nov-Dec;9(6):1101-1106, AJNR. American journal of neuroradiology
Neuronal migrational disorders of the brain represent abnormalities in the formation of the neocortex caused by faulty migration of the subependymal neuroblasts. These migrational anomalies include lissencephaly (agyria/pachygyria), pachygyria, schizencephaly, heterotopias, hemimegalencephaly, and polymicrogyria. We used MR imaging (performed on a 0.5-T or 1.5-T scanner) to evaluate 21 patients who had neuronal migratory anomalies. Four patients had lissencephaly, seven had pachygyria, including one patient with hemimegalencephaly, seven had schizencephaly, and three had heterotopias. All MR scans included T1-weighted spin-echo sequences, and seven also had inversion-recovery sequences. The cortical surface, cortex, and gray-white matter interface were well evaluated with both sequences; however, the inversion-recovery images were superior. All but two patients were imaged in both the axial and coronal planes: both projections demonstrated well the migrational abnormalities. MR is an excellent method for diagnosing the migrational anomalies of lissencephaly, pachygyria, schizencephaly, heterotopias, and hemimegalencephaly; it appears to be the imaging method of choice for evaluating these disorders
— id: 146709, year: 1988, vol: 9, page: 1101, stat: Journal Article,

Predicting patient satisfaction from physicians' nonverbal communication skills
DiMatteo, M R; Taranta, A; Friedman, H S; Prince, L M
1980 Apr;18(4):376-387, Medical care
PIP: The association between the nonverbal communication skills of physicians and patient satisfaction with medical care was assessed in 2 studies involving 71 residents in internal medicine and 462 patients. Scores on standardized, reliable, and valid measures of nonverbal skills such as the ability to communicate and to understand facial expressions, body movement, and voice tone cues to emotion were correlated with the ratings physicians received from patients regarding satisfaction with the technical and socioemotional aspects of the medical care received. Although physicians' nonverbal communication skills were little related to patients' ratings of the technical qualities of care received, measures of these skills did predict satisfaction with 'art of care' aspects. Specifically, the art of care assessment was dependent on the physicians' skill at understanding bodily nonverbal communication, the physicians' capacity to express emotion through voice tone, and their ability to avoid communicating negative emotion when intending positive. These findings provide support to the centrality of interpersonal effectiveness to the physician-patient relationship, especially nonverbal sensitivity and expressiveness. Improvements in the level of physicians' nonverbal encoding and decoding skills through training and selection can be expected to improve the quality of medical care and perhaps even its cost-effectiveness
— id: 127621, year: 1980, vol: 18, page: 376, stat: Journal Article,