Observer variation in the echocardiographic measurement of maximum atrial septal excursion: a comparison of M-mode with two-dimensional or transesophageal echocardiography.

BACKGROUND: Atrial septal aneurysm is typically diagnosed by transthoracic two-dimensional or transesophageal echocardiography (2DE or TEE). Such techniques are highly dependent on visual inspection which predisposes to observer variation. This study compares inter- and intraobserver variations in the measurement of maximum atrial septal excursion (MASE) obtained using transthoracic M-mode echocardiography (MME) with that obtained using 2DE or TEE. METHODS: Consecutive patients with highly mobile atrial septal motion by visual inspection during 2DE or TEE were studied. MASE was estimated visually on 2DE or TEE. MME tracings were obtained with the cursor bisecting the parabola formed by the atrial septum at its maximum deviation from the midline. Electronic calipers were used to measure MASE for all echocardiographic techniques. Two observers provided two measurements each. Observer variation was determined by assessing standard deviation and confidence intervals of inter- and intraobserver differences. RESULTS: Interobserver analysis showed standard deviations of 0.077 cm (95% CI 0.065-0.094) for MME and 0.280 cm (95% CI 0.242-0.334) for 2DE or TEE. Intraobserver analysis showed standard deviations of 0.08 cm (95% CI 0.068-0.101) for MME and 0.318 cm (95% CI 0.274-0.381) for 2DE or TEE. The mean magnitude of measured MASE was 0.44 cm higher with MME than with 2DE or TEE (95% CI 0.068-0.101). CONCLUSIONS: MME assessment of MASE is associated with substantially lower inter- and intraobserver variation than 2DE or TEE assessment. The magnitude of MASE is substantially higher with MME than with 2DE or TEE.

Managing heart failure better: the value of implantable device data.

The heart failure disease state is challenging, time consuming and expensive to manage. Physicians are responsible for initiating, titrating and optimizing drug and device therapy to reduce morbidity and mortality. Failure to manage these aspects of care often results in worsening of symptoms and recurrent hospitalizations. This paper reviews the data implantable devices provide and how this data can assist in optimally managing the patient with heart failure.

Echocardiography predicts adverse cardiac remodelling in heart failure.

Congestive heart failure remains a primary cause of cardiovascular-related events. Heart failure patients face two health care challenges. First, they are uncertain about their prognosis and second, they have an unpredictable clinical course with recurrent exacerbations of heart failure. The echocardiogram is an easily accessible bedside test without any associated procedural complications. Additionally, it provides a wealth of information about chamber size and function, valve integrity and the pericardial sac. In the present review, the most common echocardiographic predictors of impending cardiac events in congestive heart failure are described.

Endocrine and metabolic effects of fat: cardiovascular implications.

The prevalence of obesity is increasing rapidly in both industrialized and developing nations. Obesity causes complex metabolic, endocrine, and hemodynamic changes that may lead to adverse cardiovascular outcomes such as coronary heart disease and congestive heart failure. Adipose tissue is no longer considered to be an inert organ of energy storage, but in fact possesses important endocrine and metabolic functions that are closely involved in energy homeostasis. During the past decade, our understanding of the unique pathophysiologic changes that occur with obesity has rapidly grown. This review discusses our current understanding of the endocrine and metabolic effects of fat and their potential relation to cardiovascular disease.

Single coronary artery with the absence of a left anterior descending artery.

Anomalous origin of coronary arteries is discovered incidentally during coronary arteriography or at autopsy, and awareness among angiographers is required. We describe a case with a rare combination of a single coronary artery originating from the right sinus of Valsalva associated with an absent left anterior descending artery and a secundum-type atrial septal defect.