Clinically compressed digital echocardiography: a patient-safe alternative to videotape review

<p><b>INTRODUCTION</b>Digital storage of echocardiographic data offers logistical advantages over videotape archival. However, limited information is available on the accuracy of clinically compressed digitised examinations, an important consideration for patient safety.</p><p><b>MATERIALS AND METHODS</b>Transthoracic echocardiograms of 520 consecutive patients were prospectively acquired digitally and on videotape. Two echocardiologists, in consensus, reported studies in both formats sequentially. Using the videotape as a reference, the significance of any reported differences was graded from both imaging and clinical standpoints, and the reasons for these differences identified.</p><p><b>RESULTS</b>From an imaging perspective, differences between digital and videotaped studies were absent or minor in 459 cases (88%), fairly significant in 55 (11%) and very significant in 6 (1%). The main reasons for the observed differences were inadequate acquisition of optimal views (59%), an insufficient number of acquired cardiac cycles (25%) and suboptimal image quality (9%). These differences were considered to be of possible or definite clinical importance in 21 (4%) and 8 (2%) cases, respectively. In multinominal logistic regression models, the only independent predictor of significant difference between digitised and videotaped images was study complexity. Regardless of case complexity, most diagnostic errors arising from digital review were attributable to technical failure rather than observer error.</p><p><b>CONCLUSIONS</b>The potential for important errors arising from exclusive reporting of clinically compressed digital echocardiograms is small. Digital echocardiography, as practiced in a routine clinical setting, offers a patient-safe alternative to videotape review.</p>

Peripartum acute anterior ST segment elevation myocardial infarction: an uncommon presentation of acute aortic dissection

<p><b>INTRODUCTION</b>Atherosclerotic coronary artery thrombosis is the most common cause of acute myocardial infarction.</p><p><b>CLINICAL PICTURE</b>A 30-year-old lady presented with acute peripartum massive anterior ST segment myocardial infarction and cardiogenic shock. This was due to acute Stanford type A aortic dissection with the intimal flap occluding the left coronary ostium. The initial diagnosis was not apparent. Echocardiography confirmed the diagnosis.</p><p><b>TREATMENT AND OUTCOME</b>She underwent emergency surgical repair (Bentall procedure). Pathology confirmed underlying idiopathic cystic medial degeneration.</p><p><b>CONCLUSION</b>A high index of clinical suspicion is required in acute myocardial infarction presenting without traditional cardiovascular risk factors.</p>