Demographics of severe valvular aortic stenosis in Singapore

<p><b>INTRODUCTION</b>The treatment of aortic valve stenosis (AS) is seeing renewed interest mainly due to the availability of transcatheter therapies. However, the number of epidemiological studies of this disease in Singapore is limited. We aimed to describe the aetiology and clinical presentation of AS in Singapore, as well as patients' attitudes toward it. Our findings may facilitate the future planning and utilisation of resources to better manage these patients.</p><p><b>METHODS</b>249 consecutive patients who underwent transthoracic echocardiography (from April 1999 to April 2008) and diagnosed with severe AS were assessed. Demographic and clinical data were collected, and patients' decisions on surgery were determined.</p><p><b>RESULTS</b>The mean patient age was 71 (range 23-98) years. 50.2% of patients were male. The commonest presenting symptom was dyspnoea, and 40 (16.0%) patients had coexistent atrial fibrillation. The aetiology of AS was degenerative in 216 (86.7%), rheumatic in 11 (4.4%) and related to a bicuspid valve in 22 (8.9%) patients. The average peak velocity across the aortic valve was 4.2 ± 0.8 m/s and the mean aortic valve area was 0.76 ± 0.13 cm2. The overall mean logistic EuroSCORE was 10.7 ± 12.3. 105 (42.2%) patients who were offered surgery refused. 87 (35%) deaths were seen during the follow-up period (mean duration 14.5 months), which also saw 68 (27%) patients undergo surgery and 86 (34%) patients hospitalised for heart failure.</p><p><b>CONCLUSION</b>Degenerative AS was the commonest aetiology in this contemporary cohort of patients. Despite the known benefits of surgery, the refusal rate for surgery remained high.</p>

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>