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A Journal on Heart and Vascular Diseases

Official Journal of the Italian Society of Angiology and Vascular Pathology
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Minerva Cardioangiologica 2000 October;48(10):297-302

language: Italian

Harmonic imaging for the diagnosis of atrial septal aneurysm. Study of 550 cases in an out-patient' department

Pugliese M., Paoletti V., Rinaldi E., Paradiso M., Mammarella A., Musca A.


Background. It has been assessed whether echocardiographic harmonic imaging impro-ves the detection of atrial septal aneurysm (ASA) compared with fundamental imaging.
Methods. We studied consecutively, using fundamental and harmonic imaging, 550 patients (with or without cardiopathy; 300 females and 250 males) in an outpatients' department (age 23-76 years, mean 50 years) . We used a multifrequency transthoracic probe transmitting at 2 Mhz and receiving at 4 Mhz. The ASA was classified in three types according to Hanley et al. Type 1A, protruding into the right atrium without oscillation; Type 1B protruding into the right atrium with oscillation, and Type 2, protruding into the left atrium with oscillation. We compared atrial septal aneurysm definition in fundamental and harmonic mode, and assessed the interobserver agreement in the diagnosis of ASA. The echocardiographic images were recorded on magneto-optical disk and analysed by two blinded observer. With Pearson test we assessed the interobserver concordance in the ASA study; so we quantified the advantage of harmonic imaging as reduction of the interobserver variability.
Results. Among 550 consecutive subjects in the echocardiographic study population, ASA was diagnosed in 8 (1.45%) and 15 (2.72%) patients using fundamental and harmonic methods respectively. A significant reduction of the interobserver variability in the ASA diagnosis was found with harmonic imaging (harmonic imaging: r=0.96; fundamental imaging: r=0.70).
Conclusions. The harmonic methods drastically improves echocardiographic imaging of ASA, it may be used routinely and reduces the need for more invasive technique such as transesophageal echocardiography.

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