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Coronary artery disease (CAD) is the leading single cause of death in Australia affecting around 1.4 million people. Coronary computed tomography angiography has an established role in the assessment of patients with low to intermediate pretest probability for CAD who have chest pain and is typically used with the aim to rule out significant coronary artery stenosis. Use was initially limited because of concerns over radiation exposure, a Medicare rebate restricted to specialist referrals and an absence of data supporting its use as an alternative to functional testing in patients with chest pain. Recent advances in scanner technology and image sequencing, along with data from randomised control trials, have addressed these issues and indicate that coronary computed tomography angiography will play a greater role in the assessment of CAD in the coming years.

The clinical use of cardiac magnetic resonance (CMR) in Australian heart failure (HF) patients has limited evidence.To examine how CMR, compared with routine echocardiography, affects the diagnosis and management of patients with HF.Single-centre retrospective study of HF patients newly referred to the Advanced Heart Failure and Transplant unit at The Prince Charles Hospital, Brisbane. Between January 2010 and December 2014, all patients clinically referred for both CMR and echocardiography in the workup of HF were analysed. Imaging results, electronic records and medical charts were reviewed for final diagnosis and changes in clinical management.A total of 114 new HF referrals was included. Evaluation of HF of uncertain aetiology (70%) was the most common indication for CMR. In 20% of cases, CMR led to a completely new diagnosis or diagnostic confirmation of suspicions raised by echocardiography. Clinical decision-making was altered in 48%, with the greatest impact on decisions regarding revascularisation. Overall, CMR had a significant impact on 50% of patients. In a multivariable model, the only independent variable significantly associated with clinical impact was the presence/absence of late gadolinium enhancement (P0.001). Importantly, body mass index, echocardiography image quality and the presence of sinus rhythm did not show statistical significance in the multivariate analysis.CMR makes a substantial contribution to both the diagnosis and management of HF patients over and above standard echocardiography. This study provides evidence of its clinical utility in the HF population in Australia and supports the role of CMR in the routine assessment of this cohort.

Echocardiography is the mainstay of cardiovascular diagnostics, and is the most performed test for the evaluation of cardiac function. Critical and costly management decisions are based on quantification of left ventricular volumes and ejection fraction. Recent advances in echocardiography, such as microsphere contrast echocardiography for left ventricular opacification and perfusion imaging, three-dimensional transthoracic and trans-oesophageal imaging, strain and tissue Doppler imaging, all contribute to improving accuracy and reproducibility of these important measurements. Such techniques are now routinely available on standard echocardiography equipment in Australian centres for daily use. Hand-carried ultrasound devices have been developed, which are portable, are affordable and offer increased availability of echocardiography to the wider community. Clinicians should be actively encouraged to adopt these technologies to improve the diagnostic quality and reproducability of echocardiography for our patients. This article provides an overview of important recent advances in echocardiographic imaging with an emphasis on their role in clinical practice today.

Pulmonary thromboembolism (PE) is the third most frequent cause of cardiovascular death after ischaemic heart disease and stroke. In fatal PE, 2/3 of patients die within first hour of presentation. There is a clinical impetus to rapidly recognize, risk-stratify and appropriately treat patients with acute severe PE. Current recommendations present conflicting classification systems, and there is often some confusion in the clinical evaluation and management of patients with acute severe PE. This review presents a series of real clinical cases, which illustrate the available treatment options, ranging from conservative therapy to thrombolysis through to percutaneous catheter fragmentation and open surgical embolectomy. We evaluate the evidence for the various strategies and propose an algorithm for clinicians with a focus on early risk stratification and timely referral. This is particularly relevant to regional and remote centres, as well as secondary and tertiary institutions.