Hi 8BitMonk,
Basically, set "monitor lcd", "aspect 16:10" (or 16:9 or whatever), and play with "syncrefresh_tolerance" to decide how big the refresh difference needs to be in order to automatically turn off syncrefresh and enable triplebuffer instead. For the later, make sure that multithreading is enabled, otherwise it won't work.
The benefits are smooth scrolling and sound synchronization. It can be used with HLSL, of course, but you'll need a pretty decent card to get good performance with it.
If the monitor is old enough there's a not so remote probability that it accepts custom refresh rates. If this is the case you might want to use GroovyMAME to interface with Powerstrip to achieve custom timings (for refresh rates different than 60 Hz). Though a card that's old enough to be supported by Powerstrip won't be good for HLSL.