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Pulmonary hypertension is a condition with high morbidity and mortality. Resting transthoracic echocardiography is a pivotal diagnostic and screening test for pulmonary hypertension. The role of exercise stress echocardiography in the diagnosis of pulmonary hypertension is not well-established. We studied right ventricular size changes during exercise using exercise stress echocardiography to assess differences between normal and pulmonary hypertension patients and evaluate test safety, feasibility, and reproducibility. Healthy control and pulmonary hypertension patients performed recumbent exercise using a bicycle ergometer. Experienced echocardiography sonographers recorded the following resting and peak exercise right ventricular parameters using the apical four chamber view: end-diastolic area; end-systolic area; mid-diameter; basal diameter; and longitudinal diameter. Two cardiologists masked to clinical information subsequently analyzed the recordings. Parameters with acceptable inter-rater reliability were analyzed for statistical differences between the normal and pulmonary hypertension patient groups and their association with pulmonary hypertension. We enrolled 38 healthy controls and 40 pulmonary hypertension patients. Exercise stress echocardiography testing was found to be safe and feasible. Right ventricular size parameters were all readily obtainable and all had acceptable inter-observer reliability except for right ventricular longitudinal diameter. During exercise, healthy controls demonstrated a decrease in right ventricular end-systolic area, end-diastolic area, mid-diameter, and basal diameter ( P

Background: Multi-site healthcare organizations such as MaineHealth are challenged by integration and providing consistent patient care across geographically distant sites. To increase integration and imaging laboratory standardization across diverse locations, MaineHealth undertook an initiative in 2016 to accredit sixteen echocardiography laboratories in a single application. The purpose of this study was to assess the impact of System-wide Accreditation (SWA) at MaineHealth and examine employees’ perception of whether SWA affects efficiency. Methods: Twenty field interviews were conducted with MaineHealth staff. Responses were analyzed for overlapping themes. To quantify perceptions of SWA, researchers administered a brief, anonymous survey answered by 11 employees. Researchers conducted site visits to Maine Medical Center (MMC) and Maine Medical Partners MaineHealth Cardiology, Scarborough Office to observe the culture and practices at MaineHealth echocardiography facilities. Results: We found that MaineHealth employees believed SWA would standardize and elevate the quality of patient care, enhance staff knowledge and training, and reduce repeat echocardiograms. Employees interviewed also believed that the collaboration resulting from SWA could catalyze more widespread organizational change. Researchers calculated that SWA would save hundreds of hours in accreditation application compilation and would produce modest fee savings. However, MaineHealth has yet to demonstrate the benefit of accreditation empirically. Conclusion: This study identified, through an interview process, that MaineHealth employees anticipate SWA to reduce the number of repeated echocardiograms through standardization and increase imaging study quality, benefiting patients and MaineHealth. The employees also perceived that other hospital systems may benefit from the efficiencies realized by similar system-wide initiatives to accredit other imaging laboratories at MaineHealth. While this study is exploratory, it surfaced several testable hypotheses. As more data becomes available, further research can be undertaken to assess the effectiveness of SWA in comparison with traditional accreditation procedures. This can, in turn, guide system-wide, and even state-wide accreditation initiatives.

This article will address common cardiac conditions that require evaluation prior to noncardiac surgery, characterization of urgency and the risk associated with surgical procedures, calculation of preoperative risk assessment, indications for diagnostic testing to quantify cardiac risk, and perioperative strategies to minimize the risk of cardiac complications.

Regadenoson is a selective A2A receptor agonist approved for use as a pharmacologic stress agent for myocardial perfusion imaging after several multicenter trials demonstrated its equivalence in diagnostic accuracy for the detection of coronary artery disease and a decreased incidence of serious side effects as compared to adenosine. Recently, the FDA released a safety announcement advising of the rare but serious risk of heart attack and death associated with regadenoson and adenosine in cardiac stress testing, particularly in patients with unstable angina or cardiovascular instability. We report two cases of asystole with hemodynamic collapse in stable outpatients soon after receiving a standard regadenoson injection. The prevalence of potentially life threatening bradycardia, including asystole, associated with the use of regadenoson may be greater than previously expected. These cases highlight the need for cardiac stress labs to anticipate the potential for serious side effects with all patients during the administration of coronary vasodilators.