Improving Quality of Exercise Stress Echocardiogram Acquisition and Interpretation: Single center experience

Background: Exercise is the preferred modality of stress testing to evaluate ischemic heart disease. The sensitivity of an exercise stress echocardiogram (ESE) relies on achieving 85% of maximum predicted heart rate (MPHR) for age and on timely acquisition of images at peak stress. Guidelines recommend image acquisition within 1 minute of recovery. Our study aimed to assess the quality of ESE in our facility, both in timely image acquisition and standardized reporting. Methods: Patients who had ESE at the John D. Dingell VA between 2023 and 2024 were reviewed. Patients who attained required workload (85% MPHR for age) were selected as the study cohort. Standard ESE protocol was followed to acquire stress echocardiogram images. Demographic and clinical data were collected, and ESE images and reports were reviewed. Results: One hundred ESE reports were reviewed out of which 86 patients attained required workload. The group was predominantly men (90%) and average age was 53 years. Average METS achieved was 11.3. Only 19 patients (22%) had timely image acquisition at required workload and 74% (64/86 patients) had image acquisition within a minute of recovery. Majority of patients had rapid heart rate recovery. (97% at 1 minute). Duke treadmill score (DTS) was reported in 21% (18/86 patients) of the tests. Conclusion: Our analysis reveals room for improvement to achieve guidelines recommended timely image acquisition. Additionally, inclusion of prognostic information through DTS is underutilized in our reports. These findings highlight opportunities to enhance quality that can ultimately improve patient care and outcomes.