Predictors of Delayed Accreditation of Echocardiography Laboratories: An Analysis of the Intersocietal Accreditation Commission Database.

BACKGROUND: Intersocietal Accreditation Commission Echocardiography accreditation involves a broad-based evaluation of a given echocardiography facility's daily operation. An in-depth analysis of the most frequent noncompliant accreditation items provides learning opportunities for improvement of echocardiographic practice and facilities. METHODS: Data from 3,260 facilities applying for accreditation from 2011 to 2013 were analyzed to assess five key elements, each including multiple variables. The key elements included staff qualifications, imaging protocols, image quality, reporting, and documentation of quality improvement activities. Site characteristics for each facility were also analyzed. RESULTS: Sixty-two percent of facilities (n = 2,020) demonstrated deficiencies resulting in delayed accreditation. Deficiencies were less frequently observed at hospital-based facilities, facilities applying for reaccreditation, and facilities with credentialed sonographers. The most frequent deficiencies were related to reports (48%), followed by staff qualifications (46%), quality improvement (45%), image quality (44%), and protocols (43%). Both reports and image quality had the highest average numbers of deficiencies per facility, with 2.0 ± 1.0 and 1.83 ± 0.82, respectively. The most common deficient variables were lack of documented continuing medical education (25%), incomplete protocols (36%), incomplete interrogation of aortic stenosis from multiple views (34%), incomplete reports (36%), and insufficient annual summary of quality improvement activities (45%). CONCLUSIONS: Accreditation is delayed for a majority of facilities seeking Intersocietal Accreditation Commission Echocardiography accreditation because of major deficiencies or noncompliance. By focusing on staff continuing medical education, adoption and implementation of standard imaging protocols, ensuring acceptable image quality, using standards in reporting, and implementing quality improvement programs, echocardiography facility performance and quality as compared with the Intersocietal Accreditation Commission Echocardiography standards may be improved.

Echocardiographic findings in classical and hypermobile Ehlers-Danlos syndromes.

Structural cardiovascular alterations in the classical and hypermobile forms of Ehlers-Danlos syndrome(EDS) warrant investigation. We have examined a cohort of 38 patients with hypermobile and classical EDSs using two-dimensional echocardiography. The cohort includes 7 males and 31 females, with an age range from 12-60 years. Altered echocardiographic parameters were seen in the initial cross-sectional data analysis in 24/38 patients. Five of the 38 participants had mildly dilated aortic root (AR) or sinuses of Valsalva (SV), and an additional 7 patients had an abnormal pouching of the SV, although the absolute dimensions did not exceed the normal range. Ten patients had mild mitral, tricuspid, or aortic regurgitation, and only one patient had mitral valve prolapse (MVP). Three patients had low normal systolic function; three had evidence of mildly elevated pulmonary pressures, and two patients had mild concentric left ventricular hypertrophy (LVH). Five patients had evidence of impaired left ventricular relaxation (LVR) based on mitral valve E to A velocity ratio. Interestingly, 26/38 subjects demonstrated a prominent right coronary artery (RCA) easily visualized by trans-thoracic echocardiography, and 10/38 had an elongated cardiac silhouette on the 4-chamber apical views. The "pouching" shape of the SV was more common in hypermobile type than in the classical type of EDS. The study is ongoing and will accrue longitudinal data on 100 subjects with classical and hypermobile EDSs at 2-year intervals.