Organization and Activity of Italian Echocardiographic Laboratories: A Survey of the Italian Society of Echocardiography and Cardiovascular Imaging
Authors: Ciampi Quirino , Pepi Mauro , Antonini-Canterin Francesco , Barbieri Andrea , Barchitta Agata , Faganello Giorgio , Miceli Sofia , Parato Vito Maurizio , Tota Antonio , Trocino Giuseppe , Abbate Massimiliana , Accadia Maria , Alemanni Rossella , Angelini Andrea , Anglano Francesco , Anselmi Maurizio , Aquila Iolanda , Aramu Simona , Avogadri Enrico , Azzaro Giuseppe , Badano Luigi , Balducci Anna , Ballocca Flavia , Barbarossa Alessandro , Barbati Giovanni , Barletta Valentina , Barone Daniele , Becherini Francesco , Benfari Giovanni , Beraldi Monica , Bergandi Gianluigi , Bilardo Giuseppe , Binno Simone Maurizio , Bolognesi Massimo , Bongiovi Stefano , Bragato Renato Maria , Braggion Gabriele , Brancaleoni Rossella , Bursi Francesca , Dessalvi Christian Cadeddu , Cameli Matteo , Canu Antonella , Capitelli Mariano , Capra Anna Clara Maria , Carbonara Rosa , Carbone Maria , Carbonella Marco , Carrabba Nazario , Casavecchia Grazia , Casula Margherita , Chesi Elena , Cicco Sebastiano , Citro Rodolfo , Cocchia Rosangela , Colombo Barbara Maria , Colonna Paolo , Conte Maddalena , Corrado Giovanni , Cortesi Pietro , Cortigiani Lauro , Costantino Marco Fabio , Cozza Fabiana , Cucchini Umberto , D’Angelo Myriam , Ros Santina Da , D’Andrea Fabrizio , D’Andrea Antonello , D’Auria Francesca , De Caridi Giovanni , De Feo Stefania , De Matteis Giovanni Maria , De Vecchi Simona , Giudice Carmen Del , Dell’Angela Luca , Paoli Lucrezia Delli , Dentamaro Ilaria , Destefanis Paola , Di Fulvio Maria , Di Gaetano Renato , Di Giannuario Giovanna , Di Gioia Angelo , Di Martino Luigi Flavio Massimiliano , Di Muro Carmine , Di Nora Concetta , Di Salvo Giovanni , Dodi Claudio , Dogliani Sarah , Donati Federica , Dottori Melissa , Epifani Giuseppe , Fabiani Iacopo , Ferrara Francesca , Ferrara Luigi , Ferrua Stefania , Filice Gemma , Fiorino Maria , Forno Davide , Garini Alberto , Giarratana Gioachino Agostino , Gigantino Giuseppe , Giorgi Mauro , Giubertoni Elisa , Greco Cosimo Angelo , Grigolato Michele , Marra Walter Grosso , Holzl Anna , Iaiza Alessandra , Iannaccone Andrea , Ilardi Federica , Imbalzano Egidio , Inciardi Riccardo , Inserra Corinna Antonia , Iori Emilio , Izzo Annibale , Rosa Giuseppe La , Labanti Graziana , Lanzone Alberto Maria , Lanzoni Laura , Lapetina Ornella , Leiballi Elisa , Librera Mariateresa , Conte Carmenita Lo , Monaco Maria Lo , Lombardo Antonella , Luciani Michelangelo , Lusardi Paola , Magnante Antonio , Malagoli Alessandro , Malatesta Gelsomina , Mancusi Costantino , Manes Maria Teresa , Manganelli Fiore , Mantovani Francesca , Manuppelli Vincenzo , Marchese Valeria , Marinacci Lina , Mattioli Roberto , Maurizio Civelli , Mazza Giuseppe Antonio , Mazza Stefano , Melis Marco , Meloni Giulia , Merli Elisa , Milan Alberto , Minardi Giovanni , Monaco Antonella , Monte Ines , Montresor Graziano , Moreo Antonella , Mori Fabio , Morini Sofia , Moro Claudio , Morrone Doralisa , Negri Francesco , Nipote Carmelo , Nisi Fulvio , Nocco Silvio , Novello Luigi , Nunziata Luigi , Perini Alessandro Paoletti , Parodi Antonello , Pasanisi Emilio Maria , Pastorini Guido , Pavasini Rita , Pavoni Daisy , Pedone Chiara , Pelliccia Francesco , Pelliciari Giovanni , Pelloni Elisa , Pergola Valeria , Perillo Giovanni , Petruccelli Enrica , Pezzullo Chiara , Piacentini Gerardo , Picardi Elisa , Pinna Giovanni , Pizzarelli Massimiliano , Pizzuti Alfredo , Poggi Matteo Maria , Posteraro Alfredo , Privitera Carmen , Rampazzo Debora , Ratti Carlo , Rettegno Sara , Ricci Fabrizio , Ricci Caterina , Rolando Cristina , Rossi Stefania , Rovera Chiara , Ruggieri Roberta , Russo Maria Giovanna , Sacchi Nicola , Saladino Antonino , Sani Francesca , Sartori Chiara , Scarabeo Virginia , Sciacqua Angela , Scillone Antonio , Scopelliti Pasquale Antonio , Scorza Alfredo , Scozzafava Angela , Serafini Francesco , Serra Walter , Severino Sergio , Simeone Beatrice , Sirico Domenico , Solari Marco , Spadaro Gian Luca , Stefani Laura , Strangio Antonio , Surace Francesca Chiara , Tamborini Gloria , Tarquinio Nicola , Tassone Eliezer Joseph , Tavarozzi Isabella , Tchana Bertrand , Tedesco Giuseppe , Tinto Monica , Torzillo Daniela , Totaro Antonio , Triolo Oreste Fabio , Troisi Federica , Tusa Maurizio , Vancheri Federico , Varasano Vincenzo , Venezia Amedeo , Vermi Anna Chiara , Villari Bruno , Zampi Giordano , Zannoni Jessica , Zito Concetta , Zugaro Antonello , Di Bella Gianluca , Carerj Scipione 
Published: September 2024

Background:
The Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI) conducted a national survey to understand better how different echocardiographic modalities are used and accessed in Italy.

Methods:
We analyzed echocardiography laboratory activities over a month (November 2022). Data were retrieved via an electronic survey based on a structured questionnaire, uploaded on the SIECVI website.

Results:
Data were obtained from 228 echocardiographic laboratories: 112 centers (49%) in the northern, 43 centers (19%) in the central, and 73 (32%) in the southern regions. During the month of observation, we collected 101,050 transthoracic echocardiography (TTE) examinations performed in all centers. As concern other modalities there were performed 5497 transesophageal echocardiography (TEE) examinations in 161/228 centers (71%); 4057 stress echocardiography (SE) examinations in 179/228 centers (79%); and examinations with ultrasound contrast agents (UCAs) in 151/228 centers (66%). We did not find significant regional variations between the different modalities. The usage of picture archiving and communication system (PACS) was significantly higher in the northern (84%) versus central (49%) and southern (45%) centers (P < 0.001). Lung ultrasound (LUS) was performed in 154 centers (66%), without difference between cardiology and noncardiology centers. The evaluation of left ventricular (LV) ejection fraction was evaluated mainly using the qualitative method in 223 centers (94%), occasionally with the Simpson method in 193 centers (85%), and with selective use of the three-dimensional (3D) method in only 23 centers (10%). 3D TTE was present in 137 centers (70%), and 3D TEE in all centers where TEE was done (71%). The assessment of LV diastolic function was done routinely in 80% of the centers. Right ventricular function was evaluated using tricuspid annular plane systolic excursion in all centers, using tricuspid valve annular systolic velocity by tissue Doppler imaging in 53% of the centers, and using fractional area change in 33% of the centers. When we divided into cardiology (179, 78%) and noncardiology (49, 22%) centers, we found significant differences in the SE (93% vs. 26%, P < 0.001), TEE (85% vs. 18%), UCA (67% vs. 43%, P < 0001), and STE (87% vs. 20%, P < 0.001). The incidence of LUS evaluation was similar between the cardiology and noncardiology centers (69% vs. 61%, P = NS).

Conclusions:
This nationwide survey demonstrated that digital infrastructures and advanced echocardiography modalities, such as 3D and STE, are widely available in Italy with a notable diffuse uptake of LUS in the core TTE examination, a suboptimal diffusion of PACS recording, and conservative use of UCA, 3D, and strain. There are significant differences between northern and central-southern regions and echocardiographic laboratories that pertain to the cardiac unit. This inhomogeneous distribution of technology represents one of the main issues that must be solved to standardize the practice of echocardiography.