Stress Echocardiography in 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 , Da Ros Santina , D’Andrea Fabrizio , D’Andrea Antonello , D’Auria Francesca , De Caridi Giovanni , De Feo Stefania , De Matteis Giovanni Maria , De Vecchi Simona , Del Giudice Carmen , Dell’Angela Luca , Paoli Lucrezia Delli , Dentamaro Ilaria , Destefanis Paola , Di Bella Gianluca , 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 M. , Inserra Corinna Antonia , Iori Emilio , Izzo Annibale , La Rosa Giuseppe , 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 , Picano Eugenio , Carerj Scipione 
Published: June 2024

Abstract

Background:
The Italian Society of Echography and Cardiovascular Imaging (SIECVI) conducted a national survey to understand the volumes of activity, modalities and stressors used during stress echocardiography (SE) in Italy.

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

Results:
Data were obtained from 228 echocardiographic laboratories, and SE examinations were performed in 179 centers (80.6%): 87 centers (47.5%) were in the northern regions of Italy, 33 centers (18.4%) were in the central regions, and 61 (34.1%) in the southern regions. We annotated a total of 4057 SE. We divided the SE centers into three groups, according to the numbers of SE performed: <10 SE (low-volume activity, 40 centers), between 10 and 39 SE (moderate volume activity, 102 centers) and ≥40 SE (high volume activity, 37 centers). Dipyridamole was used in 139 centers (77.6%); exercise in 120 centers (67.0%); dobutamine in 153 centers (85.4%); pacing in 37 centers (21.1%); and adenosine in 7 centers (4.0%). We found a significant difference between the stressors used and volume of activity of the centers, with a progressive increase in the prevalence of number of stressors from low to high volume activity (P = 0.033). The traditional evaluation of regional wall motion of the left ventricle was performed in all centers, with combined assessment of coronary flow velocity reserve (CFVR) in 90 centers (50.3%): there was a significant difference in the centers with different volume of SE activity: the incidence of analysis of CFVR was significantly higher in high volume centers compared to low – moderate – volume (32.5%, 41.0% and 73.0%, respectively, P < 0.001). The lung ultrasound (LUS) was assessed in 67 centers (37.4%). Furthermore for LUS, we found a significant difference in the centers with different volume of SE activity: significantly higher in high volume centers compared to low – moderate – volume (25.0%, 35.3% and 56.8%, respectively, P < 0.001).

Conclusions:
This nationwide survey demonstrated that SE was significantly widespread and practiced throughout Italy. In addition to the traditional indication to coronary artery disease based on regional wall motion analysis, other indications are emerging with an increase in the use of LUS and CFVR, especially in high-volume centers.