Current National Availability of Advanced Echocardiography Imaging: Real World Data From an Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI) Survey

Advanced echocardiographic imaging (AEI) techniques, such as three-dimensional (3D) and multi-chamber speckle-tracking deformation imaging (strain) analysis, have been shown to be more accurate in assessing heart chamber geometry and function when compared to conventional echocardiography providing additional prognostic value. However, incorporating AEI alongside standard examinations may be heterogeneous between echo laboratories (echo labs). Thus, our goal was to gain a better understanding of the many AEI modalities that are available and employed in Italy. The Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI) conducted a national survey over a month (November 2022) to describe the use of AEI in Italy. Data were retrieved via an electronic survey based on a structured questionnaire uploaded on the SIECVI website. Data obtained from 173 echo-labs were divided into three groups, according to the numbers of echocardiograms performed: <250 exams (low-volume activity, 53 centers), between 251 and 550 exams (moderate-volume activity, 62 centers) and ≥550 exams (high-volume activity, 58 centers). Transthoracic echocardiography (TTE) 3D was in use in 75% of centers with a consistent difference between low activity volume (55%), medium (71%), and high-volume (85%), p=0.002, while 3D transesophageal echocardiography (TEE) was in use in 84% of centers, reaching the 95% in high activity volume echo-labs (p=0.006). In centers with available 3D TTE, it was used for the left ventricle (LV) analysis in 67%, for the right ventricle (RV) in 45%, and for the left atrium (LA) in 40%, showing greater use in high-volume centers compared to low and medium-volume centers (all p<0.04). Strain analysis was utilized in most echo labs (80%), with a trend toward greater use in high-volume centers than low and medium-volume centers (77%, 74%, and 90%, respectively; p=0.08). In centers with available strain analysis, it was mainly employed for the LV (80%) and much less frequently for the RV and LA (49% and 48%, respectively). In Italy, the AEI modalities are more frequently available in centers with high-volume activity but employed only in a few applications, being more frequent in analyzing the LV compared to the RV and LA. Therefore, the echocardiography community and SIECVI should promote uniformity and effective training across the Italian centers. Meanwhile, collaborations across centers with various resources and expertise should be encouraged to use the benefits of the AEI.