Stress Echocardiography in Italian Echocardiographic Laboratories: A Survey of the Italian Society of Echocardiography and Cardiovascular Imaging

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.

Keywords: Coronary flow velocity reserve; lung ultrasound; stress echocardiography.

Figure 1

Percentage of stressors used in stress echocardiography

Figure 2

Numbers of stressors used during stress echocardiography in low, moderate, and high volume centers

Figure 3

Percentage of coronary flow velocity reserve evaluation during stress echocardiography in low, moderate, and high volume centers

Figure 4

Percentage of lung ultrasound evaluation during stress echocardiography in low, moderate, and high volume centers

Figure 5

Percentage of stressors used in stress echocardiography (SE) on the center up. The symbol of stress echo 2030 on the right top. In the bottom on the left, an example of coronary flow evaluated at rest and at peak stress and percentage of coronary flow velocity reserve evaluation during SE in low, moderate and high volume centers. In the bottom on the center a picture of standard evaluation of regional wall motion with normal at rest and abnormal at peak stress. In the bottom on the right an example of lung ultrasound (LUS) evaluation at rest and at peak stress, and the percentage of LUS during SE in low-, moderate-, and high-volume centers