Abstract
Background: Cardiology divisions reshaped their activities during the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to analyze the organization of echocardiographic laboratories and echocardiography practice during the second wave of the COVID-19 pandemic in Italy, and the expectations for the post-COVID era. Methods: We analyzed two different time periods: the month of November during the second wave of the COVID-19 pandemic (2020) and the identical month during 2019 (November 2019). Results: During the second wave of the COVID-19 pandemic, the hospital activity was partially reduced in 42 (60%) and wholly interrupted in 3 (4%) echocardiographic laboratories, whereas outpatient echocardiographic activity was partially reduced in 41 (59%) and completely interrupted in 7 (10%) laboratories. We observed an important change in the organization of activities in the echocardiography laboratory which reduced the operator-risk and improved self-protection of operators by using appropriate personal protection equipment. Operators wore FFP2 in 58 centers (83%) during trans-thoracic echocardiography (TTE), in 65 centers (93%) during transesophageal echocardiography (TEE) and 63 centers (90%) during stress echocardiography. The second wave caused a significant reduction in number of echocardiographic exams, compared to November 2019 (from 513 ± 539 to 341 ± 299 exams per center, −34%, p < 0.001). On average, there was a significant increase in the outpatient waiting list for elective echocardiographic exams (from 32.0 ± 28.1 to 45.5 ± 44.9 days, +41%, p < 0.001), with a reduction of in-hospital waiting list (2.9 ± 2.4 to 2.4 ± 2.0 days, −17%, p < 0.001). We observed a large diffusion of point-of-care cardiac ultrasound (88%), with a significant increase of lung ultrasound usage in 30 centers (43%) during 2019, extended to all centers in 2020. Carbon dioxide production by examination is an indicator of the environmental impact of technology (100-fold less with echocardiography compared to other cardiac imaging techniques). It was ignored in 2019 by 100% of centers, and currently it is considered potentially crucial for decision-making in cardiac imaging by 65 centers (93%). Conclusions: In one year, major changes occurred in echocardiography practice and culture. The examination structure changed with extensive usage of point-of-care cardiac ultrasound and with lung ultrasound embedded by default in the TTE examination, as well as the COVID-19 testing.
Highlights
Cardiologists were engaged in an important way in the coronavirus disease 2019 (COVID-19) pandemic, with an important tribute in terms of infected and passed away professionals involved in clinical management and diagnostic screening with cardiac and lung ultrasound
We have taken notice of a significant increase in the usage of lung ultrasound associated to trans-thoracic echocardiography (TTE) in all patients during COVID’s second wave (+57%) compared to the same period in 2019
Major changes occurred in echocardiography practice and culture, triggered by the adaptive response to the COVID-19 pandemic
Summary
Cardiologists were engaged in an important way in the coronavirus disease 2019 (COVID-19) pandemic, with an important tribute in terms of infected and passed away professionals involved in clinical management and diagnostic screening with cardiac and lung ultrasound. We sought to provide an instant survey of the echocardiography practice during the second wave of the COVID-19 pandemic in Italy, with high expectations for the post-COVID era regarding the echocardiographic activity and the perceived role of carbon dioxide production by cardiac imaging modalities in decision-making and its importance in the future development of imaging. Cardiology divisions reshaped their activities during the coronavirus disease 2019 (COVID-19) pandemic. The examination structure changed with extensive usage of point-of-care cardiac ultrasound and with lung ultrasound embedded by default in the TTE examination, as well as the COVID-19 testing
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