Echocardiography has an established role in the diagnosis, prognostic evaluation and therapeutic orientation in several cardiovascular diseases. The great technological development in the last decades has allowed the digitization and standardization of medical images (DICOM), miniaturization of echocardiography equipment (portable cardiac ultrasound) and the transfer of images over the internet. In this scenario, strategies for the use of telemedicine-associated echocardiography, called tele-echocardiography, have been employed in the context of clinical research with the support of teleconsultation for remote expert review, in real time or after image storage and submission. In recognition of the demands generated by the ongoing digital transformation in health, the Brazilian Society of Cardiology recently published the Telemedicine Guideline in Cardiology. The document recognizes tele-echocardiography as a strategy for early detection of congenital heart disease in newborns and screening for early detection of subclinical cases of rheumatic heart disease in children and adolescents (both recommended as indication class IIa, level of evidence B). In addition, it evokes potential application in primary health care in remote locations, where it could enable early detection of cases of heart disease and assist in prioritizing referrals to specialized care (indication class IIb, level of evidence C). It should be emphasized that such recommendations are made within the conditions of regular use of the method in Brazil, which would include the need for doctors at both ends, i.e., the execution and interpretation of the exam. The text of the Guideline explicitly states the need for regulation and legal provision for the participation of other professionals in performing diagnostic procedures (in this case, obtaining echocardiographic images by non-doctors), currently not allowed by the country’s legislation.

In recent years, tele-echocardiography has extended the application of the method to individuals in geographically distant locations, such as remote rural communities or even space. A rural area is classified as remote when 50% of the local population needs at least 45 to 60 minutes of travel by motor vehicle to reach a population center of at least 50,000 inhabitants. Several situations have been experimentally tested, with a study on focused echocardiographic by non-cardiologist physicians,^, non-physicians,^, or remote-operated robotic devices, combined with remote interpretation by echocardiography cardiologists.

[…]