EACVI TTE Echo Certification (Easy Guide)

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What is the EACVI TTE Echo Certificate

The EACVI TTE Certificate is an internationally recognized certification in transthoracic echocardiography (TTE).

It is issued by the European Association of Cardiovascular Imaging (EACVI), which is part of the ESC (European Society of Cardiology).

The EACVI TTE Certificate is highly respected and recognized both in Europe and internationally.
The list of certificate holders is publicly available, as is the list of accredited echocardiography laboratories.

This makes it easy to verify the authenticity of the certificate.

Who can obtain the TTE Certificate

The certificate can be obtained by a physician (MD) or a biomedical engineer (Ing.).
A physician does not need to be board-certified, does not need to be a cardiologist, and does not need to work in a cardiology department.
It does not matter where the physician works or how many years of experience they have.
To obtain the certificate, you must pass an online exam.

You do not need to travel anywhere; the entire exam is conducted online.

How to register for the exam

Register on the website of the European Society of Cardiology (escardio.org).
Then, create a membership in the EACVI society as a Silver member (costs €75 if you are under 40 years old).

If you are a Silver member of EACVI, you will receive a discount on the exam fee – it's worth it.
EACVI stands for the European Association of Cardiovascular Imaging.

Exam Date

The exam date is always twice a year (June and November).
The online test begins between 11:00 – 14:00.
You will be informed about all details by email after registration.

Registration Process

Registration for the exam opens 3 months before the exam date.
Registration closes when the participant capacity is reached (which may happen in a few weeks),

or 15 days before the exam takes place.

Register as early as possible—don’t underestimate it.

How much does the exam cost?

The exam fee is €660.
It is recommended to register on the website of the European Society of Cardiology (escardio.org) and purchase a Silver EACVI membership, which costs €156 or €78 (if you are under 40 years old).
If you are a Silver EACVI member, the exam fee is €432.
You can retake the exam up to 2 times.

The fee for the 1st retake is €252.
The fee for the 2nd retake is €138.

If you want to obtain the TTE echo certificate, it is best to take the exam as soon as possible.

If you fail the first time, you will at least get familiar with the exam format, and the second time you’ll know exactly what to study.

Exam Format

The exam is online and consists of 2 parts (theoretical part and practical part):
Theoretical part (125 questions)

Each question has 5 answer options (a, b, c, d, e), and only one is correct.

There is no penalty for incorrect answers, so always select one option.

The theoretical part (125 questions) includes 2 tests:

50 questions (echo images and echo videos) – time limit: 1 hour 30 minutes.
75 questions (echo theory) – time limit: 1 hour 50 minutes.

Practical part (Logbook and 6 patients)

The logbook is an Excel file in which you list 250 patients you have examined with TTE.
6 patients – for each of these you must submit an echo report, echo images, and echo videos.

Structure of the Theoretical Exam (125 Questions)

The exam is taken online on a computer with a camera – definitely take it on a laptop.
You must be alone in the room, with only a blank sheet of paper and a pen.

No mobile phones or calculators allowed.

Before the exam, the EACVI coordinator will ask you to turn on your laptop camera.

You will be required to walk around the room with the laptop and camera – this is to check that you are alone and not using any cheat sheets.

During the exam, the proctor will enable remote desktop access to see your screen,

if you open any window with unauthorized content, you will be disqualified from the exam.

Throughout the exam, the camera and remote desktop must remain active – you are continuously monitored,

you must not leave the camera’s field of view under any circumstances.

What You Need for the Exam

EACVI TTE exam Tutor

A ChatGPT AI assistant
Sources include textbooks and blogs recommended for TTE exam preparation.
Finds and displays YouTube echo videos needed for the practical exam part.
It’s a “cardiologist” that knows everything you need for the EACVI TTE certificate.

Critical and analytical thinking.
All current exam information is available on the ESC website
ChatGPT

To help correct echo report conclusions and communicate quickly in English with EACVI.
EACVI may ask you to write a brief patient history to accompany your echo report.

A supervisor

A physician who recommends you for the exam and signs off that you have performed 250 echocardiographies.
Does not have to be a department head, professor, or EACVI-certified echocardiographer.

Basic IT skills

In the practical part of the exam, you must submit 6 examined patients,
which includes exporting echo images and videos from your echo machine.

Echo machine with ECG

This is not mandatory, but EACVI may ask you to send additional images with ECG tracing.

TECHmED Echo reporting software
- A free online echo reporting tool, used to submit your 6 echo reports.
- The software calculates BSA-adjusted values and shows how you calculated regurgitations (VTI, aliasing velocity, EROA, volumes, etc.)
If you are preparing for the TTE certificate with minimal knowledge, start learning like this:

Go through all TTE courses on medmastery.com
Read the calculation blogs and formulas on Cardioserv blog
Read the book: The EACVI Echo Handbook
Watch videos, especially Shorts, from these two YouTube channels:

Supervisor Letter

You must be recommended for the exam by a supervisor, who must sign a letter for you.
You can download the supervisor letter here,

but it is recommended to always download the most up-to-date version from the ESC website (A signed supervisor letter).

How to fill in the supervisor letter:

Translate the supervisor letter using ChatGPT.
Then fill in the required information in Slovak and translate it into English.
Have the supervisor sign the letter (this letter has minimal impact on the exam itself).

Logbook (250 Echocardiographies)

The logbook is an Excel file in which you enter 250 echocardiography cases you have performed.

It is recommended to always download the most up-to-date logbook from the ESC website (A logbook of 250 cases).

You do not insert complete echo reports, images, or videos in the logbook – only:

Date, main diagnosis, echo category, comment (optional)

The echocardiography cases must not be older than one year before the exam, i.e.:

If you plan to take the exam in 2027, the cases must be from 2026–2027.

The logbook must include cases from 9 categories, and each category has a required minimum number.

For example, you must perform at least 15 echocardiographies with mitral or aortic valvulopathy.

In the table below, you can find:

9 categories (each must be represented in the logbook)
Main diagnoses according to the echo (to be written in the logbook)
Minimum required number for each category

Echo Category (to be listed in the logbook)	Main Diagnosis (to be listed in the logbook)	Minimum Number
1. Left Ventricular Function	Reduced EF, hyperkinesia, hypokinesia, dilated or hypertrophic cardiomyopathy	>15
2. Myocardial Infarction	Segmental wall motion abnormalities, aneurysm, LV thrombus	>15
3. Valvular Disease (Ao, Mi)	Stenosis / regurgitation, prolapse, bicuspid valve, prosthetic valve, vegetations	>15
4. Congenital Heart Defects	ASD, VSD, bicuspid aortic valve, patent ductus arteriosus	>5
5. Aortic Disease	Aortic dilation, dissection, aneurysm	>3
6. Right Heart Disease	RV dilation, tricuspid regurgitation, pulmonary hypertension	>3
7. Pericardial Disease	Pericardial effusion, tamponade, constrictive pericarditis	>3
8. Masses / Thrombi	Cardiac tumors, thrombus in atrium or ventricle	>3
9. No Significant Abnormalities	Normal chamber size and function, no valve disease, preserved EF	<84

The logbook must be signed by the supervisor – the same one who signed your supervisor letter.
It is possible that the EACVI committee will ask you to anonymously submit a complete echo report for a specific patient (e.g., patient no. 128), but this is unlikely.
The EACVI exam does not solely depend on the logbook.

Someone may independently perform 1000 echocardiographies and not know how to measure the AVA (Aortic Valve Area),
while someone else may do only 50 echocardiographies and know how to measure AVA properly.

6 Patients (Echo Reports, Echo Images, Echo Videos)

You must examine 6 patients, each of whom must have:

Normal echo findings
Wall motion abnormality due to coronary artery disease
Aortic stenosis (moderate or severe)
Mitral regurgitation (moderate or severe)
Aortic regurgitation (moderate or severe)
A patient of your choice (e.g., hypertensive heart)

For each patient, you must:

write an echo report, which you generate via TECHmED Echo software.
download a specifically defined echo projection from the ultrasound machine with image or video.

Which echo images and videos you must download is detailed in the document (6 patients).

It is recommended to always download the most up-to-date version from the ESC website (6 TTE cases).

The table below shows the echo reports, echo images, and echo videos.

Echo Finding	Echo Report	Echo Images and Videos
1. Normal echo finding
2. Wall motion abnormality due to coronary artery disease
3. Aortic stenosis (moderate or severe)
4. Mitral regurgitation (moderate or severe)
5. Aortic regurgitation (moderate or severe)
6. Patient of your choice (e.g., hypertensive heart)

You must upload the 6 patients exactly according to this table (6 patients).

After registering for the exam, you will receive an email with a link where you upload the echo reports, images, and videos.

This part is very important for the exam. If the EACVI committee finds anything unclear, they may ask follow-up questions

or request additional images, videos, or revisions of your echo report.
If the EACVI committee returns one of your reports, it does not mean you need to retake the exam.

Passing the theoretical part (125 questions) is crucial for the exam, but you will only receive the certificate after properly submitting these 6 cases.
You can submit the 6 patients and the logbook after completing the theoretical exam, up to one year later.

However, it's recommended to submit it before or soon after the exam. If they return your submission, you only need to complete the missing data.

Theoretical Exam – 50 Questions (Echo Images and Videos)

Each question contains an echo video or an echo image.
For each question, you have 5 answer choices, and only one is correct.

No points are deducted for incorrect answers, so always select an option.

You have 90 minutes for 50 questions, which is approximately 1 minute and 40 seconds per question.
The test is designed to assess your ability to identify the full spectrum of physiological and pathological TTE findings.
You may have performed 500 TTEs, but still not encountered many relevant findings,

or you may have seen them without realizing they were abnormalities – or knowing what they are called.

Do you know how the following findings appear on TTE and from which projections they can be visualized?

You can review the full range of TTE findings on these two YouTube channels:

Dr. M Usman Javed

Mastering & Guidelines in Ultrasound & Echo-Card

Shorts

Theoretical Exam – 75 Questions (Theory)

Each question is theoretical, without visual content (no echo video, no echo image).
Each question has 5 answer options, and only one is correct.

No points are deducted for incorrect answers, so always choose an answer.

You have 110 minutes for these 75 questions, which is about 1 minute and 40 seconds per question.
Prepare primarily from these two textbooks:

The test is not designed to assess whether you’ve memorized every measurable value.

However, you must memorize the basic reference values.

The test is not focused on:

Strain
3D echo
Congenital heart diseases
Prosthetic valves
Correction angle α/180° or α/120° in regurgitant volume calculations

A significant part of the exam covers hemodynamics, which must be calculated on paper.
The online interface includes a basic calculator icon in the top bar. You are allowed to use this calculator.

You are not allowed to use your own computer or mobile calculator.

Using paper and the online calculator, you must be able to calculate or apply the following parameters/formulas:

CSA (Cross Section Area)
VTI (Velocity Time Integral)
Aliasing velocity and PISA for calculating regurgitant volumes
Bernoulli equation (4 × v²)
EROA (Effective Regurgitant Orifice Area)
Right atrial pressure using the inferior vena cava
Shunt calculation using Qp:Qs ratio
Pulmonary artery systolic and diastolic pressure via pulmonary regurgitation
Which measured parameter most affects the AVA (LVOT diameter because it is squared)
Regurgitant volumes
Continuity equation for aortic stenosis
Low flow low gradient aortic stenosis
Other parameters in hemodynamics...

All these formulas are included in The EACVI Echo Handbook.

The formulas are the same for all valves – if you learn to calculate one valve,

you will be able to calculate any valve.

All calculations are clearly explained on the Cardioserv blog, for example:

Also review:

Key differences: athlete’s heart vs. hypertrophic CMP vs. amyloidosis, constrictive pericarditis vs. restrictive cardiomyopathy, etc.
How to calculate Wall Motion Score Index (WMSI) – this is a common test question where you are given segment data and must compute WMSI.
Review diastolic dysfunction in The EACVI Echo Handbook.

You will be given parameters and must classify them into Grades I, II, or III.

There will likely be 1–3 questions on strain.

Definitely review strain here: Echo strain – Medmastery (the course is 47 minutes long and explained simply).
Especially memorize how "red bull’s eye" patterns appear (amyloidosis, hypertrophic CMP, hypertensive heart...).

Practical advice after completing the theoretical exam

As soon as you finish the test (125 questions) and the EACVI coordinator logs you out of the online platform,

start writing down all the questions you remember on paper – especially those you were unsure about.

If you need to retake the test, many questions tend to appear in a similar format...

Exam result

You will receive your exam result approximately 2 months after completing the theoretical part (125 questions).
This is because the EACVI committee needs to review your logbook

and especially the 6 cases (echo reports, echo images, echo videos).

It is essential to successfully pass the theoretical part (125 questions).

The 50 visual echo questions and the 75 theoretical questions are evaluated separately.
You must pass both sections. If you fail one part, you must repeat the entire theoretical section (125 questions).

If you fail the practical part (logbook or 6 cases), the EACVI will ask you to amend or complete your findings.

You do not need to retake the exam – you only submit the specific findings that the EACVI requests.

If you pass the theoretical part (125 questions), you must also correctly submit the practical part (logbook and 6 cases).

The practical part can be submitted repeatedly and later without needing to retake the theoretical exam.

Certificate validity

The TTE certificate is valid for 5 years.
You have a 1-year window for recertification (6 months before and 6 months after the certificate expiry date).

You will receive an automatic email reminder about recertification, but we recommend that you also contact EACVI yourself and not rely solely on the notification.

The recertification fee is:

€200 for non-members of EACVI
€75 for EACVI Silver Members

To recertify, you need:

A signed letter from your supervisor confirming you perform an average of 250 echocardiographic exams per year.
50 CME credits, with at least 25 credits in echocardiography.

You can earn CME credits online, e.g., via medmastery.com
or see the list of events on the ESC website.

EACVI TTE Echo Certification (Practical Guide)

What is the EACVI TTE Echo Certificate

Who can obtain the TTE Certificate

How to register for the exam

Exam Date

Registration Process

How much does the exam cost?

Exam Format

Structure of the Theoretical Exam (125 Questions)

What You Need for the Exam

Supervisor Letter

Logbook (250 Echocardiographies)

6 Patients (Echo Reports, Echo Images, Echo Videos)

Theoretical Exam – 50 Questions (Echo Images and Videos)

Theoretical Exam – 75 Questions (Theory)

Practical advice after completing the theoretical exam

Exam result

Certificate validity