Echocardiographic parameters in haemodynamic assessment of patients with cardiogenic shock: the role of isovolumetric times

Cardiogenic shock (CS) is a complex syndrome characterised by reduced cardiac output, tissue hypoperfusion and multi-organ dysfunction. Despite advances in management, in-hospital mortality remains high. Accurate phenotyping using readily available, repeatable parameters is crucial. Among these, total isovolumetric time (t-IVT) has emerged as a marker of left ventricular performance and global electromechanical efficiency.

The aim of our study was to investigate the role of t-IVT in CS. We assessed its correlation with other echocardiographic parameters, with haemodynamic indices estimated by echocardiography (‘ecodynamic’ parameters), and with ventricular-arterial coupling (VAC). Temporal changes in t-IVT and its potential prognostic value were also evaluated.

A prospective, observational study was conducted including patients admitted to two Hospitals for CS between 1 March and 31 August 2025. Patients with isolated right ventricular dysfunction were excluded. Vital signs, arterial and venous blood gases, standard echocardiographic and ‘ecodynamic’ parameters, VAC (Chen single-beat method) and t-IVT were measured at admission (T1), 24–48 hours after starting haemodynamic support(T2) and at the end of support in patients with restored spontaneous circulation (T3).

The study included 22 patients (median age 72.5 years, 72.7% male), all required inotropic support. Most parameters improved significantly or near-significantly over the three time points, particularly t-IVT and VAC. t-IVT showed strong or near-significant correlations across T1 to T3 with left ventricular systolic function, lateral mitral annular systolic velocity, left ventricular velocity time integral, stroke volume indexed to BSA, cardiac index, cardiac power index and VAC. Changes in t-IVT (Δt-IVT, T3–T1) correlated positively but non-significantly with duration of haemodynamic support (Spearman’s rho=0.18, p=0.41), and significantly with 30-day mortality risk estimated by the CardShock Risk Score. Patients at low mortality risk showed greater Δt-IVT improvement (median -8.1 s/min) compared to intermediate-high risk patients (median –4.05 s/min, p=0.04). Among patients who died (n=2), Δt-IVT either increased or remained unchanged.

t-IVT is a readily obtainable, repeatable parameter that correlates well with standard echocardiographic and ‘ecodynamic’ parameters and with VAC. Its changes over time may have prognostic value for risk of short-term mortality and cardiac reserve. Larger multicentre studies are needed to confirm its prognostic role and potential in guiding personalised therapy.

Variaton of key parameters