title: A reduction in total isovolumic time with cardiac resynchronisation therapy is a predictor of clinical outcomes.
abstract: BACKGROUND
  Total isovolumic time (t-IVT) reflects left ventricular (LV) asynchrony (when the ventricle is neither ejecting nor filling). It is prolonged in left bundle branch block (LBBB). Cardiac resynchronisation therapy (CRT) is a treatment for patients with heart failure, reduced LV ejection fraction and LBBB. CRT shortens t-IVT, but the long-term clinical benefit of such reduction after CRT has not been studied in this patient group.
  
  
  METHODS
  Seventy-three patients who underwent CRT had t-IVT measured before and after CRT implantation. The study end-point was a composite of unplanned heart failure hospitalisation and all-cause mortality.
  
  
  RESULTS
  Baseline t-IVT showed considerable scatter: 30 patients had t-IVT values longer than 15s/min (upper 95% limit of normal). The change in t-IVT with CRT was also variable: t-IVT shortened in 50 patients (from 16.2 ± 4.8s/min to 11.7 ± 3.7s/min: group A), and lengthened in 23 patients (from 11.7 ± 4.2s/min to 14.5 ± 4.33 s/min: group B). The magnitude of change in t-IVT with CRT negatively correlated with baseline t-IVT (r=-0.619, p<0.001); thus t-IVT (significantly longer in group A than group B before CRT: 16.2 ± 4.8s/min vs. 11.7 ± 4.2s/min, p<0.001) became significantly shorter in group A compared to group B after CRT (11.7 ± 3.7s/min vs. 14.5 ± 4.3s/min, p=0.005). After follow-up of 30 months, 70% group A patients had event-free survival compared to 39% group B patients. The presence of any fall in t-IVT after CRT was an independent predictor of event-free survival.
  
  
  CONCLUSIONS
  T-IVT is a marker of global cardiac asynchrony that has predictive capacity on functional, symptomatic, and mortality endpoints in patients with advanced heart failure.
authors.affiliation: Dept of Cardiology, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London, SW3 6NP, United Kingdom. k.guha@rbht.nhs.uk
authors.forename: Kaushik
authors.initials: K
authors.lastname: Guha
authors.forename: Lilian
authors.initials: L
authors.lastname: Mantziari
authors.forename: Rakesh
authors.initials: R
authors.lastname: Sharma
authors.forename: Theresa A
authors.initials: TA
authors.lastname: McDonagh
authors.forename: Derek
authors.initials: D
authors.lastname: Gibson
authors.forename: Alison M
authors.initials: AM
authors.lastname: Duncan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058406:Cardiac Resynchronization Therapy / Q000379:methods / Q000639:trends*; D002306:Cardiac Volume / Q000502:physiology*; D016208:Databases, Factual / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography