What is the clinical evidence from this study?

Study design: Observational. Population: Cardiac amyloidosis (n=52). Intervention: Left atrioventricular coupling index (LACI) by TTE vs. Left atrial reservoir strain (LASr) by TTE. Primary outcome: Detection of significant diastolic dysfunction (AUC 0.837, 95% CI 0.7 - 0.9, p=0.2).

What does this research mean for the field?

LACI-TTE shows comparable accuracy to LASr-TTE for detecting diastolic dysfunction in patients with cardiac amyloidosis, with a sensitivity of 84% and specificity of 72%. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

February 2, 2026

Assessing diastolic dysfunction in cardiac amyloidosis: a comparative evaluation of left atrial coupling index and left atrial reservoir strain

Key Result

Left atrioventricular coupling index by echocardiography showed comparable accuracy to left atrial reservoir strain for detecting significant diastolic dysfunction (AUC 0.837 vs 0.713; P=0.2).

Key Points

This research evaluates LACI and LASr as markers of diastolic dysfunction in cardiac amyloidosis patients.
Patients underwent both transthoracic echocardiography and cardiac magnetic resonance imaging at CA diagnosis.
Diastolic dysfunction was graded according to established criteria for sinus rhythm and atrial fibrillation.
Correlation coefficients and ROC curve analysis determined relationships and diagnostic accuracy of LACI and LASr.
Moderate correlation between LACI-CMR and LACI-TTE (ρ = 0.58, p < 0.001), and LACI-TTE with diastolic dysfunction grade (ρ = 0.57, p < 0.001).
LACI-TTE had comparable diagnostic performance to LASr-TTE for detecting significant diastolic dysfunction, with AUCs of 0.837 and 0.713 respectively.
Optimal cut-off for LACI-TTE was 0.45 (84% sensitivity, 72% specificity) and for LASr-TTE was 8.6% (60% sensitivity, 83% specificity).

Study Design

Type

Observational (n=52)

Structured PICO

Does left atrioventricular coupling index (LACI) accurately detect significant diastolic dysfunction in patients with cardiac amyloidosis compared to left atrial reservoir strain (LASr)?

Population

52 consecutive patients with cardiac amyloidosis (median age 71, 77% male) evaluated with TTE and CMR at the time of diagnosis.

Exposure

Assessment of left atrioventricular coupling index (LACI) using transthoracic echocardiography (TTE) and cardiac magnetic resonance (CMR)

Comparator

Left atrial strain during the reservoir phase (LASr) using TTE and CMR

Outcome

Diagnostic accuracy (Area Under the Curve) for detecting significant diastolic dysfunction (defined as DD grade >1 in sinus rhythm, or monophasic filling pattern with deceleration time <160 ms or E/e′ ratio >11 in atrial fibrillation)surrogate

Echocardiography-derived left atrioventricular coupling index (LACI) is a simple and accurate noninvasive marker for detecting significant diastolic dysfunction in patients with cardiac amyloidosis, performing comparably to left atrial reservoir strain.

Main Result

Effect estimate: AUC 0.837 (95% CI 0.7 - 0.9)

p-value: p=0.2

Abstract

Abstract Background Left atrioventricular coupling index (LACI) and left atrial strain during the reservoir phase (LASr) calculated with transthoracic echocardiography (TTE) and cardiac magnetic resonance (CMR) have emerged as markers of diastolic dysfunction (DD) associated with poor prognosis. However, data on the role of LACI as a marker of DD in cardiac amyloidosis (CA) are limited, and no direct comparison between LACI and LASr has been performed. Purpose Our aim was to evaluate the role of LACI and LASr as markers of diastolic dysfunction in patients with CA using TTE and CMR. Methods All patients underwent both TTE and CMR at the time of CA diagnosis. LACI —defined as the ratio between end-diastolic left atrial volume and end-diastolic left ventricular volume—and LASr were assessed using both TTE (LACI-TTE and LASr-TTE) and CMR (LACI-CMR and LASr-CMR). DD was graded according to the recommendations of the European Association of CardioVascular Imaging. Significant diastolic dysfunction was defined as DD grade 1 in patients with sinus rhythm, or as either a monophasic filling pattern with deceleration time 160 ms or E/e′ ratio 11 in those with atrial fibrillation. Correlation coefficients were calculated to evaluate the relationship between LACI and other imaging parameters. Receiver operating characteristic (ROC) curve analysis was used to determine the areas under the curves (AUCs) for LACI and LASr and to assess their diagnostic accuracy in detecting significant diastolic dysfunction. Optimal cut-off values for both LACI and LASr were determined using the Youden index, while the DeLong test was used to compare the ROC curves. Results A total of 52 consecutive patients were included in the study (median age 71 years IQR: 64–76; 77% male). A moderate correlation was observed between LACI-CMR and LACI-TTE (ρ = 0.58, p 0.001), as well as between LACI-TTE and LASr-TTE (ρ = – 0.62, p 0.001), and between LACI-CMR and LASr-CMR (ρ = – 0.64, p 0.001). LACI-TTE showed a moderate correlation with diastolic dysfunction grade (ρ = 0.57, p 0.001), whereas LACI-CMR was not correlated (ρ = 0.29, p = 0.09). In ROC curve analysis for the detection of significant DD, the diagnostic performance of LACI-TTE (AUC = 0.837, CI 95%: 0.7 - 0.9) was comparable to that of LASr-TTE (AUC = 0.713, CI 95%: 0.5 - 0.9; p = 0.2). The optimal cut-off values for predicting significant diastolic dysfunction were 0.45 for LACI-TTE, with 84% sensitivity and 72% specificity, and 8.6% for LASr-TTE, with 60% sensitivity and 83% specificity. Conclusion In patients with CA, LACI derived from echocardiography—but not from CMR—is associated with diastolic dysfunction grade (DD). LACI-TTE demonstrated comparable accuracy for detecting diastolic dysfunction to LASr-TTE, with the added advantages of being simple, feasible, and noninvasive. These findings support its potential role as a complementary marker for assessing diastolic function in patients with cardiac amyloidosis.

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