Enhanced risk stratification in chronic coronary syndrome using the left atrioventricular coupling index

OBJECTIVE: The study aimed to assess the prognostic value of left atrioventricular coupling index (LACI), measured by cardiovascular magnetic resonance (CMR), in predicting cardiovascular events in patients with chronic coronary syndrome (CCS). METHODS: We retrospectively analyzed patients with CCS who underwent CMR stress testing between 2008 and 2018. LACI was defined as the ratio of left atrial end-diastolic volume to left ventricular end-diastolic volume. Additionally, global longitudinal strain was obtained. The primary endpoint was the occurrence of a major adverse cardiovascular event (MACE), including cardiac death and myocardial infarction. Secondary endpoints included hospitalization for heart failure (HFH) and all-cause death. RESULTS: In the cohort of 613 patients (81.2% male, median age 70 (63-76) years), 81 (13.2%) experienced MACE after a median follow-up of 5.6 (4.2-6.8) years. LACI was not significantly associated with MACE (HR per 1% increment 1.01; 95% CI 0.99-1.01, p = 0.07), but was significantly associated with HFH (HR per 1% increment 1.02, 95% CI 1.01-1.03, p < 0.0001) and all-cause death (HR per 1% increment 1.02, 95% CI 1.01-1.03, p < 0.0001). After adjusting for clinical as well as standard CMR parameters, the association of LACI remained significant for HFH and all-cause death. LACI showed incremental prognostic value for HFH in various multivariable models beyond traditional CMR parameters and global longitudinal strain. CONCLUSION: LACI is a significant predictor for all-cause death and HFH in a cohort with CCS and provides incremental prognostic value for HFH, beyond traditional cardiovascular risk factors and imaging parameters.