The emerging role of left atrioventricular coupling index in heart failure: a new frontier for cardiac magnetic resonance

This editorial refers to ‘Prognostic value of left atrioventricular coupling index in heart failure’, by G. Kasa et al., https://doi.org/10.1093/ehjci/jeaf010. Echocardiography, owing to its accessibility and widespread availability, is currently an essential first-line imaging modality for assessing cardiac chamber dimensions and both diastolic and systolic function in patients with heart failure (HF) and suspected cardiomyopathy.1,2 However, while echocardiography excels in the initial classification of cardiomyopathy phenotypes (such as hypertrophic, restrictive, dilated, or non-dilated), it falls short in providing detailed information about the aetiology, which is fundamental for tailoring therapy and optimizing follow-up.1 Contrast-enhanced cardiac magnetic resonance (CMR) provides unparalleled insight into cardiac chamber dimensions, systolic function, and tissue characterization, making it a cornerstone in modern cardiology,1,3,4 and an indispensable tool in the evaluation of cardiomyopathy, with a class I recommendation (level of evidence B) for its use in the initial assessment according to the 2023 European Society of Cardiology guidelines on cardiomyopathy.1 Indeed, by integrating assessments of cardiac chamber dimensions, systolic function, and tissue characterization through techniques such as late gadolinium enhancement (LGE), T1 and T2 mapping, and extracellular volume analysis, CMR is often regarded as a ‘one-stop-shop’ imaging modality.1,3 This capability is particularly useful in the context of dilated cardiomyopathy, where LGE patterns can distinguish ischaemic (characterized by sub-endocardial or transmural LGE) from non-ischaemic aetiologies (such as intra- or sub-epicardial LGE).1,3 Such information is useful to guide further investigations, such as genetic testing for suspected hereditary conditions or invasive coronary angiography for suspected ischaemic causes, in order to allow patients to receive tailored treatment and appropriate risk stratification.1