Association of left atrioventricular coupling index with mortality in heart failure with preserved ejection fraction

Background The left atrioventricular coupling index (LACI) is a novel echocardiographic parameter reflecting atrioventricular interaction and cardiac remodelling. However, its association with mortality in heart failure with preserved ejection fraction (HFpEF) remains unclear. We investigated the relationship between LACI and all-cause mortality in patients with HFpEF.Methods This retrospective observational study included 193 patients with HFpEF. Clinical and echocardiographic data were analysed. LACI was calculated as the ratio of left atrial end-diastolic volume to left ventricular end-diastolic volume. ROC curve, Kaplan–Meier, and multivariable logistic regression analyses evaluated the association between LACI and mortality.Results Patients were stratified using an ROC-derived LACI cut-off of 0.374. Elevated LACI was associated with significantly higher 1-year and 2-year all-cause mortality compared with lower LACI (25.8% vs. 5.8% and 38.2% vs. 8.7%, respectively; both p < 0.001). Higher LACI was also associated with increased systolic pulmonary artery pressure, impaired right ventricular systolic function, reduced left atrial functional parameters, and impaired left ventricular global longitudinal strain. LACI predicted mortality (AUC: 0.714, p < 0.001) and remained independently associated with all-cause mortality in multivariable logistic regression.Conclusion Elevated LACI was associated with increased all-cause mortality and adverse cardiac remodelling in patients with HFpEF. As a practical echocardiographic parameter, LACI may provide additional information on atrioventricular and atrial remodelling. These hypothesis-generating findings require confirmation in larger prospective studies.