Key result
Higher 3D left atrioventricular coupling index predicts increased risk of 12-month MACE after AMI.
Why the study?
Although left atrioventricular coupling index has demonstrated prognostic value after AMI, its clinical utility and incremental value beyond established functional and deformation indices when derived from 3D echocardiography remain incompletely established.
Does 3D left atrioventricular coupling index (LACI) improve risk prediction for major adverse cardiac events beyond conventional echocardiographic indices in patients with acute myocardial infarction undergoing primary PCI?
Cohort (n=120)
Does 3D left atrioventricular coupling index (LACI) improve risk prediction for major adverse cardiac events beyond conventional echocardiographic indices in patients with acute myocardial infarction undergoing primary PCI?
3D left atrioventricular coupling index measured within 24 hours of admission independently predicts 12-month major adverse cardiac events after acute myocardial infarction, outperforming conventional 2D and 3D echocardiographic parameters.
Background Left atrioventricular coupling (LACI) integrates left atrial (LA) and left ventricular (LV) function and may provide mechanistic insight into early hemodynamic impairment following acute myocardial infarction (AMI). Although LACI has demonstrated incremental prognostic value in this population, its clinical utility when derived from three-dimensional (3D) echocardiography remains incompletely established. Purpose To assess whether 3D LACI provides incremental prognostic value beyond established functional and deformation indices in patients with AMI undergoing primary percutaneous coronary intervention (PCI). Methods In this prospective longitudinal study, we enrolled 120 consecutive patients with AMI treated with primary PCI. All patients underwent comprehensive echocardiography within 24 hours of admission. We acquired 3D full-volume datasets to quantify LV and LA volumes and ejection fraction. 3D LACI was calculated as the ratio of 3D LA end-diastolic volume to 3D LV end-diastolic volume. Speckle-tracking analysis provided LV global longitudinal strain (LVGLS) and LA reservoir strain (LASr). Patients were followed for 12 months. The primary endpoint was major adverse cardiac events (MACE): all-cause mortality, hospitalization for heart failure, and reinfarction. Multivariable Cox regression analysis adjusted for clinical risk score and conventional echocardiographic indices. Results During 12-month follow-up, MACE occurred in 18.3% of patients. Patients with events showed higher 3D LACI than those without events (23.6% vs. 18.2%, p = 0.001). 3D LACI demonstrated higher discrimination for MACE (AUC 0.794, p < 0.001) compared with LVEF (0.702), LVGLS (0.732), LASr (0.708), and LAEF (0.784). The combination of 3D LACI and 3D LVEF further improved prognostic performance (AUC 0.806). In multivariate Cox regression analysis, 3D LACI remained independently associated with MACE (HR 1.42 per 1% increase, 95% CI 1.11–1.81; p = 0.005). A cut-off value of 23.5% identified a higher-risk subgroup (log-rank p < 0.001). Conclusion 3D LACI independently predicts adverse outcomes after AMI and provides incremental prognostic value beyond conventional echocardiographic parameters. Quantitative assessment of left atrioventricular coupling by 3D echocardiography may refine early post-infarction risk stratification.ROC for predicting MACE
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Ngoc et al. (2026) conducted a cohort in Acute myocardial infarction (n=120). 3D left atrioventricular coupling index (3D LACI) vs. Conventional functional and deformation echocardiographic indices (LVEF, LVGLS, LASr, LAEF) was evaluated on Major adverse cardiac events (MACE): all-cause mortality, hospitalization for heart failure, and reinfarction (HR 1.42 per 1% increase, 95% CI 1.11-1.81, p=0.005). 3D left atrioventricular coupling index independently predicted 12-month MACE after AMI (HR 1.42 per 1% increase, 95% CI 1.11-1.81; p=0.005) with superior discrimination (AUC 0.794).
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