Key result
Pathologic LACI linked to worse composite outcomes in aortic regurgitation by win-loss analysis.
Why the study?
Risk stratification in patients with aortic regurgitation remains challenging, and the prognostic role of the cardiac magnetic resonance-derived Left Atrioventricular Coupling Index in these patients was unknown.
Does CMR-derived Left Atrioventricular Coupling Index (LACI >30% vs ≤30%) predict a composite of all-cause death, new-onset heart failure, and heart failure hospitalization in patients with more-than-moderate aortic regurgitation?
Cohort (n=67)
Does CMR-derived Left Atrioventricular Coupling Index (LACI >30% vs ≤30%) predict a composite of all-cause death, new-onset heart failure, and heart failure hospitalization in patients with more-than-moderate aortic regurgitation?
CMR-derived Left Atrioventricular Coupling Index (>30%) identifies a higher-risk phenotype in patients with more-than-moderate aortic regurgitation, showing worse hierarchical clinical outcomes over a median 4.12-year follow-up.
Background Risk stratification in patients with aortic regurgitation (AR) remains challenging. The Left Atrioventricular Coupling Index (LACI) is a novel imaging-derived parameter reflecting atrioventricular coupling and has demonstrated prognostic value in heart failure and valvular heart disease. However, its prognostic role in AR remains unknown. Purpose To evaluate the prognostic value of cardiac magnetic resonance (CMR)-derived LACI in patients with AR. Methods We conducted an observational cohort study including 67 patients (mean age 68 years, 84 % male) with more-than-moderate AR (regurgitant fraction measured with CMR >20%) who underwent clinical evaluation and CMR between 2012 and 2024. Patients with more than mild aortic stenosis or significant mitral valve disease were excluded. Left atrial and left ventricular volumes were quantified by CMR, and LACI was calculated as a percentage. Pathologic LACI (uncoupling) was defined as >30%. The primary endpoint was a composite of all-cause death, new-onset heart failure, and heart failure hospitalization. Median follow-up was 4.12 years (IQR 1.82–6.51). Prognostic assessment included hierarchical win–loss and Kaplan–Meier analyses. Results Patients with atrioventricular uncoupling (pathologic LACI>30%) had a worse clinical profile, including older age, higher prevalence of heart failure, and more advanced NYHA class symptoms. During a median follow-up of 4.1 years, 41 patients reached the primary endpoint. Hierarchical win–loss analysis demonstrated significantly worse outcomes in patients with pathologic LACI, while LACI≤30% was associated with better outcomes (win ratio 0.37, 95% CI 0.16–0.83; p=0.02). Kaplan–Meier analysis did not show significant differences in event-free survival (HR 0.97, 95% CI 0.45–2.11; log-rank p=0.94), likely due to limited statistical power. However, early and sustained separation of survival curves was observed. Conclusion CMR-derived LACI identifies a high-risk phenotype in patients with AR and may provide incremental prognostic value for risk stratification.
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Rojas et al. (2026) conducted a cohort in Aortic regurgitation (n=67). Pathologic Left Atrioventricular Coupling Index (LACI >30%) vs. LACI ≤30% was evaluated on Composite of all-cause death, new-onset heart failure, and heart failure hospitalization (Win ratio 0.37, 95% CI 0.16-0.83, p=0.02). Pathologic LACI (>30%) in aortic regurgitation was associated with worse composite outcomes via win-loss analysis (win ratio 0.37, 95% CI 0.16-0.83; p=0.02), though KM survival did not differ (HR 0.97).
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