Key result
Worsening left atrioventricular coupling index linked to ~41% higher HFpEF risk per SD, but not HFrEF.
Why the study?
Early risk markers for HFpEF remain limited despite its increasing prevalence. It was unknown whether longitudinal change in the CMR-derived left atrioventricular coupling index (∆LACI) predicts incident HFpEF versus HFrEF in adults free of clinical CVD.
Does longitudinal change in the left atrioventricular coupling index (∆LACI) on cardiac magnetic resonance predict incident heart failure with preserved ejection fraction versus reduced ejection fraction in adults free of clinical cardiovascular disease?
Cohort (n=2,461)
Does longitudinal change in the left atrioventricular coupling index (∆LACI) on cardiac magnetic resonance predict incident heart failure with preserved ejection fraction versus reduced ejection fraction in adults free of clinical cardiovascular disease?
Longitudinal increase in the left atrioventricular coupling index on cardiac MRI independently predicts incident HFpEF and improves risk discrimination beyond traditional risk factors in adults free of baseline cardiovascular disease.
∆LACI rise on serial CMR was associated with incident HFpEF; hypothesis-generating for risk stratification and requires prospective validation.
Aims Heart failure with preserved ejection fraction (HFpEF) is increasing, yet early risk markers remain limited. The left atrioventricular coupling index (LACI), a ratio of left atrial (LA) to left ventricular (LV) end-diastolic volumes, may capture atrioventricular remodeling preceding HF. We tested whether longitudinal change in LACI (∆LACI) from cardiac magnetic resonance (CMR) predicts incident HFpEF versus HF with reduced ejection fraction (HFrEF) in adults free of clinical cardiovascular disease (CVD). Methods We studied 2461 multi-ethnic participants free of CVD who underwent baseline and repeat CMR ~9.5±0.5 years apart. ∆LACI (%/year) was derived between scans. Participants were followed from second scan for 8.9±2.3 years to incident HF, classified as HFpEF or HFrEF (EF≥50% or <50%). Results During follow-up, 102 participants developed HF (HFpEF n=56; HFrEF n=48). Each 1-standard deviation (SD) increase in ∆LACI independently predicted HFpEF (hazard ratio (HR) 1.41, 95% confidence interval (CI) 1.21-1.61, p<0.001) but not HFrEF (HR 1.18, 95%CI 0.90-1.54, p=0.22). Participants with ∆LACI≥1.6%/year had >2-fold higher adjusted HFpEF risk (HR 2.23, 95%CI 1.29-3.85, p=0.004). Adding ∆LACI to risk factors improved discrimination (C-statistic 0.812→0.837, ∆C=0.025, p=0.01), model fit (likelihood ratio test (LRT) p<0.001) and preserved calibration (Grønnesby and Borgan test (G-B) p=0.11). For HFrEF, ∆LACI did not significantly improve discrimination (∆C=0.023, p=0.06), whereas ∆minimum indexed LA volume (∆LAVimin) provided the greatest incremental value (∆C=0.031, p=0.03, LRT p=0.009, G-B p=0.10). Conclusion In a multi-ethnic, community-based cohort, rising ∆LACI on CMR was an independent predictor of incident HFpEF, improving discrimination and model fit with preserved calibration, while offering limited value for HFrEF, for which ∆LAVimin performed best.Figure 1Figure 2
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Lim et al. (2026) conducted a cohort in Incident heart failure with preserved ejection fraction (HFpEF) versus reduced ejection fraction (HFrEF) (n=2,461). Longitudinal change in left atrioventricular coupling index (∆LACI) vs. Lower or baseline ∆LACI (per 1-SD increase or <1.6%/year) was evaluated on Incident heart failure with preserved ejection fraction (HFpEF, EF ≥50%) (HR 1.41, 95% CI 1.21-1.61, p=<0.001). Each 1-SD increase in longitudinal change in left atrioventricular coupling index (∆LACI) independently predicted incident HFpEF (HR 1.41, 95% CI 1.21-1.61, p<0.001) but not HFrEF.
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