Higher left atrial volumetric/mechanical coupling index is associated with postoperative adverse events in significant aortic regurgitation

Q: What are the key findings of this study?

Each 1-unit increase in LACI independently increased the risk of postoperative cardiovascular death or heart failure hospitalization by 9.6%.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Significant chronic aortic regurgitation undergoing surgical aortic valve replacement (n=248). Intervention: Left atrial volumetric/mechanical coupling index (LACI, defined as LAVImax / septal a') vs. Lower LACI (stratified by median =5.9, or analyzed per 1-unit increase). Primary outcome: Composite of cardiovascular death and hospitalization for heart failure (adjusted HR 1.096 per 1-unit increase, 95% CI 1.053-1.141, p=<0.001).

Q: What does this research mean for the field?

A higher left atrial volumetric/mechanical coupling index is independently associated with an increased risk of postoperative cardiovascular death and heart failure hospitalization in patients undergoing aortic valve replacement for significant aortic regurgitation. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To assess the relationship between the left atrial volumetric/mechanical coupling index (LACI) and postoperative adverse outcomes in patients with significant aortic regurgitation undergoing surgical intervention.

Na Chen; Siqi Cao; Huiyu Tang; Wenhui Gu; Siyao Sun; Qiwu Sun; Tao Cong; Haibo Wu; Jun Wu

doi:10.3389/fcvm.2026.1935880

November 13, 2026Frontiers in Cardiovascular MedicineOpen Access

Higher left atrial volumetric/mechanical coupling index is associated with postoperative adverse events in significant aortic regurgitation

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Key result

Higher LACI is linked to ~10% higher risk of postoperative CV death or HF hospitalization per unit.

adjusted HR 1.096 per 1-unit increase
95% CI 1.053-1.141
P<0.001
n=248

Why the study?

The role of the left atrial volumetric/mechanical coupling index (LACI) and its relationship with postoperative adverse events in patients with significant aortic regurgitation remained unclear.

Does a higher preoperative left atrial volumetric/mechanical coupling index (LACI) predict postoperative cardiovascular death and heart failure hospitalization in patients with significant chronic aortic regurgitation undergoing aortic valve replacement?

Key Points

To assess the relationship between the left atrial volumetric/mechanical coupling index (LACI) and postoperative adverse outcomes in patients with significant aortic regurgitation undergoing surgical intervention.
Retrospective dual-center cohort study evaluating 248 patients with significant aortic regurgitation who underwent aortic valve replacement from December 2019 to June 2025.
LACI was calculated as the maximal left atrial volume index divided by septal mitral annular late diastolic velocity (a′), with patients stratified by the cohort median cutoff of 5.9.
The primary composite endpoint of cardiovascular death and heart failure hospitalization was evaluated using multivariable Cox proportional hazards regression, C-index, IDI, and NRI with 1,000 bootstrap resamples.
Over a median follow-up of 27.3 months (IQR, 17.2–36.7), 52 patients (21.9%) reached the composite primary endpoint.
Kaplan–Meier survival analysis demonstrated significantly higher event-free survival in patients with LACI <5.9 compared to those with higher values (log-rank P < 0.001).
Multivariable analysis identified higher LACI as an independent predictor of the primary endpoint (adjusted HR 1.096, 95% CI 1.053–1.141, P < 0.001), yielding a receiver operating characteristic area under the curve of 0.738.

Study Design

Type

Cohort (n=248)

Blinding

Blinded outcome/imaging analysis (two blinded sonographers)

Multicenter

Yes

Structured PICO

Does a higher preoperative left atrial volumetric/mechanical coupling index (LACI) predict postoperative cardiovascular death and heart failure hospitalization in patients with significant chronic aortic regurgitation undergoing aortic valve replacement?

P

Population

248 adults with moderate-to-severe or severe chronic aortic regurgitation undergoing surgical AVR across two centers in China (median age 64 years, 18.5% female, free of preoperative atrial fibrillation), followed for a median of 27.3 months.

E

Exposure

Preoperative assessment of left atrial volumetric/mechanical coupling index (LACI), defined as maximal left atrial volume index (LAVImax) divided by septal mitral annular late diastolic velocity (a'), with patients stratified by the median LACI value (≥5.9 vs <5.9) and optimal ROC cutoff (8.4).

C

Comparator

Lower left atrial volumetric/mechanical coupling index (LACI <5.9) and core parameters recommended by current guidelines (Baseline Model: age, LVESDI, LVEF, and NYHA class).

O

Outcome

Composite of cardiovascular death and hospitalization for heart failure at a median follow-up of 27.3 (IQR, 17.2-36.7) months.composite

Main Result

Hazard Ratio: 1.096 (95% CI 1.053–1.141)

p-value: p=<0.001

Preoperative left atrial volumetric/mechanical coupling index (LACI) is independently associated with postoperative cardiovascular death and heart failure hospitalization in patients undergoing surgical aortic valve replacement for significant aortic regurgitation, adding incremental prognostic value beyond current guideline-recommended parameters.

Limitations

Retrospective dual-center cohort design
Complete-case analysis excluding patients with incomplete imaging or follow-up data

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Implication

Higher preoperative LACI may refine postoperative risk stratification after AVR for AR; extends guideline parameters yet leaves open need for prospective validation.

Abstract

Background The role of left atrial volumetric/mechanical coupling index (LACI) in significant aortic regurgitation (AR) remains unclear. Objective This study aimed to clarify the relationship between LACI and postoperative adverse events in significant AR. Methods This dual-center retrospective cohort comprised 248 patients with significant AR who underwent aortic valve replacement (AVR) from December 2019 to June 2025. LACI was obtained by dividing maximal left atrial volume index by septal mitral annular late diastolic velocity (a′). Patients were stratified by the median LACI value (5.9). The composite primary endpoint was cardiovascular death and hospitalization for heart failure. Associations between LACI and clinical outcomes were assessed using multivariable Cox proportional hazards regression. The incremental prognostic value of LACI was evaluated by concordance index (C-index), integrated discrimination improvement (IDI), and net reclassification improvement (NRI), with internal validation performed using 1,000 bootstrap resamples. Subgroup and sensitivity analyses were performed to confirm the robustness of findings. Results During a median follow-up of 27.3 (IQR, 17.2–36.7) months, 52 (21.9%) patients experienced the composite primary endpoint. Kaplan–Meier analysis demonstrated significantly higher event-free survival in the LACI <5.9 group (log-rank P < 0.001). After multivariable adjustment, higher LACI remained independently associated with the primary endpoint (adjustedHR 1.096, 95% CI 1.053–1.141, P < 0.001), with each additional unit raising event risk by 9.6%. Receiver operating characteristic analysis indicated that LACI had an area under the curve of 0.738. C-index, IDI, and NRI confirmed that LACI added incremental prognostic information to the core parameters recommended by current guidelines. Conclusion Higher LACI was independently associated with worse postoperative outcomes in patients with significant AR. LACI may add incremental prognostic information to the core parameters recommended by current guidelines.

Discussion

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Cite This Study

Chen et al. (2026) conducted a cohort in Significant chronic aortic regurgitation undergoing surgical aortic valve replacement (n=248). Left atrial volumetric/mechanical coupling index (LACI, defined as LAVImax / septal a') vs. Lower LACI (stratified by median <5.9 vs >=5.9, or analyzed per 1-unit increase) was evaluated on Composite of cardiovascular death and hospitalization for heart failure (adjusted HR 1.096 per 1-unit increase, 95% CI 1.053-1.141, p=<0.001). Each 1-unit increase in LACI independently increased the risk of postoperative cardiovascular death or heart failure hospitalization by 9.6%.

synapsesocial.com/papers/6af88c530e4d8f4b089c1c15 https://doi.org/10.3389/fcvm.2026.1935880

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Higher left atrial volumetric/mechanical coupling index is associated with postoperative adverse events in significant aortic regurgitation

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Higher left atrial volumetric/mechanical coupling index is associated with postoperative adverse events in significant aortic regurgitation

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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