What is the clinical evidence from this study?

Study design: Cohort. Population: Chronic coronary syndrome (n=613). Intervention: Left atrioventricular coupling index (LACI). Primary outcome: Major adverse cardiovascular event (MACE) (HR 1.01, 95% CI 0.99-1.02, p=0.07).

June 23, 2025Open Access

Enhanced risk stratification in chronic coronary syndrome using the left atrioventricular coupling index

AHAilís Ceara HaneyHeidelberg University JSJanek SalatzkiCardiac Imaging YBYahya BadranHeidelberg University

Key Result

The left atrioventricular coupling index was not significantly associated with MACE (HR 1.01) in patients with chronic coronary syndrome, but significantly predicted heart failure hospitalization.

Study Design

Type

Cohort (n=613)

Multicenter

Structured PICO

Does left atrioventricular coupling index (LACI) predict major adverse cardiovascular events, heart failure hospitalization, and all-cause death in patients with chronic coronary syndrome?

Population

613 patients with chronic coronary syndrome (moderate 50-75% to severe >75% stenosis or history of CABG) who underwent CMR stress testing, median age 70, 81.2% male. Excluded: significant left-sided valvular disease or follow-up <3 years.

Intervention

Left atrioventricular coupling index (LACI) measured by cardiovascular magnetic resonance (CMR)

Outcome

Major adverse cardiovascular event (MACE), comprised of cardiac death and non-fatal myocardial infarction (STEMI or non-STEMI)composite

LACI measured by CMR provides incremental prognostic value for predicting heart failure hospitalization and all-cause death in patients with chronic coronary syndrome, beyond traditional risk factors and imaging parameters.

Main Result

Effect estimate: HR 1.01 (95% CI 0.99-1.02)

p-value: p=0.07

Limitations

Heterogeneous nature of CCS may have introduced selection bias
Severity of coronary artery disease was not assessed by fractional flow reserve
Retrospective, single-center design
Lack of a control group without coronary artery disease
Lack of echocardiographic information at the time of CMR
Use of both 1.5T and 3T scanners
No assessment of longitudinal changes in LACI over time

Abstract

OBJECTIVE: The study aimed to assess the prognostic value of left atrioventricular coupling index (LACI), measured by cardiovascular magnetic resonance (CMR), in predicting cardiovascular events in patients with chronic coronary syndrome (CCS). METHODS: We retrospectively analyzed patients with CCS who underwent CMR stress testing between 2008 and 2018. LACI was defined as the ratio of left atrial end-diastolic volume to left ventricular end-diastolic volume. Additionally, global longitudinal strain was obtained. The primary endpoint was the occurrence of a major adverse cardiovascular event (MACE), including cardiac death and myocardial infarction. Secondary endpoints included hospitalization for heart failure (HFH) and all-cause death. RESULTS: In the cohort of 613 patients (81.2% male, median age 70 (63-76) years), 81 (13.2%) experienced MACE after a median follow-up of 5.6 (4.2-6.8) years. LACI was not significantly associated with MACE (HR per 1% increment 1.01; 95% CI 0.99-1.01, p = 0.07), but was significantly associated with HFH (HR per 1% increment 1.02, 95% CI 1.01-1.03, p < 0.0001) and all-cause death (HR per 1% increment 1.02, 95% CI 1.01-1.03, p < 0.0001). After adjusting for clinical as well as standard CMR parameters, the association of LACI remained significant for HFH and all-cause death. LACI showed incremental prognostic value for HFH in various multivariable models beyond traditional CMR parameters and global longitudinal strain. CONCLUSION: LACI is a significant predictor for all-cause death and HFH in a cohort with CCS and provides incremental prognostic value for HFH, beyond traditional cardiovascular risk factors and imaging parameters.

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