A 1-unit increase in the left atrioventricular coupling index (LACI) was independently associated with a higher risk of all-cause death or heart failure hospitalization (HR 2.34; 95% CI 1.35-4.03; P=0.002).
Cohort (n=1,400)
Yes
Does the left atrioventricular coupling index (LACI) predict all-cause death or HF-hospitalization in patients with stable heart failure?
LACI is associated with diastolic dysfunction severity and serves as an independent predictor of all-cause death or HF hospitalization in stable heart failure patients, offering incremental prognostic value over traditional diastolic dysfunction grading.
Hazard Ratio: 2.34 (95% CI 1.35–4.03)
p-value: p=0.002
Abstract Background Left atrioventricular coupling index (LACI), an index coupling left atrial (LA) to left ventricular (LV) volume at end-diastole (Figure 1), showed to be associated with prognosis in different clinical settings. However, the relation between LACI and LV diastolic dysfunction (DD) remains to be established. Purpose The present study aimed to investigate the association between LACI and LV DD and to assess its prognostic value in patients with heart failure (HF). Methods We retrospectively analyzed 1158 stable HF patients (mean age 66±12 years, 75% men) on optimal medical therapy (derivation cohort). Clinical and echocardiographic features were characterized across LACI tertiles. The independent prognostic value of LACI (endpoint: all-cause death/HF-hospitalization) was assessed by Cox regression and spline curve analyses. Results were validated in an external cohort of 242 HF patients. Results In the derivation cohort, the median LACI value was 0.29 (IQR:0.19-0.42). Patients in the third tertile (LACI0.36) were older and presented with more advanced HF symptoms. While prevalence of grade-1 DD (ASE/EACVI classification) progressively decreased across LACI tertiles, the prevalence of grade-3 DD significantly increased (8%,23%, and 46% respectively, P0.0001). A cut-off value ³0.26 identified moderate-to-severe DD with an area-under the-curve of 0.75. During follow-up (median 28 months, IQR:11-53), 407 (35%) patients reached the endpoint. On multivariable analysis, LACI was independently associated with outcomes (HR for 1-unit-increase 2.34; 95%CI 1.35-4.03; P=0.002 – Figure 2), showing incremental predictive value over the DD grading system (net reclassification improvement=0.150, P0.0001). The prognostic value of LACI was consistent in the external validation cohort. Conclusions LACI is associated with DD severity and is an independent predictor of outcomes in HF patients.How to assess LACIPrognostic value of LACI in HF
Fortuni et al. (Tue,) conducted a cohort in Heart failure (n=1,400). Left atrioventricular coupling index (LACI) vs. Lower LACI values was evaluated on All-cause death or heart failure hospitalization (HR 2.34, 95% CI 1.35-4.03, p=0.002). A 1-unit increase in the left atrioventricular coupling index (LACI) was independently associated with a higher risk of all-cause death or heart failure hospitalization (HR 2.34; 95% CI 1.35-4.03; P=0.002).