Kasa Gizem, Teis Albert, De Raffele Martina, Cediel German, Juncà Gladys, Lupón Josep, Santiago-Vacas Evelyn, Codina Pau, Bayés-Genis Antoni, Delgado Victoria
Department of Cardiology, Heart Institute, Germans Trias i Pujol University Hospital, Carretera del Canyet, 08916 Badalona, Spain.
Cardiovascular Institute, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy.
Eur Heart J Cardiovasc Imaging. 2025 Mar 27;26(4):610-617. doi: 10.1093/ehjci/jeaf010.
To investigate the distribution of left atrioventricular coupling index (LACI) among patients with heart failure and left ventricular ejection fraction (LVEF) < 50% and to explore its association with the combined endpoint of all-cause death or HF hospitalization at long-term follow-up.
Patients with HF and LVEF < 50% undergoing cardiac magnetic resonance were evaluated. Patients with atrial fibrillation or flutter were excluded. Left atrioventricular coupling index was measured as the ratio between the left atrial (LA) and the LV end-diastolic volumes. Patient population was divided according to LACI tertiles and followed up. Total of 478 patients (mean age 62 ± 12 years, 78% male) were included. The median value of LACI was 27.1% (interquartile range 19.9-34.5). Patients within the worst LACI tertile (≥30.9%) showed smaller LV volumes and larger LA volumes as compared with patients in the first or second tertile (LACI 6.2-22.2 and LACI 22.3-30.9, respectively). Left atrioventricular coupling index was significantly associated with the combined endpoint [hazard ratio (HR) 1.87, P = 0.01]. After adjusting for sex, age, ischaemic HF aetiology, LVEF, LA reservoir strain, diabetes mellitus, LV scar, mitral regurgitation, and LVEDVi, LACI remained significantly associated with the combined endpoint (HR 1.77, P = 0.02). Patients with the highest LACI values had worse outcomes compared with patients in first and second tertiles (HR 1.69, P = 0.02 and HR 1.77, P = 0.02, respectively).
In patients with HF and LVEF <50%, LACI is independently associated with adverse events. Patients with most impaired left atrioventricular coupling have the worst clinical outcomes.
研究左房室耦合指数（LACI）在心力衰竭且左心室射血分数（LVEF）<50%患者中的分布情况，并探讨其与长期随访中全因死亡或心力衰竭住院复合终点的相关性。
对接受心脏磁共振检查的心力衰竭且LVEF<50%的患者进行评估。排除心房颤动或心房扑动患者。左房室耦合指数通过左心房（LA）与左心室舒张末期容积之比来测量。根据LACI三分位数对患者群体进行划分并随访。共纳入478例患者（平均年龄62±12岁，78%为男性）。LACI的中位数为27.1%（四分位间距19.9 - 34.5）。与第一或第二三分位数（分别为LACI 6.2 - 22.2和LACI 22.3 - 30.9）的患者相比，LACI最差三分位数（≥30.9%）的患者左心室容积较小，左心房容积较大。左房室耦合指数与复合终点显著相关[风险比（HR）1.87，P = 0.01]。在调整性别、年龄、缺血性心力衰竭病因、LVEF、左心房储备应变、糖尿病、左心室瘢痕、二尖瓣反流和左心室舒张末期容积指数后，LACI仍与复合终点显著相关（HR 1.77，P = 0.02）。与第一和第二三分位数的患者相比，LACI值最高的患者预后较差（分别为HR 1.69，P = 0.02和HR 1.77，P = 0.02）。
在心力衰竭且LVEF<50%的患者中，LACI与不良事件独立相关。左房室耦合受损最严重的患者临床结局最差。
