Prognostic value of left atrioventricular coupling index in heart failure

Aims: 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.

Methods and results: Patients with HF and LVEF<50% undergoing cardiac magnetic resonance (CMR) were evaluated. Patients with atrial fibrillation or flutter were excluded. LACI 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 to patients in the first or second tertile (LACI 6.2-22.2 and LACI 22.3-30.9; respectively). LACI was significantly associated with the combined endpoint (hazard ratio [HR] 1.87, p=0.01). After adjusting for sex, age, ischemic 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 highest LACI values had worse outcomes compared to patients in first and second tertiles (HR 1.69, p=0.02 and HR 1.77, p=0.02; respectively).

Conclusion: 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.