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. 2021 Sep;78(3):661-671.
doi: 10.1161/HYPERTENSIONAHA.121.17339. Epub 2021 Jul 6.

Left Atrioventricular Coupling Index as a Prognostic Marker of Cardiovascular Events: The MESA Study

Theo Pezel  1   2 , Bharath Ambale Venkatesh  1 , Henrique Doria De Vasconcellos  1 , Yoko Kato  1 , Mahsima Shabani  1 , Eric Xie  1 , Susan R Heckbert  3 , Wendy S Post  1 , Steven J Shea  4 , Norrina B Allen  5 , Karol E Watson  6 , Colin O Wu  1 , David A Bluemke  7 , João A C Lima  1
Affiliations

Left Atrioventricular Coupling Index as a Prognostic Marker of Cardiovascular Events: The MESA Study

Theo Pezel et al. Hypertension. 2021 Sep.

Abstract

[Figure: see text].

Keywords: atrial fibrillation; heart failure; myocardial infarction; prognosis; risk factors.

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Conflict of interest statement

DECLARATION OF INTEREST: Disclosure: The authors have nothing to disclose.

All authors declare that the submitted work is original and has not been published before (neither in English nor in any other language) and that the work is not under consideration for publication elsewhere.

Figures

Figure 1.
Figure 1.. Flowchart of the study.
Figure 2.
Figure 2.. Schematic comparison of LACI variations in different subclinical pathophysiological settings.
Figure 2A illustrates the method to assess LACI by CMR defined by the ratio between the LA end-diastolic volume and the LV end-diastolic volume. A stack of short-axis cine images was acquired to encompass both ventricles and LV end-diastolic volume was measured using cardiac image modeler (CIM) software (green volume, top panel). LA end-diastolic volume was measured using multimodality tissue-tracking (MTT) software to track LA wall motion during the end-diastole (pink borders) in the 4-chamber and 2-chamber views (bottom panel). In the Figure 2B, four patients from this cohort have the same normal value of LA EDVi (10 ml/m2) but different normal LV EDVi values (top panel), and four other patients with the same normal value of LV EDVi (60 ml/m2) but different normal LA EDVi values (bottom panel). Although these values of LA EDVi or LV EDVi were identical, LACI increased significantly in all cases. These eight patients belonged to one of the LACI quartiles with significantly different risk levels of cardiovascular events which were not detected by the value of LA EDVi or LV EDVi alone. A higher LACI reflects a higher dysfunction of the left atrioventricular coupling defined by a subclinical dilation of LA compared to LV. Abbreviations: CMR: cardiovascular magnetic resonance; LA: left atrium; LACI: left atrioventricular coupling index; EDVi: end-diastolic volume indexed; LV: left ventricle.
Figure 3.
Figure 3.. Kaplan-Meier survival curves for incident AF (A), incident HF (B), CHD death (C) and hard CVD (D) by LACI quartiles.
The cumulative hazard was systematically significantly greater in the 4th quartile compared with the other quartiles for each outcome (log-rank for difference; p<0.0001).
Figure 4.
Figure 4.. Kaplan-Meier survival curves for incident AF (A), incident HF (B), CHD death (C) and hard CVD (D) stratified by LACI >25%.
See this image and copyright information in PMC

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