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Left atrioventricular coupling index assessed using cardiac CT as a prognostic marker of cardiovascular death
Théo Pezel1, Jean-Guillaume Dillinger2, Solenn Toupin3
1Université Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010, Paris, France; Université Paris Cité, Department of Radiology, Hôpital Lariboisière - APHP, 75010, Paris, France.
Insights
The left atrioventricular coupling index (LACI) measured by cardiac CT effectively predicts cardiovascular death in patients without known heart disease. This index offers significant prognostic value beyond traditional risk factors and CT findings.
Area of Science:
- Cardiology
- Radiology
- Biomedical Engineering
Background:
- Cardiovascular disease remains a leading cause of mortality worldwide.
- Accurate risk stratification is crucial for early intervention and improved patient outcomes.
- Cardiac computed tomography (CT) offers detailed anatomical and functional information.
Purpose of the Study:
- To evaluate the prognostic capability of the left atrioventricular coupling index (LACI) using cardiac CT.
- To determine if LACI can predict cardiovascular death in patients undergoing cardiac CT for coronary analysis.
- To assess the incremental value of LACI over established risk factors and CT findings.
Main Methods:
- A single-center study included 1,444 consecutive patients without known cardiovascular disease referred for cardiac CT between 2010 and 2020.
- LACI was calculated as the ratio of left atrial to left ventricle end-diastolic volumes.
- Cox regression models were employed to analyze the association between LACI and cardiovascular death, adjusting for confounders.
Main Results:
- A total of 67 patients (4.3%) experienced cardiovascular death during a median follow-up of 6.8 years.
- Adjusted analyses revealed a significant positive association between LACI and both cardiovascular death (aHR 1.07 per 1% increment) and all-cause death (aHR 1.05 per 1% increment).
- A LACI threshold of ≥ 25% demonstrated superior model discrimination and reclassification for predicting cardiovascular death.
Conclusions:
- The left atrioventricular coupling index (LACI), derived from cardiac CT, is an independent predictor of cardiovascular and all-cause mortality.
- LACI provides significant prognostic information that complements traditional risk factors and cardiac CT angiography findings.
- Cardiac CT-derived LACI can enhance risk stratification in patients without known cardiovascular disease.
Purpose:
The purpose of this study was to investigate the prognostic value of left atrioventricular coupling index (LACI) assessed by cardiac computed tomography (CT), to predict cardiovascular death in consecutive patients referred for cardiac CT with coronary analysis.
Materials And Methods:
Between 2010 and 2020, we conducted a single-centre study with all consecutive patients without known cardiovascular disease referred for cardiac CT. LACI was defined as the ratio of left atrial to left ventricle end-diastolic volumes. The primary outcome was cardiovascular death. Cox regressions were used to evaluate the association between LACI and primary outcome after adjustment for traditional risk factors and cardiac CT angiography findings.
Results:
In 1,444 patients (mean age, 70 ± 12 [standard deviation] years; 43% men), 67 (4.3%) patients experienced cardiovascular death after a median follow-up of 6.8 (Q1, Q3: 5.9, 9.1) years. After adjustment, LACI was positively associated with the occurrence of cardiovascular death (adjusted hazard ratio [HR], 1.07 [95% CI: 1.05-1.09] per 1% increment; P < 0.001), and all-cause death (adjusted HR, 1.05 [95% CI: 1.03-1.07] per 1% increment; P <0.001). After adjustment, a LACI ≥ 25% showed the best improvement in model discrimination and reclassification for predicting cardiovascular death above traditional risk factors and cardiac CT findings (C-statistic improvement: 0.27; Nnet reclassification improvement = 0.826; Integrative discrimination index =0.209, all P < 0.001; likelihood-ratio-test, P < 0.001).
Conclusion:
LACI measured by cardiac CT is independently associated with cardiovascular death and all-cause death in patients without known cardiovascular disease referred for cardiac CT, with an incremental prognostic value over traditional risk factors and cardiac CT findings.
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