Enhanced risk stratification in chronic coronary syndrome using the left atrioventricular coupling index
Ailís Ceara Haney1,2, Janek Salatzki3,4, Yahya Badran3
1Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany. ailisceara.haney@med.uni-heidelberg.de.
Insights
The left atrioventricular coupling index (LACI) predicts heart failure hospitalizations and all-cause death in chronic coronary syndrome patients. This cardiovascular magnetic resonance imaging metric offers value beyond traditional risk factors.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Prognostics
Background:
- Chronic coronary syndrome (CCS) poses significant cardiovascular risk.
- Predictive markers for adverse outcomes in CCS are crucial for patient management.
- Cardiovascular magnetic resonance (CMR) offers advanced imaging capabilities for risk stratification.
Purpose of the Study:
- To evaluate the prognostic significance of the left atrioventricular coupling index (LACI) in patients with CCS.
- To determine if LACI, measured by CMR, predicts major adverse cardiovascular events (MACE), heart failure hospitalizations (HFH), and all-cause death.
- To assess the incremental prognostic value of LACI beyond established clinical and imaging parameters.
Main Methods:
- Retrospective analysis of 613 CCS patients who underwent CMR stress testing (2008-2018).
- LACI calculated as the ratio of left atrial to left ventricular end-diastolic volume.
- Primary endpoint: MACE (cardiac death, myocardial infarction). Secondary endpoints: HFH, all-cause death. Global longitudinal strain also assessed.
Main Results:
- LACI did not significantly predict MACE (HR 1.01, p=0.07).
- LACI significantly predicted HFH (HR 1.02, p<0.0001) and all-cause death (HR 1.02, p<0.0001).
- LACI demonstrated incremental prognostic value for HFH, independent of clinical factors and global longitudinal strain.
Conclusions:
- LACI is a significant predictor of all-cause death and HFH in CCS patients.
- LACI provides added prognostic information for HFH beyond traditional risk factors and CMR parameters.
- LACI may enhance risk stratification in patients with chronic coronary syndrome.
Objective:
The study aimed to assess the prognostic value of left atrioventricular coupling index (LACI), measured by cardiovascular magnetic resonance (CMR), in predicting cardiovascular events in patients with chronic coronary syndrome (CCS).
Methods:
We retrospectively analyzed patients with CCS who underwent CMR stress testing between 2008 and 2018. LACI was defined as the ratio of left atrial end-diastolic volume to left ventricular end-diastolic volume. Additionally, global longitudinal strain was obtained. The primary endpoint was the occurrence of a major adverse cardiovascular event (MACE), including cardiac death and myocardial infarction. Secondary endpoints included hospitalization for heart failure (HFH) and all-cause death.
Results:
In the cohort of 613 patients (81.2% male, median age 70 (63-76) years), 81 (13.2%) experienced MACE after a median follow-up of 5.6 (4.2-6.8) years. LACI was not significantly associated with MACE (HR per 1% increment 1.01; 95% CI 0.99-1.01, p = 0.07), but was significantly associated with HFH (HR per 1% increment 1.02, 95% CI 1.01-1.03, p < 0.0001) and all-cause death (HR per 1% increment 1.02, 95% CI 1.01-1.03, p < 0.0001). After adjusting for clinical as well as standard CMR parameters, the association of LACI remained significant for HFH and all-cause death. LACI showed incremental prognostic value for HFH in various multivariable models beyond traditional CMR parameters and global longitudinal strain.
Conclusion:
LACI is a significant predictor for all-cause death and HFH in a cohort with CCS and provides incremental prognostic value for HFH, beyond traditional cardiovascular risk factors and imaging parameters.
More Related Videos
Related Concept Videos
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:30Heart Failure IV: Classification and Diagnostic Evaluation
01:30Acute Coronary Syndrome I: Introduction
01:26Coronary Artery Disease II: Pathophysiology
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Coronary Artery Disease I: Introduction