Atrioventricular Coupling Index: A Novel Approach to Risk-Stratification for Major Adverse Cardiovascular Events in...

Area of Science:

• Cardiology
• Medical Imaging
• Prognostics

Background:

• The prognostic value of the left atrioventricular coupling index (LACI) in acute myocardial infarction (AMI) is established.
• The prognostic role of the right atrioventricular coupling index (RACI) in AMI remains less understood.

Purpose of the Study:

• To investigate the prognostic significance of both LACI and RACI in patients following AMI.
• To determine if these indices offer incremental prognostic value beyond conventional risk factors.

Main Methods:

• A retrospective analysis of 1083 ST-elevation AMI patients who underwent cardiac MRI within 7 days of percutaneous coronary intervention.
• LACI and RACI were calculated from MRI-derived indexed atrial and ventricular end-diastolic volumes.
• Major adverse cardiac events (MACE), including all-cause death, reinfarction, and heart failure hospitalization, were tracked over a median of 38 months.

Main Results:

• Both LACI and RACI were independently associated with MACE in AMI patients.
• The addition of LACI and/or RACI significantly improved the prognostic model's predictive power (Harrell's C index increased from 0.679 to 0.762).
• In patients with right ventricular myocardial infarction (RVMI), RACI demonstrated superior prognostic performance compared to LACI.

Conclusions:

• LACI and RACI are independent predictors of MACE in AMI.
• These indices provide valuable incremental prognostic information, enhancing risk assessment beyond traditional factors.
• RACI may be particularly important for prognostication in RVMI patients.