Prognostic value of left atrioventricular coupling index in patients undergoing transcatheter aortic valve...

Transcatheter aortic valve implantation (TAVI) is an alternative procedure for patients with symptomatic aortic stenosis who are not suitable candidates for open-heart surgery. Preoperative left ventricular diastolic function influences TAVI outcomes. The left atrioventricular coupling index (LACI) is a novel prognostic indicator in cardiovascular research that is significantly correlated with left ventricular diastolic function. Its role in TAVI remains unclear. The aim of this study was thus to investigate the prognostic value of the echocardiography-derived LACI in predicting major adverse cardiac events (MACEs) after TAVI.

This study included patients with moderate-to-severe aortic stenosis undergoing TAVI (June 2021-December 2024). Preoperative transthoracic echocardiography assessed LACI [defined as left atrial to ventricular end-diastolic volume ratio (LAEDV/LVEDV)], left atrial/ventricular function, and diastolic parameters. Baseline clinical data were systematically collected from electronic medical records. Postoperative MACEs (malignant arrhythmia, heart failure rehospitalization, or all-cause mortality) were tracked via follow-up.

Ultimately, 148 patients [mean age 81.3±4.8 years; 40.5% female; mean European System for Cardiac Operative Risk Evaluation (EuroSCORE) II 2.79%±1.13%] were included. MACEs occurred in 25 patients. The MACE group, compared to the non-MACE group, showed higher preoperative LACI (37.84±10.38 vs. 28.18±6.05; P<0.001), left atrial volume index (59.34±18.22 vs. 50.19±19.07; P=0.035), and E/e' ratio (16.00±5.00 vs. 11.96±6.38; P<0.001), along with lower left ventricular global longitudinal strain (11.30±2.76 vs. 13.28±2.28; P<0.001) and left atrial reservoir strain (11.70±3.97 vs. 17.43±7.79; P<0.001). Multivariate Cox analysis demonstrated that LACI was significantly associated with MACE occurrence (hazard ratio: 1.16, 95% confidence interval: 1.10-1.22; P<0.001). Receiver operating characteristic analysis suggested that an LACI ≥28% had acceptable sensitivity and specificity for predicting MACEs, and Kaplan-Meier curves revealed a higher MACE incidence among patients with LACI ≥28% (P<0.001).

LACI is an independent risk factor for adverse cardiac events in TAVI. Patients exhibiting left atrioventricular decoupling (LACI ≥28%) appear to have an elevated risk of MACEs.