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Left atrioventricular coupling index and atrial fibrillation and stroke in hypertrophic cardiomyopathy: a CMR study

Martina De Raffele1, Guillem Casas2, Victoria Delgado3

  • 1iCor, Departament de Cardiologia, Secció d'Imatge Cardiovascular, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Istituto Cardiovascolare, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy.

Revista Espanola De Cardiologia (English Ed.)
|January 8, 2026
PubMed

Insights

The left atrioventricular coupling index (LACI) and left atrial strain predict atrial fibrillation and stroke in hypertrophic cardiomyopathy (HCM) patients. Higher LACI indicates increased risk for these adverse events.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Clinical Research

Background:

  • Left atrial remodeling is common in hypertrophic cardiomyopathy (HCM) and linked to atrial fibrillation (AF) and thromboembolic events.
  • Existing AF risk models show poor performance in HCM patients.
  • The left atrioventricular coupling index (LACI) is a novel marker for atrial remodeling and AF risk.

Purpose of the Study:

  • To evaluate the association between LACI and new-onset AF, transient ischemic attack, or ischemic stroke in HCM patients.
  • To assess the predictive value of LACI for adverse cardiovascular events in HCM.

Main Methods:

  • Retrospective analysis of 287 HCM patients without prior AF or stroke.
  • Cardiac magnetic resonance imaging used to measure left atrial and ventricular volumes.
  • LACI calculated as ratio of minimum left atrial volume to left ventricular end-diastolic volume; Cox models used for analysis.

Main Results:

  • Over 60 months median follow-up, 17.9% of patients experienced the composite endpoint.
  • Highest LACI tertile (≥36%) showed significantly higher risk of AF or thromboembolic events (aHR, 2.88).
  • Left atrial booster strain independently associated with adverse outcomes.

Conclusions:

  • LACI is an independent predictor of new-onset AF and thromboembolic events in HCM.
  • Left atrial booster strain also independently associated with adverse outcomes in this population.
Abstract

Keywords:
AcoplamientoAcoplamiento auriculoventricular izquierdoAtrial fibrillationCardiac magnetic resonanceCouplingFibrilación auricularHypertrophic cardiomyopathyLeft atrioventricular couplingMiocardiopatía hipertróficaPrognosisPronósticoResonancia magnética cardiaca

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