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Updated: Apr 27, 2026
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Combined Atrioventricular Coupling Index in Transfusion-Dependent Thalassemia: Insights From a Cross-Sectional
Antonella Meloni1, Luca Saba2, Vincenzo Positano1
1Bioengineering Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy.
Insights
The combined atrioventricular coupling index (CACI) is higher in transfusion-dependent thalassemia (TDT) patients and helps distinguish them from healthy individuals. Elevated CACI is linked to heart complications in TDT.
Area of Science:
- Cardiology
- Hematology
- Medical Imaging
Background:
- Transfusion-dependent thalassemia (TDT) poses significant cardiovascular risks.
- Assessing cardiac function and complications in TDT is crucial for patient management.
- Novel biomarkers are needed to better understand cardiac involvement in TDT.
Purpose of the Study:
- To investigate the association between the combined atrioventricular coupling index (CACI) and various factors in TDT patients.
- To determine if CACI can differentiate TDT patients from healthy controls.
- To explore the relationship between CACI and demographic, clinical, cardiovascular magnetic resonance (CMR) findings, and cardiac complications in TDT.
Main Methods:
- A cross-sectional study involving 292 TDT patients and 32 healthy controls.
- Calculation of CACI as the sum of left (LACI) and right (RACI) atrioventricular coupling indices.
- Evaluation of demographic characteristics, clinical variables, CMR findings (including late gadolinium enhancement - LGE), and cardiac complications.
Main Results:
- TDT patients had significantly higher CACI values compared to healthy controls (50.83% vs. 34.62%, p < 0.0001).
- CACI showed superior discriminatory performance over LACI in distinguishing TDT patients.
- Higher CACI was associated with older age, prior splenectomy, diabetes, and the presence of LGE. LGE was an independent predictor of CACI.
- TDT patients with cardiac complications exhibited significantly higher CACI values.
Conclusions:
- Elevated CACI effectively distinguishes TDT patients from healthy individuals.
- CACI is significantly associated with LGE, a marker of myocardial damage.
- Impaired CACI is observed in TDT patients experiencing cardiac complications, highlighting its potential as a marker for adverse cardiac events.
Purpose:
The purpose of this cross-sectional study was to investigate the association between the combined atrioventricular coupling index (CACI) and demographic characteristics, clinical variables, cardiovascular magnetic resonance (CMR) findings, and cardiac complications (heart failure, pulmonary hypertension, and arrhythmias) in patients with transfusion-dependent tlhalassemia (TDT).
Methods:
We evaluated 292 consecutive patients with TDT (151 females; mean age 36.72 ± 11.76 years) enrolled in the Extension-Myocardial Iron Overload in Thalassemia (E-MIOT) project. In addition, 32 age- and sex-matched healthy controls (12 females; mean age 40.78 ± 14.35 years) were included. The CACI was calculated as the sum of the left atrioventricular coupling index (LACI) and the right atrioventricular coupling index (RACI).
Results:
Compared with healthy controls, patients with TDT exhibited significantly higher CACI values (50.83% ± 20.34% vs. 34.62% ± 12.59%; p < 0.0001). Moreover, CACI demonstrated superior discriminatory performance compared with LACI in distinguishing TDT patients from controls (p = 0.001). Aging was significantly and positively associated with CACI, and higher CACI values were observed in patients with prior splenectomy, diabetes, and the presence of late gadolinium enhancement (LGE). In stepwise regression analysis, LGE emerged as an independent predictor of CACI (F = 15.40; p < 0.0001). Finally, TDT patients with cardiac complications showed significantly higher CACI values than those without cardiac complications.
Conclusion:
CACI values were higher in patients with TDT, enabling discrimination of TDT patients. Higher CACI values were significantly associated with the presence of LGE. Furthermore, patients with cardiac complications exhibited impaired CACI.
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