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Sex-Specific Prognostic Value of Left Atrioventricular Coupling Index in Acute Coronary Syndrome: Insights From
Siwen Qin1, Difei Li1, Guanming Qi2
1Department of Ultrasound The Fourth Affiliated Hospital of China Medical University Shenyang People's Republic of China.
Insights
Left atrioventricular coupling index (LACI) predicts adverse cardiovascular events in men with acute coronary syndrome, but not in women. AI-derived LACI from 3D echo offers sex-specific prognostic value for risk stratification.
Area of Science:
- Cardiology
- Medical Imaging
- Artificial Intelligence
Background:
- Left atrioventricular coupling index (LACI) is a prognostic biomarker.
- Its sex-specific relevance in acute coronary syndrome (ACS) is not well-established.
Purpose of the Study:
- To investigate the sex-specific prognostic value of AI-derived LACI in patients with ACS.
- To assess the association between LACI and major adverse cardiovascular events (MACE) in men versus women.
Main Methods:
- Retrospective cohort of 880 ACS patients undergoing PCI.
- LACI quantified using AI-based dynamic heart model from 3D echocardiography.
- Cox and Fine-Gray models analyzed LACI association with MACE, with sensitivity analyses and external validation.
Main Results:
- Women had higher median LACI than men.
- LACI significantly associated with increased MACE risk in men (HR 1.23), but not in women.
- A linear dose-response association was observed in men; findings were consistent across validation cohorts.
Conclusions:
- AI-derived LACI from 3D echocardiography has significant sex-specific prognostic value in ACS.
- LACI is associated with adverse cardiovascular outcomes in men, supporting sex-specific risk stratification.
- Atrioventricular coupling assessment holds clinical relevance for ACS risk evaluation.
Background:
Left atrioventricular coupling index (LACI) has emerged as a prognostic biomarker, but its sex-specific relevance in acute coronary syndrome remains unclear.
Methods:
This retrospective cohort included 880 patients with acute coronary syndrome (625 men; 255 women) undergoing percutaneous coronary intervention between February 2022 and June 2023. LACI was automatically quantified from 3-dimensional echocardiography using an artificial intellgience-based dynamic heart model. Patients were stratified by sex-specific median LACI values and followed for major adverse cardiovascular events. Cox proportional hazards and Fine-Gray competing risk models evaluated associations between LACI and outcomes. A sensitivity analysis was performed in 3 ways: (1) using propensity score matching, (2) excluding patients with atrial fibrillation, and (3) repeating propensity score matching in the cohort after excluding patients with atrial fibrillation. Results were verified in 3 independent cohorts: 285 internal validation, 124 coronary computed tomography angiography, and 128 external 3-dimensional echocardiography cohorts.
Results:
Over a median 18-month follow-up, 219 major adverse cardiovascular events occurred. Women had significantly higher median LACI values than men. LACI was significantly associated with increased major adverse cardiovascular event risk in men (hazard ratio [HR], 1.23 [95% CI, 1.03-1.46]; P=0.020; P for interaction=0.027) but not in women. Restricted cubic spline analysis demonstrated a linear dose-response association in men. Fine-Gray analysis demonstrated a significant association between LACI and major adverse cardiovascular events in men. Findings remained consistent after AF exclusion, PSM, and across all validation cohorts.
Conclusions:
Artificial intelligence-derived LACI from 3-dimensional echocardiography demonstrates clear sex-specific prognostic value in acute coronary syndrome, and is significantly associated with adverse cardiovascular outcomes in men but not in women. These results support sex-specific risk stratification and highlight the clinical relevance of atrioventricular coupling assessment.
Registration:
URL: https://www.chictr.org.cn/. Unique identifier: ChiCTR2500099592.
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