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Updated: May 19, 2026
Evaluation of Left Ventricular Structure and Function using 3D Echocardiography
Published on: October 28, 2020
Left atrioventricular coupling index by 2D and 3D echocardiography: association with exercise capacity in chronic
Ruonan Wang1, Fan Zhao2, Wenjia Shi1
1Department of Echocardiography, The First Clinical Medical School of Gansu University of Chinese Medicine, Gansu Provincial Hospital, Lanzhou, China.
Insights
The left atrioventricular coupling index (LACI) predicts exercise capacity in chronic kidney disease (CKD) patients. Higher LACI indicates worse exercise capacity, with 3D-LACI offering superior predictive accuracy.
Area of Science:
- Cardiology
- Nephrology
- Medical Imaging
Background:
- The left atrioventricular coupling index (LACI) relates left atrial (LA) and left ventricular (LV) end-diastolic volumes.
- Elevated LACI is linked to poorer prognosis in cardiovascular diseases.
- The association between LACI and exercise capacity in chronic kidney disease (CKD) is not well understood.
Purpose of the Study:
- To investigate the relationship between resting LACI and exercise capacity in CKD patients.
- To compare the efficacy of 2D and 3D echocardiography in assessing LACI for predicting exercise capacity.
Main Methods:
- 122 CKD patients underwent resting echocardiography and treadmill testing.
- LACI was calculated using EchoPAC software from LA and LV end-diastolic volumes.
- Exercise capacity was measured in metabolic equivalents (METs), with reduced capacity defined as ≤7 METs.
Main Results:
- Patients with higher exercise capacity (>7.20 METs) had significantly lower LACI.
- Both 2D-LACI and 3D-LACI were independent predictors of reduced exercise capacity in CKD.
- 3D-LACI showed higher diagnostic accuracy (AUC=0.8105) compared to 2D-LACI (AUC=0.7718).
Conclusions:
- LACI is an independent predictor of exercise capacity in CKD patients, reflecting impaired atrioventricular interaction.
- 3D-LACI provides superior prediction performance over 2D-LACI.
- 3D-LACI may improve early detection of exercise intolerance in CKD.
Background:
The left atrioventricular coupling index (LACI) quantifies the relationship between left atrial (LA) and left ventricular (LV) volumes at end-diastole, and a higher LACI has been associated with worse prognosis and adverse clinical outcomes across various cardiovascular conditions. However, the relationship between LACI and exercise capacity remains unknown. The objective of this study was to evaluate the association between resting LACI, as measured by two-dimensional echocardiography (2DE) and three-dimensional echocardiography (3DE), and exercise capacity in individuals diagnosed with chronic kidney disease (CKD).
Methods:
A total of 122 patients with CKD underwent resting echocardiography and treadmill training in the study at a single tertiary care center. LACI, the ratio of the LA to LV volume at end-diastole, was calculated offline using EchoPAC 204. Exercise capacity was evaluated as metabolic equivalents (METs) and reduced exercise capacity was defined as METs of ≤7.
Results:
Patients in the highest tertile of exercise capacity (METs >7.20) exhibited significantly lower LACI compared with those in the lower tertiles. Both 2D-LACI {β, -0.266 [95% confidence interval (CI): -4.964, -0.635]; P=0.010} and 3D-LACI [β, -0.333 (95% CI: -5.388, -0.181); P=0.003] were independent predictors of reduced exercise capacity in patients with CKD after adjustment for confounders. The 3D-LACI demonstrated the higher diagnostic accuracy [the area under the curve (AUC) =0.8105; optimal cutoff: 0.2850], outperforming 2D-LACI (AUC =0.7718; cutoff: 0.2097) (DeLong test: P=0.014).
Conclusions:
LACI, a marker of deteriorated atrioventricular interaction, is an independent predictor of exercise capacity in patients with CKD. Moreover, 3D-LACI offers superior prediction performance compared to 2D-LACI, potentially enhancing early detection of exercise capacity intolerance.
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