Left Atrioventricular Coupling Index: A Novel Diastolic Parameter to Refine Prognosis in Heart Failure

IF 5.4 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Society of Echocardiography Pub Date : 2024-11-01 DOI:10.1016/j.echo.2024.06.013

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引用次数: 0

Abstract

Background

Left atrioventricular coupling index (LACI), an index coupling left atrial to left ventricular (LV) volume at end-diastole, has been shown to be associated with prognosis in different clinical settings. However, the relation between LACI and LV diastolic dysfunction (DD) remains to be established. The aims of the present study were to investigate the association between LACI and LV DD and to assess its prognostic value in patients with heart failure (HF).

Methods

A total of 1,158 patients with HF in stable condition, on optimal medical therapy, were retrospectively analyzed (derivation cohort). Clinical and echocardiographic features were characterized across LACI tertiles. The independent prognostic value of LACI (end point: all-cause death or HF hospitalization) was assessed using Cox regression. Results were validated in an external cohort of 242 patients with HF.

Results

In the derivation cohort, the median LACI value was 0.29 (interquartile range, 0.19-0.42). Patients in the third tertile (LACI > 0.36) were older and presented with more advanced HF symptoms. Although the prevalence of grade 1 DD (American Society of Echocardiography/European Association of Cardiovascular Imaging classification) progressively decreased across LACI tertiles, the prevalence of grade 3 DD significantly increased (8%, 23%, and 46%, respectively; P < .0001). A cutoff value of ≥0.26 identified moderate to severe DD with an area under the curve of 0.75. During follow-up (median, 28 months; interquartile range, 11-53 months), 407 patients (35%) reached the end point. On multivariable analysis, LACI was independently associated with outcomes (hazard ratio for a 1-SD increase, 1.16; 95% CI, 1.06-1.28; P = .002), showing incremental predictive value over the DD grading system (net reclassification improvement = 0.150, P < .0001). The prognostic value of LACI was consistent in the external validation cohort.

Conclusions

LACI is associated with DD severity and is an independent predictor of outcomes in patients with HF.

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左心房-心室耦合指数：完善心力衰竭预后的新型舒张参数

背景：左房室耦合指数（LACI）是舒张末期左心房（LA）与左心室（LV）容积的耦合指数，在不同的临床环境中显示与预后有关。然而，LACI 与左心室舒张功能障碍（DD）之间的关系仍有待确定。本研究旨在调查 LACI 与左心室舒张功能障碍之间的关系，并评估其在心力衰竭（HF）患者中的预后价值：我们回顾性分析了1158名接受最佳药物治疗的稳定型心力衰竭患者（衍生队列）。临床和超声心动图特征体现在不同的 LACI 分层中。通过 Cox 回归评估了 LACI 的独立预后价值（终点：全因死亡/房颤住院）。结果在一个由 242 名高频患者组成的外部队列中得到验证：在衍生队列中，LACI 的中位值为 0.29（IQR:0.19-0.42）。第三个三分位数（LACI>0.36）的患者年龄较大，并伴有较严重的心房颤动症状。虽然 1 级 DD（ASE/EACVI 分级）的患病率在 LACI 三等分中逐渐降低，但 3 级 DD 的患病率却显著增加（分别为 8%、23% 和 46%，PC 结论：LACI 与 DD 严重程度相关，是预测高血压患者预后的独立指标。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the American Society of Echocardiography 医学-心血管系统

CiteScore

9.50

自引率

12.30%

发文量

257

审稿时长

66 days

期刊介绍： The Journal of the American Society of Echocardiography(JASE) brings physicians and sonographers peer-reviewed original investigations and state-of-the-art review articles that cover conventional clinical applications of cardiovascular ultrasound, as well as newer techniques with emerging clinical applications. These include three-dimensional echocardiography, strain and strain rate methods for evaluating cardiac mechanics and interventional applications.