Incremental prognostic value of three-dimensional left atrioventricular coupling index beyond conventional echocardiography in acute myocardial infarction
H Le Thi Ngoc, H Tran Duc, T Luong CongAbstract
Background
Left atrioventricular coupling (LACI) integrates left atrial (LA) and left ventricular (LV) function and may provide mechanistic insight into early hemodynamic impairment following acute myocardial infarction (AMI). Although LACI has demonstrated incremental prognostic value in this population, its clinical utility when derived from three-dimensional (3D) echocardiography remains incompletely established.
Purpose
To assess whether 3D LACI provides incremental prognostic value beyond established functional and deformation indices in patients with AMI undergoing primary percutaneous coronary intervention (PCI).
Methods
In this prospective longitudinal study, we enrolled 120 consecutive patients with AMI treated with primary PCI. All patients underwent comprehensive echocardiography within 24 hours of admission. We acquired 3D full-volume datasets to quantify LV and LA volumes and ejection fraction. 3D LACI was calculated as the ratio of 3D LA end-diastolic volume to 3D LV end-diastolic volume. Speckle-tracking analysis provided LV global longitudinal strain (LVGLS) and LA reservoir strain (LASr). Patients were followed for 12 months. The primary endpoint was major adverse cardiac events (MACE): all-cause mortality, hospitalization for heart failure, and reinfarction. Multivariable Cox regression analysis adjusted for clinical risk score and conventional echocardiographic indices.
Results
During 12-month follow-up, MACE occurred in 18.3% of patients. Patients with events showed higher 3D LACI than those without events (23.6% vs. 18.2%, p = 0.001). 3D LACI demonstrated higher discrimination for MACE (AUC 0.794, p < 0.001) compared with LVEF (0.702), LVGLS (0.732), LASr (0.708), and LAEF (0.784). The combination of 3D LACI and 3D LVEF further improved prognostic performance (AUC 0.806). In multivariate Cox regression analysis, 3D LACI remained independently associated with MACE (HR 1.42 per 1% increase, 95% CI 1.11–1.81; p = 0.005). A cut-off value of 23.5% identified a higher-risk subgroup (log-rank p < 0.001).
Conclusion
3D LACI independently predicts adverse outcomes after AMI and provides incremental prognostic value beyond conventional echocardiographic parameters. Quantitative assessment of left atrioventricular coupling by 3D echocardiography may refine early post-infarction risk stratification.ROC for predicting MACE