Prognostic role of the left atrioventricular coupling index in patients with aortic regurgitation
M Rojas, M Trichilo, E Ferrer, A Teis, V DelgadoAbstract
Background
Risk stratification in patients with aortic regurgitation (AR) remains challenging. The Left Atrioventricular Coupling Index (LACI) is a novel imaging-derived parameter reflecting atrioventricular coupling and has demonstrated prognostic value in heart failure and valvular heart disease. However, its prognostic role in AR remains unknown.
Purpose
To evaluate the prognostic value of cardiac magnetic resonance (CMR)-derived LACI in patients with AR.
Methods
We conducted an observational cohort study including 67 patients (mean age 68 years, 84 % male) with more-than-moderate AR (regurgitant fraction measured with CMR >20%) who underwent clinical evaluation and CMR between 2012 and 2024. Patients with more than mild aortic stenosis or significant mitral valve disease were excluded. Left atrial and left ventricular volumes were quantified by CMR, and LACI was calculated as a percentage. Pathologic LACI (uncoupling) was defined as >30%. The primary endpoint was a composite of all-cause death, new-onset heart failure, and heart failure hospitalization. Median follow-up was 4.12 years (IQR 1.82–6.51). Prognostic assessment included hierarchical win–loss and Kaplan–Meier analyses.
Results
Patients with atrioventricular uncoupling (pathologic LACI>30%) had a worse clinical profile, including older age, higher prevalence of heart failure, and more advanced NYHA class symptoms. During a median follow-up of 4.1 years, 41 patients reached the primary endpoint. Hierarchical win–loss analysis demonstrated significantly worse outcomes in patients with pathologic LACI, while LACI≤30% was associated with better outcomes (win ratio 0.37, 95% CI 0.16–0.83; p=0.02). Kaplan–Meier analysis did not show significant differences in event-free survival (HR 0.97, 95% CI 0.45–2.11; log-rank p=0.94), likely due to limited statistical power. However, early and sustained separation of survival curves was observed.
Conclusion
CMR-derived LACI identifies a high-risk phenotype in patients with AR and may provide incremental prognostic value for risk stratification.Win RatioKaplan