Left Atrioventricular Coupling Index in Heart Failure Patients Using Echocardiography: A Simple Yet Effective Metric
Authors: Nguyen Ngoc Dang Hai , Viet Luong Thang , Khanh Tran Hung , Ha Tuyet Le Ny , Hoang Nhat Nguyen Minh , Chi Doan Thang , Minh Nguyen Hung 
Published: June 2024

Background

Heart failure (HF) is a global health challenge, with significant rates of hospitalization and mortality. Timely diagnosis is crucial for patient outcomes. Noninvasive imaging techniques assess early changes in HF but typically focus on specific aspects of the left atrium (LA) or left ventricle (LV). However, the close physiological interplay between the LA and LV suggests that indices evaluating both chambers, like the left atrioventricular coupling index (LACI), may offer superior diagnosis value for HF.

Method

The cross-sectional study randomly selected 1145 people at a hospital in Vietnam. Following the exclusion criteria, 160 subjects were eligible for analysis and divided into patient and healthy control groups. The patient group consisted of 60 adults meeting the criteria for HF diagnosis according to the 2022 AHA/ACC/HFSA Guideline.

Results

LACI levels were significantly higher in the HF group compared to the control group. Notably, LACI levels were higher in the HF with preserved ejection fraction (HFpEF) group than in the HF with reduced ejection fraction (HFrEF) group. The LACI showed a diagnostic value for HFpEF, with the highest AUC of 0.95 (95% CI: 0.921 - 0.981, p<0.001) compared to LASr, LAScd, and LAVI, with an optimal threshold of 33.07 (sensitivity: 97.1%, specificity: 87.3%). In multivariate analysis, LACI was an independent factor of HFpEF when compared to standard indices for diagnosing HFpEF (OR = 1.144, 95% CI: 1.087–1.205, p<0.001).

Conclusion

HF patients display increased LACI variability compared to healthy individuals, with the most significant increase observed in the HFpEF group. The LACI is an easily assessable parameter with potential value in diagnosing HFpEF.

What is already known on this topic

Previous studies assessing the Left Atrioventricular Coupling Index (LACI) using cardiac magnetic resonance imaging have demonstrated its predictive role in cardiovascular risk. However, clinical practice shows that echocardiography can also calculate the LACI. Echocardiography is widely available and can be performed repeatedly. Despite its promising utility, no studies to date have utilized echocardiography-measured LACI for diagnosing heart failure with preserved ejection fraction (HFpEF).

What this study adds

Patients with heart failure exhibit significantly higher LACI compared to the control group. Among heart failure patients, HFpEF have the highest LACI values. Additionally, LACI demonstrates superior diagnostic value for HFpEF compared to current echocardiographic parameters recommended in clinical practice.

How this study might affect research, practice or policy

This study holds promising potential by contributing to the development of a straightforward echocardiographic index that can diagnose HFpEF compared to current measures. Further research on LACI across diverse global populations could provide more compelling evidence of its efficacy. This could potentially lead to recommendations for integrating this index into clinical practice guidelines for guiding the clinical diagnosis of HFpEF.

Graphical Abstract

Graphical Abstract: Left Atrioventricular Coupling Index in Heart Failure Patients Using Echocardiography: A Simple Yet Effective Metric. HFpEF, heart failure with preserved ejection fraction; LACI, left atrioventricular coupling index; LAVI, left atrial volume index, LASr, left atrial reservoir strain, LV GLS, left ventricular global longitudinal strain; LV EF, left ventricular ejection fraction; LAEDV, left atrial end-diastolic volume; LVEDV, left ventricular end-diastolic volume.