ArticleESC heart failure2026
Cardiac magnetic resonance-derived left atrioventricular coupling index predicts outcome in reduced ejection fraction.
Article in ESC heart failure, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Discrimination of sustained VT in structural heart disease using LGE-CMR and computational simulation: moving beyond LVEF.Frontiers in cardiovascular medicine · 2026Article
- A fully automated machine learning assisted pipeline to predict disease progression for early-stage hypertrophic cardiomyopathy from echocardiography.Frontiers in cardiovascular medicine · 2026Article
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65 authors.
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Abstract
introductionThe left atrioventricular coupling index (LACI) has emerged as a potential prognostic marker in several clinical settings. This study evaluated the prognostic value of cardiac magnetic resonance (CMR)-derived LACI in patients with heart failure (HF) and reduced left ventricular ejection fraction (LVEF).
methodsPatients from the multicentre DERIVATE registry with LVEF <50% who underwent CMR were included. LACI was calculated as the ratio between left atrial and left ventricular end-diastolic volumes. Univariable and multivariable Cox regression models estimated hazard ratios (HR) with 95% confidence intervals (CI) for predicting all-cause mortality (ACM), ACM or HF, and HF alone (competing-risk analysis). Time-dependent receiver operating characteristic analysis identified optimal cut-offs for 3-year outcomes.
resultsA total of 2170 patients were included (mean age 59.8 ± 13.9 years; 24.7% women; mean LVEF 31.6 ± 11.3%). Median follow-up was 1016 days (580-1609). Median LACI was 19.4% (13.3-28.8). During follow-up, ACM occurred in 191 patients (8.8%), ACM or HF in 565 (26.0%), and HF in 442 (20.4%). After adjustment for clinical and CMR parameters, including LVEF and late gadolinium enhancement (LGE), each 5% increase in LACI was associated with higher risk of ACM (HR 1.06, 95% CI 1.01-1.11; P = .016), ACM or HF (HR 1.09, 95% CI 1.06-1.12; P < .001), and HF (HR 1.09, 95% CI 1.05-1.12; P < .001). The optimal cut-off for ACM was LACI ≥21% (AUC 0.617, 95% CI 0.561-0.673), identifying patients at higher risk of ACM, ACM or HF, and HF (log-rank P < .001 for all).
conclusionCMR-derived LACI independently predicts ACM and HF in patients with reduced LVEF and provides incremental prognostic value beyond LVEF and LGE. A cut-off of ≥21% identifies higher-risk patients and may support clinical risk stratification.
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