ArticleQuantitative imaging in medicine and surgery2026
Left atrioventricular coupling index by 2D and 3D echocardiography: association with exercise capacity in chronic kidney disease.
Article in Quantitative imaging in medicine and surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The left atrioventricular coupling index (LACI) quantifies the relationship between left atrial (LA) and left ventricular (LV) volumes at end-diastole, and a higher LACI has been associated with worse prognosis and adverse clinical outcomes across various cardiovascular conditions. However, the relationship between LACI and exercise capacity remains unknown. The objective of this study was to evaluate the association between resting LACI, as measured by two-dimensional echocardiography (2DE) and three-dimensional echocardiography (3DE), and exercise capacity in individuals diagnosed with chronic kidney disease (CKD). Methods: A total of 122 patients with CKD underwent resting echocardiography and treadmill training in the study at a single tertiary care center. LACI, the ratio of the LA to LV volume at end-diastole, was calculated offline using EchoPAC 204. Exercise capacity was evaluated as metabolic equivalents (METs) and reduced exercise capacity was defined as METs of ≤7. Results: Patients in the highest tertile of exercise capacity (METs >7.20) exhibited significantly lower LACI compared with those in the lower tertiles. Both 2D-LACI {β, -0.266 [95% confidence interval (CI): -4.964, -0.635]; P=0.010} and 3D-LACI [β, -0.333 (95% CI: -5.388, -0.181); P=0.003] were independent predictors of reduced exercise capacity in patients with CKD after adjustment for confounders. The 3D-LACI demonstrated the higher diagnostic accuracy [the area under the curve (AUC) =0.8105; optimal cutoff: 0.2850], outperforming 2D-LACI (AUC =0.7718; cutoff: 0.2097) (DeLong test: P=0.014). Conclusions: LACI, a marker of deteriorated atrioventricular interaction, is an independent predictor of exercise capacity in patients with CKD. Moreover, 3D-LACI offers superior prediction performance compared to 2D-LACI, potentially enhancing early detection of exercise capacity intolerance.
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