ArticleClinical research in cardiology : official journal of the German Cardiac Society2026
Echocardiography-derived Left Atrial Volumetric-Mechanical Coupling Index predicts early new-onset atrial fibrillation after embolic stroke/transient ischemic attack of undetermined source.
Article in Clinical research in cardiology : official journal of the German Cardiac Society, 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
aimIn patients with embolic stroke or transient ischemic attack of undetermined source (ESUS/TIA), occult atrial fibrillation (AF) is a frequent underlying mechanism with critical therapeutic implications, yet selecting patients who warrant intensified rhythm monitoring remains challenging. The Left Atrioventricular Coupling Index (LACI = LA end-diastolic volume/LV end-diastolic volume) captures atrioventricular uncoupling, whereas the Left Atrial Volumetric-Mechanical Coupling Index (LACI-VM = LAVi/a') integrates atrial size with mechanical performance; both may capture complementary domains of atrial remodelling relevant to subclinical AF. We aimed to investigate the association of LACI-VM and LACI with incident AF in ESUS/TIA. METHODS AND
resultsIn this retrospective single-center cohort, 285 consecutive patients with ESUS/TIA of undetermined source underwent transthoracic echocardiography at index hospitalization, including measurement of LACI-VM and LACI. The primary endpoint was new-onset AF during follow-up. Median age was 71 years and 43% were women. Over a median follow-up of 10.9 months, AF occurred in 24 patients (8.4%), with 62% of events occurring within the first year. LACI-VM was higher in patients who developed AF and remained independently associated with incident AF after multivariable adjustment (HR 6.64, CI 1.34-59.88; p = 0.041). LACI showed a non-significant association overall (HR 2.28, CI 0.74-7.01; p = 0.09), with predictive value confined to events within 12 months. A combined assessment of LACI-VM and LV filling pressures further refined risk stratification: patients with preserved LACI-VM (< 2.5) and normal filling pressures (E/e' ≤ 10) had a very low AF incidence (~ 2%), identifying a truly low-risk subgroup; conversely, when both LACI-VM (≥ 2.5) and filling pressures (E/e' > 10) were impaired, AF risk was ~ tenfold higher (~ 20%).
conclusionIn ESUS/TIA, echocardiography-derived LACI-VM independently predicts incident AF and identifies patients at genuinely low risk. As a simple echocardiographic metric, its integration with LV filling pressures may support a more personalized use of rhythm monitoring.
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