Cardiac magnetic resonance-derived left atrioventricular coupling index predicts outcome in reduced ejection fraction.
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Guglielmo Marco, Fedele Damiano, Bergamaschi Luca, Armillotta Matteo, Angeli Francesco, Ciarlantini Mariachiara, Buccella Ilaria, Pizzi Carmine, Pezel Theo, Aquaro Giovanni Donato, Baggiano Andrea, Barison Andrea, Bogaert Jan, Calò Leonardo, Camastra Giovanni, Carigi Samuela, Carrabba Nazario, Casavecchia Grazia, Censi Stefano, Cicala Gloria, De Cecco Carlo N, De Lazzari Manuel, Di Giovine Gabriella, Dobrovie Monica, Focardi Marta, Fusini Laura, Gaibazzi Nicola, Gismondi Annalaura, Gravina Matteo, van der Harst Pim, Lanzillo Chiara, Lombardi Massimo, Lorenzoni Valentina, Lorano-Torres Jordi, Margonato Davide, Martini Chiara, Marzo Francesca, Masci Pier-Giorgio, Masi Ambra, Moro Claudio, Muscogiuri Giuseppe, Mushtaq Saima, Nese Alberto, Palumbo Alessandro, Pedrotti Patrizia, Perazzolo Marra Martina, Pradella Silvia, Presicci Cristina, Rabbat Mark G, Raineri Claudia, Rodriguez-Palomares Jose' F, Sbarbati Stefano, Squeri Angelo, Sverzellati Nicola, Symons Rolf, Tat Emily, Timpani Mauro, Todiere Giancarlo, Valentini Adele, Varga-Szemes Akos, Volpe Alessandra, Guaricci Andrea Igoren, Schwitter Juerg, Pavon Anna Giulia, Pontone Gianluca
Аннотация
METHODS: Patients 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.
RESULTS: A 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).
CONCLUSION: CMR-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.