A New Imaging Marker to Predict Incident Heart Failure: Annual Change in Left Atrioventricular Coupling Index. A cardiovascular MRI report from the Multi-Ethnic Study of Atherosclerosis (MESA)

• Published in: Archives of Cardiovascular Diseases Supplements Vol. 14; no. 1; pp. 28 - 29
• Main Authors: Pezel, T., Venkatesh, B.A., Kato, Y., De Vasconcellos, H., Heckbert, S.R., Wu, C., Post, W., Bluemke, D.A., Cohen Solal, A., Henry, P., Lima, J.
• Format: Journal Article
• Language: English
• Published: Elsevier Masson SAS 01.01.2022
• ISSN: 1878-6480
• DOI: 10.1016/j.acvdsp.2021.09.064

Although left atrial (LA) and left ventricular (LV) structural and functional parameters have independent prognostic value as predictors of HF, the close physiological relationship between the LA and LV suggest that the assessment of LA/LV coupling could better reflect left atrioventricular dysfunction and be a better predictor of heart failure (HF). To assess the prognostic value of a new left atrioventricular coupling index (LACI), measured by CMR, as well as annual change in LACI to predict incident HF. In the MESA, 2250 study participants, free of cardiovascular disease at baseline, had LACI assessed by CMR imaging at baseline (2000), and ten years later (2010). LACI was defined as the ratio of LA to LV end-diastolic volumes. Cox proportional hazard models were used to evaluate the associations of LACI and average annualized change in LACI (ΔLACI) with incident HF after adjustment for traditional HF risk factors. The incremental risk prediction was calculated using C-stat, categorical net reclassification index (NRI) and integrative discrimination index (IDI). Among the 2,250 participants (59±9 years; 47.6% male), 50 incident HFs occurred over 6.8±1.3 years after the second CMR exam. After adjustment, greater LACI and ΔLACI were independently associated with HF (HR 1.44, 95%CI [1.25-1.66] and HR 1.55, 95%CI [1.30-1.85], respectively; both P<0.0001). Adjusted models for LACI showed significant improvement in model discrimination and reclassification compared to currently used HF risk score model for predicting HF incidence (C-stat: 0.81 vs. 0.77; NRI=0.411; IDI=0.043). After adjustment, ΔLACI showed also significant improvement in model discrimination compared to the model with traditional HF risk factors (C-stat: 0.82 vs. 0.77; NRI=0.491; IDI=0.058) (Fig. 1). LACI and ΔLACI are independently associated with incident HF. Both have incremental prognostic value for predicting HF over traditional risk factors.