Left atrioventricular coupling index assessed using cardiac CT as a prognostic marker of cardiovascular death - 30/11/23
, Jean-Guillaume Dillinger a, Solenn Toupin c, Raphael Mirailles a, Damien Logeart a, Alain Cohen-Solal a, Alexandre Unger a, d, Elena Sofia Canuti a, e, Florence Beauvais a, Alexandre Lafont a, Trecy Gonçalves a, Antoine Lequipar a, Emmanuel Gall a, Alexandre Boutigny f, Tania Ah-Sing b, Lounis Hamzi b, Joao A.C. Lima g, Valérie Bousson b, Patrick Henry a
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Highlights |
• | The concept of left atrioventricular (AV) coupling is supported by a left AV coupling index, which has a better prognostic value than individual left atrium or left ventricle parameters measured separately. |
• | The left AV coupling index assessed using cardiac CT demonstrates excellent intra- and inter-reader reproducibilities allowing even easier distribution. |
• | The simple method to measure the new left AV coupling index allows rapid and immediate routine use as a cardiovascular risk stratification tool. |
• | The left AV coupling index is independently associated with cardiovascular death in patients after adjustment for traditional risk factors and cardiac CT findings. |
Abstract |
Purpose |
The purpose of this study was to investigate the prognostic value of left atrioventricular coupling index (LACI) assessed by cardiac computed tomography (CT), to predict cardiovascular death in consecutive patients referred for cardiac CT with coronary analysis.
Materials and methods |
Between 2010 and 2020, we conducted a single-centre study with all consecutive patients without known cardiovascular disease referred for cardiac CT. LACI was defined as the ratio of left atrial to left ventricle end-diastolic volumes. The primary outcome was cardiovascular death. Cox regressions were used to evaluate the association between LACI and primary outcome after adjustment for traditional risk factors and cardiac CT angiography findings.
Results |
In 1,444 patients (mean age, 70 ± 12 [standard deviation] years; 43% men), 67 (4.3%) patients experienced cardiovascular death after a median follow-up of 6.8 (Q1, Q3: 5.9, 9.1) years. After adjustment, LACI was positively associated with the occurrence of cardiovascular death (adjusted hazard ratio [HR], 1.07 [95% CI: 1.05–1.09] per 1% increment; P < 0.001), and all-cause death (adjusted HR, 1.05 [95% CI: 1.03–1.07] per 1% increment; P <0.001). After adjustment, a LACI ≥ 25% showed the best improvement in model discrimination and reclassification for predicting cardiovascular death above traditional risk factors and cardiac CT findings (C-statistic improvement: 0.27; Nnet reclassification improvement = 0.826; Integrative discrimination index =0.209, all P < 0.001; likelihood-ratio-test, P < 0.001).
Conclusion |
LACI measured by cardiac CT is independently associated with cardiovascular death and all-cause death in patients without known cardiovascular disease referred for cardiac CT, with an incremental prognostic value over traditional risk factors and cardiac CT findings.
Le texte complet de cet article est disponible en PDF.Keywords : All-cause death, Cardiac computed tomography angiography, Cardiovascular death, Left atrioventricular coupling index
Abbreviations : CI, CMR, CCTA, CT, CV, CVD, HR, IDI, LACI, LR, LV, LVEF, MESA, NRI, SD
Plan
Vol 104 - N° 12
P. 594-604 - décembre 2023 Retour au numéro
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