Prognostic implications of Left Atrioventricular Coupling Index (LACI) in Transthyretin Cardiomyopathy (ATTR-CM): Exploring novel diastolic metrics in ATTR-CM - 08/01/26
, S. Istratoaie 2, M. Bézard 3, P. Rasmeehirun 1, G. L’Official 1, A. Al Wazzan 2, E. Donal 1Abstract |
Introduction |
Transthyretin amyloid cardiomyopathy (ATTR-CM) is a progressive infiltrative disorder marked by left ventricular hypertrophy and atrial remodeling, culminating in restrictive heart failure. Although disease-modifying therapies exist, risk stratification remains inadequate. The Left Atrioventricular Coupling Index (LACI) – an echocardiographic metric capturing LA-LV interaction – has shown promise in heart failure but remains untested in ATTR-CM.
Objective |
To evaluate the prognostic value of LACI in ATTR-CM, focusing on its association with all-cause death and/or heart failure (HF) hospitalization.
Method |
We retrospectively analyzed 335 patients diagnosed with wild-type (ATTRwt) and hereditary (ATTRv) TTR amyloidosis who underwent clinical and comprehensive echocardiographic assessment at University Hospital of Rennes. LACI was calculated with conventional echocardiography as the ratio of left atrial minimal volume (measured at the end of LV diastole) divided by the left ventricular end-diastolic volume (LVEDV). The primary endpoint was all-cause death and/or HF hospitalization.
Results |
The median age of patients was 83 years, with 85% being male. Among the cohort, 95% had wild-type transthyretin amyloidosis, while 5% had the hereditary form. Patients were predominantly classified as NYHA class II (62%) and III (24%). Over a median follow-up of 22 months (IQR: 8–40 months), 39% (132 patients) reached the composite endpoint of all-cause mortality and/or HF hospitalization. Multivariate analysis identified elevated LACI as an independent predictor of adverse outcomes in patients under 83 years (HR 2.59 [95% CI: 1.36–4.95], p = 0.0039), irrespective of tafamidis use. ROC curve established an optimal LACI cutoff value of 0.67. Kaplan-Meier survival analysis stratified patients under 83 years based on this cutoff, defining the high-risk cohort as LACI > 0.67 ( Fig. 1 ). This group exhibited a significantly higher cumulative incidence of all-cause mortality and/or HF hospitalization (log-rank p = 0.034).
Conclusion |
LACI is a simple, non-invasive marker that identifies younger ATTR-CM patients at elevated risk for mortality or HF hospitalization. Its integration into routine echocardiographic practice may improve early risk stratification and help tailor follow-up intensity and therapeutic timing.
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Vol 119 - N° 1S
P. S63-S64 - janvier 2026 Retour au numéro
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