Heart failure & cardiomyopathiesCohort study
Cardiac magnetic resonance-derived left atrioventricular coupling index predicts outcome in reduced ejection fraction
- multicentre DERIVATE registry
- Univariable and multivariable Cox regression models
- competing-risk analysis
- Time-dependent receiver operating characteristic analysis
Authors' 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.
Study context
- Population
- Patients with heart failure (HF) and reduced left ventricular ejection fraction (LVEF <50%) who underwent cardiac magnetic resonance (CMR)patients included
- Participants
- 2,170 patients
- Exposure
- Each 5% increase in left atrioventricular coupling index (LACI); LACI ≥21% cut-off
Main finding
As reported in the abstract
ACM, ACM or HF, and HF events · Median follow-up was 1016 days (580-1609)
All-cause mortality (ACM) occurred in 191 patients
8.8%
ACM or HF in 565
26.0%
HF in 442
20.4%
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| Risk associated with each 5% increase in LACI — each 5% increase in LACI | 1.06 (1.01–1.11) | P = 0.016 | |
| Risk associated with each 5% increase in LACI — each 5% increase in LACI · ACM or HF; adjusted | 1.09 (1.06–1.12) | P < 0.001 | |
| Risk associated with each 5% increase in LACI — each 5% increase in LACI · HF; adjusted | 1.09 (1.05–1.12) | P < 0.001 | |
| 0.512Hazard ratio (log scale) |
- Risk associated with each 5% increase in LACI: ACM; adjusted for clinical and CMR parameters, including LVEF and LGE
- Risk associated with each 5% increase in LACI: After adjustment for clinical and CMR parameters, including LVEF and late gadolinium enhancement (LGE)
Baseline characteristics
- mean age
- 59.8 ± 13.9 years
- women
- 24.7%
- mean LVEF
- 31.6 ± 11.3%
- Median LACI
- 19.4% (13.3-28.8)
Optimal cut-off for ACM · 3-year outcomes
- 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
Original publication
Cardiac magnetic resonance-derived left atrioventricular coupling index predicts outcome in reduced ejection fraction. ESC Heart Fail. Published 13 May 2026. doi:10.1093/eschf/xvag130
Summarised from the published abstract; every number is checked against it