Increased left atrioventricular coupling index as a marker of atrial myopathy in patients with atrial fibrillation

Atrial fibrillation (AF) is often linked to left ventricular (LV) dysfunction and left atrial (LA) remodeling. The left atrioventricular coupling index (LACi), a novel echocardiographic metric reflecting LA-LV interaction and diastolic function, may offer insights into AF progression. However, its relationship with AF type remains unclear and cutoff values have not been precisely defined.

The aim of the present study was to investigate the potential differences in LACi between patients with paroxysmal (PAF) and persistent AF (PerAF).

In this prospective study, 26 patients with PAF [46% female, mean age: 65.58 ± 8.45 years, mean AF duration: 43.85± 47.84 months] and 15 patients with PerAF [26% female, mean age: 63.13± 8.83, mean AF duration: 57.47± 113.59 months] were examined. All patients underwent standard TTE using a GE Vivid E95, to assess systolic and diastolic left ventricular (LV) function, LA diameter, end-systolic and end-diastolic LA volumes. LACi was derived from the ratio of LA end-diastolic volume to LV end-diastolic volume.

Results indicated that PerAF exhibited higher LACi values than the PAF group (0.52±0.27 vs 0.36±0.14, p=0.036). After adjusting for age and gender, the observed statistically significant difference in LACi between the PAF and PerAF groups remained, demonstrating that AF type is an important predictor of LACi.

From a pathophysiological standpoint, LACi is a marker of LA-LV decoupling and diastolic dysfunction and appears to be elevated in PerAF compared to PAF. Measurement is easily accessible with 2D TTE. This suggests that LACi may be a valuable non-invasive tool for risk stratification, potentially predicting AF progression and outcomes of rhythm control strategies. Further studies are warranted to validate its prognostic utility in predicting AF recurrence post-cardioversion or ablation.

Baseline characteristics