{"id":"87c65d7bc11a","type":"article","url":"https://hartvaat.nl/2026/05/05/cmr-laci-21-identificeert-hoogrisicopatienten-met-hfref-onafhankelijk-van-lvef-e/","title":"CMR-LACI ≥21% identificeert hoogrisicopatiënten met HFrEF — onafhankelijk van LVEF en LGE","title_en":"","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["hfpef"],"journal":"ESC heart failure","doi":"10.1093/eschf/xvag130","source_url":"https://doi.org/10.1093/eschf/xvag130","authors":["Marco Guglielmo","Damiano Fedele","Luca Bergamaschi","Matteo Armillotta","Francesco Angeli","Mariachiara Ciarlantini","Ilaria Buccella","Carmine Pizzi","Theo Pezel","Giovanni Donato Aquaro","Andrea Baggiano","Andrea Barison","Jan Bogaert","Leonardo Calò","Giovanni Camastra","Samuela Carigi","Nazario Carrabba","Grazia Casavecchia","Stefano Censi","Gloria Cicala","Carlo N De Cecco","Manuel De Lazzari","Gabriella Di Giovine","Monica Dobrovie","Marta Focardi","Laura Fusini","Nicola Gaibazzi","Annalaura Gismondi","Matteo Gravina","Pim van der Harst","Chiara Lanzillo","Massimo Lombardi","Valentina Lorenzoni","Jordi Lorano-Torres","Davide Margonato","Chiara Martini","Francesca Marzo","Pier-Giorgio Masci","Ambra Masi","Claudio Moro","Giuseppe Muscogiuri","Saima Mushtaq","Alberto Nese","Alessandro Palumbo","Patrizia Pedrotti","Martina Perazzolo Marra","Silvia Pradella","Cristina Presicci","Mark G Rabbat","Claudia Raineri","Jose' F Rodriguez-Palomares","Stefano Sbarbati","Angelo Squeri","Nicola Sverzellati","Rolf Symons","Emily Tat","Mauro Timpani","Giancarlo Todiere","Adele Valentini","Akos Varga-Szemes","Alessandra Volpe","Andrea Igoren Guaricci","Juerg Schwitter","Anna Giulia Pavon","Gianluca Pontone"],"significance":6,"published":"2026-06-30","source_date":"2026-05-05","image":"","kennis":["https://hartvaat.nl/kennis/diagnostiek/cardiale-mri/","https://hartvaat.nl/kennis/hartfalen/ischemische-cardiomyopathie/"],"congress":"","summary_en":"Analysis within the multicenter DERIVATE registry: 2,170 patients with LVEF <50% who underwent cardiac MRI (mean age 59.8 years, 24.7% women, median LVEF 31.6%). LACI (left atrioventricular coupling index) was calculated as the ratio of left atrial to left ventricular end-diastolic volume. Median LACI 19.4%. During a median follow-up of 1,016 days, all-cause mortality occurred in 8.8%, mortality/HF in 26.0%, and HF in 20.4%. After adjustment for clinical and CMR parameters (including LVEF and late gadolinium enhancement), each 5% increase in LACI was associated with greater all-cause mortality (HR 1.06), mortality/HF (HR 1.09), and HF (HR 1.09). The optimal cut-off for all-cause mortality was LACI ≥21% (AUC 0.617). LACI provides incremental prognostic information beyond LVEF and LGE in HFrEF.","created":"2026-07-03T10:33:08Z","updated":"2026-07-03T13:32:02Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse binnen het multicenter DERIVATE-register: 2.170 patiënten met LVEF <50% die cardiale MRI ondergingen (gemiddelde leeftijd 59,8 jaar, 24,7% vrouw, mediane LVEF 31,6%). LACI (left atrioventricular coupling index) werd berekend als ratio tussen linkeratrium- en linkerventrikel-eind-diastolisch volume. Mediane LACI 19,4%. Tijdens mediane follow-up van 1.016 dagen trad totale sterfte op bij 8,8%, sterfte/HF bij 26,0% en HF bij 20,4%. Na correctie voor klinische en CMR-parameters (incl. LVEF en late gadolinium enhancement) was elke 5% stijging in LACI geassocieerd met meer totale sterfte (HR 1,06), sterfte/HF (HR 1,09) en HF (HR 1,09). De optimale afkapwaarde voor totale sterfte was LACI ≥21% (AUC 0,617). LACI biedt incrementele prognostische informatie bovenop LVEF en LGE bij HFrEF.","abstract_original":"INTRODUCTION: The left atrioventricular coupling index (LACI) has emerged as a potential prognostic marker in several clinical settings. This study evaluated the prognostic value of cardiac magnetic resonance (CMR)-derived LACI in patients with heart failure (HF) and reduced left ventricular ejection fraction (LVEF). METHODS: Patients from the multicentre DERIVATE registry with LVEF <50% who underwent CMR were included. LACI was calculated as the ratio between left atrial and left ventricular end-diastolic volumes. Univariable and multivariable Cox regression models estimated hazard ratios (HR) with 95% confidence intervals (CI) for predicting all-cause mortality (ACM), ACM or HF, and HF alone (competing-risk analysis). Time-dependent receiver operating characteristic analysis identified optimal cut-offs for 3-year outcomes. RESULTS: A total of 2170 patients were included (mean age 59.8 ± 13.9 years; 24.7% women; mean LVEF 31.6 ± 11.3%). Median follow-up was 1016 days (580-1609). Median LACI was 19.4% (13.3-28.8). During follow-up, ACM occurred in 191 patients (8.8%), ACM or HF in 565 (26.0%), and HF in 442 (20.4%). After adjustment for clinical and CMR parameters, including LVEF and late gadolinium enhancement (LGE), each 5% increase in LACI was associated with higher risk of ACM (HR 1.06, 95% CI 1.01-1.11; P = .016), ACM or HF (HR 1.09, 95% CI 1.06-1.12; P < .001), and HF (HR 1.09, 95% CI 1.05-1.12; P < .001). The optimal cut-off for ACM was 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). 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."}