# CMR-LACI ≥21% identificeert hoogrisicopatiënten met HFrEF — onafhankelijk van LVEF en LGE

*geplaatst 2026-06-30 · Hartfalen · ESC heart failure · doi 10.1093/eschf/xvag130 · https://hartvaat.nl/2026/05/05/cmr-laci-21-identificeert-hoogrisicopatienten-met-hfref-onafhankelijk-van-lvef-e/*

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.

## English: 

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.

## Abstract (original, from the publication)

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.

Auteurs: 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

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Bron: ESC heart failure, https://doi.org/10.1093/eschf/xvag130. Bijgewerkt 2026-07-03T13:32:02Z. 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.