Clinical Usefulness of Atrioventricular Coupling in Cardiovascular Disease

doi:10.37015/AUDT.2025.240060

Abstract

Abstract:

Atrioventricular Coupling (AV-Coupling) refers to the functional coordination between atrial and ventricular systole and diastole in the heart. Currently, the primary method for evaluating AV-Coupling is through the left atrioventricular coupling index (LACI), measured using imaging techniques. A higher LACI indicates a greater mismatch between the volumes of left atrium and left ventricle at the end of ventricular diastole, reflecting a more significant impairment of left AV-Coupling. AV-Coupling plays a vital role in the pathophysiology and progression of cardiovascular diseases. Therefore, early and accurate assessment of AV-Coupling is essential for evaluating a patient’s condition, guiding clinical decisions, stratifying risk, and determining prognosis. This review aims to summarize the physiological mechanisms and evaluation methods of AV-Coupling, as well as its clinical significance in various cardiovascular diseases.

Key words: Echocardiography; Atrioventricular coupling; Left atrioventricular coupling index; Heart failure; Atrial fibrillation

Yang Lan, Li Zhenyi, Chen Ya, Chen Anni, Wang Xinqi, Jin Lin, Li Zhaojun. Clinical Usefulness of Atrioventricular Coupling in Cardiovascular Disease. Advanced Ultrasound in Diagnosis and Therapy, 2025, 9(1): 1-9.

Figures/Tables 3

Figure 1

Table 1

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References 68

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Measurement	Advantage	Disadvantage	Author	Population	Main results
Echocardiography	Wide availability, portable, and cheap	Operator-dependent	Meucci, M. et al. [22]	373 patients with HCM and no history of AF	In patients with HCM, LACI was more predictive of the occurrence of new-onset AF than conventional LA parameters.
	Simultaneous assessment of chambers, function, valve, pericardium	Poor acoustic windows in patients with obesity	Fortuni, F. et al. [23]	1,158 patients with stable HF and no AF	LACI was associated with DD severity and is an independent predictor of outcomes in patients with HF.
			Vîjîiac, et al. [24]	121 patients with DCM in sinus rhythm	LACI>20% was an independent predictor for MACE.
	Highly accurate and reproducible	Expensive examination and time-consuming post-processing	Lange, T. et al. [30]	1046 patients following acute myocardial infarction	LACI was significantly higher in patients with MACE compared to those without MACE.
CMR	No ionizing radiation	Expensive	MESA study/ Pezel, T. et al. [9,28]	4,124 participants without known CVD	Greater LACI was independently associated with atrial fibrillation, heart failure, hard cardiovascular, and coronary heart disease.
	Simultaneous assessment of chambers, function, valve, pericardium, perfusion	Cannot be used in patients with implantable devices that are not MRI-compatible	Rui Shi, et al. [50]	176 patients with DM, 103 with hypertension (DM + HP) and 73 without hypertension (DM-HP)	Hypertension was found increase LACI in DM patients, indicating potential atrioventricular coupling index alterations.