Two-dimensional ultrasound is optimal for screening; RT-3DE shows highest consistency with cardiovascular magnetic resonance for precise diagnosis, and 3DE-LACI has demonstrated independent prognostic value in cardiac amyloidosis.
Abstract
Background The Left Atrioventricular Coupling Index (LACI) is an emerging echocardiographic parameter for assessing left atrial and ventricular diastolic function. While accumulating evidence supports its prognostic value, technical standardization for clinical implementation remains lacking. Methods This narrative review compares four LACI measurement approaches: two-dimensional echocardiography (2DE), real-time three-dimensional echocardiography (RT-3DE), speckle-tracking echocardiography (STE), and artificial intelligence (AI)-assisted analysis. We evaluate technical characteristics, standardization challenges, and evidence gaps. Results Two-dimensional ultrasound is optimal for screening; RT-3DE shows highest consistency with cardiovascular magnetic resonance for precise diagnosis, and 3DE-LACI has demonstrated independent prognostic value in cardiac amyloidosis. STE aids mechanistic exploration but requires algorithmic standardization. AI demonstrates potential but needs multicenter validation. Key limitations include absent cross-platform calibration, fragmented reference values, and lack of externally validated cutoffs. Conclusion LACI is a promising marker of diastolic function with proven prognostic value; however, technical heterogeneity and inconsistent thresholds have hindered its clinical application. Future efforts should focus on cross-manufacturer standardization, the establishment of reference values for specific populations, and randomized controlled trials evaluating LACI as a guide for treatment.
Overall, MAPSE has a clinically important role meriting integration into routine cardiac imaging and care, and demonstrated strong prognostic value, outperforming LVEF and global longitudinal strain in predicting adverse events in several studies.
Debbie Falconer, F. Fröjdh, N. Wyeth et al.· Journal of the American Hear...· 2 citations
Routine clinical practice, standard echocardiographic measurements showed overall good reproducibility, with the strongest performance for left ventricular indices.
Raúl Reyes-Toledo, D. G. David-Pardo, G. Lemus-Barrios et al.· Frontiers in Cardiovascular...· 0 citations
This review will provide methodology, normal reference values, and clinical applications of right ventricular global longitudinal strain, specifically for the Indian context, incorporating recent Indian studies across acute myocardial infarction, valvular heart disease, cardiac surgery, heart failure with preserved ejection fraction, and diabetes mellitus.
Parminder Sharma, Arghadip Bose, Basant Kumar· Indian Journal of Clinical C...· 0 citations
RACI is a novel parameter that effectively integrates RA and RV remodeling, and independently predicts all-cause mortality in functional TR, and incorporating RACI into clinical assessment may help with improving risk stratification and guiding the timing of intervention in patients with functional TR.
Robert S. Zhang, G. Falco, E. Li et al.· Circulation Cardiovascular I...· 0 citations
Background: Atrial stiffness can be estimated non-invasively using speckle-tracking echocardiography (STE) and has recently emerged as an outcome predictor. We aimed to assess left atrial (LA) and right atrial (RA) phasic function; the LA stiffness index (LASI), the RA stiffness index (RASI) and their sum; and the biatrial stiffness index (BASI) in dilated cardiomyopathy (DCM), and to test whether combining the two atria adds prognostic information over either index alone. Methods: A total of 121 patients with non-ischaemic DCM in sinus rhythm were followed prospectively for a composite endpoint of all-cause death, non-fatal cardiac arrest, or hospitalisation for heart failure decompensation. LASI was defined as the mitral E/e′ ratio divided by LA reservoir strain, RASI as the tricuspid Et/e′t ratio divided by RA reservoir strain, and BASI as the sum of the two. Cox models were adjusted for NYHA class, LV ejection fraction (LVEF), maximal LA volume (LAVmax) and pulmonary artery systolic pressure (PASP). Results: After 19 ± 11 months, 55 patients reached the endpoint. LA reservoir and contraction strain, all three components of RA strain and all three stiffness indices were significantly impaired in patients with events. All stiffness indices were independent outcome predictors in multivariable Cox regression (HR 2.79 [95% CI, 1.35–5.75], p = 0.006 for LASI, HR 1.84 [95% CI, 1.02–3.29], p = 0.04 for RASI and HR 2.74 [95% CI, 1.36–5.51], p = 0.005 for BASI). BASI showed the greatest increase in risk prediction (Δ likelihood ratio χ2 test = 10.3, p = 0.001) over NYHA class, left ventricular ejection fraction, LA maximal volume and pulmonary artery systolic pressure. BASI showed the highest discrimination (AUC = 0.73); however, it was not significantly better than LASI or RASI alone. Conclusions: Left and right atrial stiffness are both associated with adverse outcome in DCM and add prognostic information to an LV-centred risk model. Their unweighted sum performs at least as well as either component and offers a single parsimonious measure, whose incremental clinical value remains to be established in larger, externally validated cohorts.
A. Vijiiac, I. Petre, S. Onciul et al.· Journal of Clinical Medicine· 0 citations
A practical framework for the perioperative use of myocardial strain is provided by summarizing the current evidence, clarifying its methodological limitations, simplifying its acquisition and interpretation for non-expert users, distinguishing established clinical applications from future research directions, and identifying the key evidence gaps that must be addressed.
C. Beyls, F. Gonzalez, E. Donal et al.· Journal of Clinical Medicine· 0 citations