Artificial intelligence-enhanced three-dimensional echocardiography reveals left atrial-ventricular coupling index as a novel prognostic marker in coronary artery disease

Comprehensive Summary

Qin and their colleagues studied whether the left atrial-ventricular coupling index (LACI) measured using AI-enhanced three-dimensional echocardiography improves prognostic assessment in coronary artery disease (CAD). The cohort included 1,084 adults with confirmed CAD, in which the LACI was automatically calculated using AI-based software. Patients were followed for a median of 13 months, during which 216 major adverse cardiovascular events occurred (death, reinfarction, heart failure hospitalization). Patients who experienced these events had higher LACI values than those without events (0.22 vs 0.20, p<0.001). After adjustment for demographics, comorbidities, biomarkers, Gensini score, and conventional echocardiographic parameters, LACI remained independently associated with the rate of cardiovascular events (HR 1.68, 95% CI 1.25–2.27). Predictive performance improved when LACI was added to clinical and echocardiographic models, particularly in patients with severe coronary lesions, where discrimination reached AUC 0.77 (95% CI 0.71–0.82).

Outcomes and Implications

This study suggests that LACI captures left atrial–ventricular dysfunction not reflected by anatomy or LVEF alone. In practice, adding LACI to routine three-dimensional echocardiography could help clinicians identify higher-risk CAD patients who may benefit from closer surveillance or more aggressive therapy, even when standard echocardiographic findings appear reassuring. More studies are needed before seeing if the model can alter clinical decisions.