{"database":"biostudies-literature","file_versions":[],"scores":null,"additional":{"omics_type":["Unknown"],"volume":["14(15)"],"submitter":["Okada M"],"pubmed_abstract":["<h4>Background</h4>Left atrial (LA) dysfunction is common in heart failure with preserved ejection fraction (HFpEF). The LA volumetric/mechanical coupling index (LACI), calculated as the LA volume index divided by the late diastolic mitral annular velocity (a'), is a recently advocated parameter reflecting LA contractile function based on the atrial Frank-Starling mechanism. An elevated LACI signifies impaired mechanical performance despite greater atrial volume, indicating volumetric/mechanical uncoupling. Its associations with echocardiographic indices and prognostic significance in HFpEF remain unclear.<h4>Methods</h4>This study included 562 patients from the PURSUIT-HFpEF (Prospective Multicenter Observational Study of Patients With Heart Failure With Preserved Ejection Fraction) registry, a prospective multicenter registry for HFpEF. LACI was calculated and categorized into quartiles. Associations with echocardiographic indices and clinical outcomes were examined.<h4>Results</h4>LA volume index and late diastolic mitral annular velocity were negatively correlated (<i>r</i>=-0.26; <i>P</i><0.001), reflecting impaired atrial Frank-Starling mechanism in this cohort. The median LACI was 6.44 (interquartile range, 4.16-9.69). Patients with elevated LACI had unfavorable backgrounds with increased filling pressure and diastolic dysfunction. During a median follow-up of 40 months, 171 patients experienced cardiovascular death or rehospitalization for heart failure, with event incidence increasing across LACI quartiles (quartile 1, 26.4%; quartile 2, 39.0%; quartile 3, 46.1%; quartile 4, 46.4%; log-rank, <i>P</i>=0.001). After multivariable adjustment, LACI remained a significant predictor of cardiovascular outcomes (hazard ratio, 1.18 per quartile increase [95% CI, 1.00-1.38]; <i>P</i>=0.045).<h4>Conclusions</h4>In patients with HFpEF, LA mechanical activity decreased with LA enlargement, suggesting volumetric/mechanical uncoupling inherent in this cohort. LACI may serve as a clinically relevant index for risk stratification of cardiovascular death or rehospitalization for heart failure in patients with HFpEF.<h4>Registration</h4>URL: https://www.clinicaltrials.gov; Unique identifier: UMIN000021831."],"journal":["Journal of the American Heart Association"],"pagination":["e040646"],"full_dataset_link":["https://www.ebi.ac.uk/biostudies/studies/S-EPMC12449986"],"repository":["biostudies-literature"],"pubmed_title":["Left Atrial Volumetric/Mechanical Coupling Index in Heart Failure With Preserved Ejection Fraction."],"pmcid":["PMC12449986"],"pubmed_authors":["Onishi T","Okada K","Yasumura Y","Yamada T","Okada M","Hayashi T","Seo M","Sakata Y","OCVC‐Heart Failure Investigators","Sakamoto D","Nakatani D","Nakagawa A","Tanaka N","Tamaki S","Sotomi Y","Nakagawa Y","Iwakura K","Yano M","Hikoso S"],"additional_accession":[]},"is_claimable":false,"name":"Left Atrial Volumetric/Mechanical Coupling Index in Heart Failure With Preserved Ejection Fraction.","description":"<h4>Background</h4>Left atrial (LA) dysfunction is common in heart failure with preserved ejection fraction (HFpEF). The LA volumetric/mechanical coupling index (LACI), calculated as the LA volume index divided by the late diastolic mitral annular velocity (a'), is a recently advocated parameter reflecting LA contractile function based on the atrial Frank-Starling mechanism. An elevated LACI signifies impaired mechanical performance despite greater atrial volume, indicating volumetric/mechanical uncoupling. Its associations with echocardiographic indices and prognostic significance in HFpEF remain unclear.<h4>Methods</h4>This study included 562 patients from the PURSUIT-HFpEF (Prospective Multicenter Observational Study of Patients With Heart Failure With Preserved Ejection Fraction) registry, a prospective multicenter registry for HFpEF. LACI was calculated and categorized into quartiles. Associations with echocardiographic indices and clinical outcomes were examined.<h4>Results</h4>LA volume index and late diastolic mitral annular velocity were negatively correlated (<i>r</i>=-0.26; <i>P</i><0.001), reflecting impaired atrial Frank-Starling mechanism in this cohort. The median LACI was 6.44 (interquartile range, 4.16-9.69). Patients with elevated LACI had unfavorable backgrounds with increased filling pressure and diastolic dysfunction. During a median follow-up of 40 months, 171 patients experienced cardiovascular death or rehospitalization for heart failure, with event incidence increasing across LACI quartiles (quartile 1, 26.4%; quartile 2, 39.0%; quartile 3, 46.1%; quartile 4, 46.4%; log-rank, <i>P</i>=0.001). After multivariable adjustment, LACI remained a significant predictor of cardiovascular outcomes (hazard ratio, 1.18 per quartile increase [95% CI, 1.00-1.38]; <i>P</i>=0.045).<h4>Conclusions</h4>In patients with HFpEF, LA mechanical activity decreased with LA enlargement, suggesting volumetric/mechanical uncoupling inherent in this cohort. LACI may serve as a clinically relevant index for risk stratification of cardiovascular death or rehospitalization for heart failure in patients with HFpEF.<h4>Registration</h4>URL: https://www.clinicaltrials.gov; Unique identifier: UMIN000021831.","dates":{"release":"2025-01-01T00:00:00Z","publication":"2025 Aug","modification":"2026-06-03T14:37:06.519Z","creation":"2026-05-29T03:05:10.483Z"},"accession":"S-EPMC12449986","cross_references":{"pubmed":["40736082"],"doi":["10.1161/JAHA.124.040646"]}}