Sex-Specific Prognostic Value of Left Atrioventricular Coupling Index in Acute Coronary Syndrome: Insights From Artificial Intelligence-Enhanced 3-Dimensional Echocardiography.
Authors
Affiliations (3)
Affiliations (3)
- Department of Ultrasound The Fourth Affiliated Hospital of China Medical University Shenyang People's Republic of China.
- Department of Medicine, Upstate Medical University Norton College of Medicine Syracuse NY USA.
- Department of Cardiovascular Medicine The Fourth Affiliated Hospital of China Medical University Shenyang People's Republic of China.
Abstract
Left atrioventricular coupling index (LACI) has emerged as a prognostic biomarker, but its sex-specific relevance in acute coronary syndrome remains unclear. This retrospective cohort included 880 patients with acute coronary syndrome (625 men; 255 women) undergoing percutaneous coronary intervention between February 2022 and June 2023. LACI was automatically quantified from 3-dimensional echocardiography using an artificial intellgience-based dynamic heart model. Patients were stratified by sex-specific median LACI values and followed for major adverse cardiovascular events. Cox proportional hazards and Fine-Gray competing risk models evaluated associations between LACI and outcomes. A sensitivity analysis was performed in 3 ways: (1) using propensity score matching, (2) excluding patients with atrial fibrillation, and (3) repeating propensity score matching in the cohort after excluding patients with atrial fibrillation. Results were verified in 3 independent cohorts: 285 internal validation, 124 coronary computed tomography angiography, and 128 external 3-dimensional echocardiography cohorts. Over a median 18-month follow-up, 219 major adverse cardiovascular events occurred. Women had significantly higher median LACI values than men. LACI was significantly associated with increased major adverse cardiovascular event risk in men (hazard ratio [HR], 1.23 [95% CI, 1.03-1.46]; <i>P</i>=0.020; <i>P</i> for interaction=0.027) but not in women. Restricted cubic spline analysis demonstrated a linear dose-response association in men. Fine-Gray analysis demonstrated a significant association between LACI and major adverse cardiovascular events in men. Findings remained consistent after AF exclusion, PSM, and across all validation cohorts. Artificial intelligence-derived LACI from 3-dimensional echocardiography demonstrates clear sex-specific prognostic value in acute coronary syndrome, and is significantly associated with adverse cardiovascular outcomes in men but not in women. These results support sex-specific risk stratification and highlight the clinical relevance of atrioventricular coupling assessment. URL: https://www.chictr.org.cn/. Unique identifier: ChiCTR2500099592.