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However, the studies on cardiac magnetic resonance-derived LACI in hypertrophic cardiomyopathy (HCM) patients are limited, and the prognostic value of LACI has still not been studied thoroughly, so we aimed to explore the association between LACI and adverse clinical outcomes in HCM patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 206 HCM patients underwent cardiac magnetic resonance examination were retrospectively enrolled. LACI is defined by the ratio between the left atrial (LA) volume and the left ventricular (LV) volume in LV end-diastolic phase. The composite endpoint was categorized into death-related, heart failure-related, and arrhythmia-related events, reflecting mortality risk, heart failure progression, and arrhythmia burden, respectively. Receiver operating characteristics curve analysis was used to determine the optimal cut-off value for LACI to distinguish HCM patients at high risk of adverse clinical outcome. Multivariable Cox regression models were built including significant clinical variables, LA ejection fraction (LAEF), LA volume index (LAVI), late gadolinium enhancement (LGE) extent and LACI. The improvement of discrimination by adding LACI to a clinical model was assessed using C-statistic, net reclassification improvement (NRI) and integrated discrimination improvement (IDI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Thirty-four HCM patients reached the endpoint during a median follow-up time of 60 [interquartile range (50\u201368)] months. In the multivariate Cox regression analysis, LACI [hazard ratio 1.054, 95% confidence interval (CI): 1.037, 1.071; P &amp;lt; 0.001] was an independent predictor of the composite events after adjustment for age and atrial fibrillation. Then 40.09% was identified as an optimal cut-off for LACI in the risk stratification. Integrating LACI to the clinical model yielded higher C-statistic 0.892 with 95% CI (0.861, 0.922) compared with LA diameter, LAEF, LAVI and LGE extent, providing an improvement in prediction of high-risk patients (NRI = 0.627, 95% CI: 0.112\u20130.934; IDI = 0.295, 95% CI: 0.016\u20130.709).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>LACI is an independent risk factor for clinical adverse outcome and is superior to conventional LA parameters and LGE extent for the identification of high-risk HCM patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ehf2.15237","type":"journal-article","created":{"date-parts":[[2025,2,5]],"date-time":"2025-02-05T02:03:45Z","timestamp":1738721025000},"page":"2177-2189","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Cardiac Magnetic Resonance Left Atrioventricular Coupling Index as a Prognostic Tool in Hypertrophic Cardiomyopathy"],"prefix":"10.1093","volume":"12","author":[{"given":"Jinyang","family":"Wen","sequence":"first","affiliation":[{"name":"Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junhao","family":"Tu","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University , Nanchang ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinwei","family":"Tao","sequence":"additional","affiliation":[{"name":"Bayer Healthcare , Shanghai ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanyuan","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhaoxia","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziyi","family":"Pan","sequence":"additional","affiliation":[{"name":"Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunlin","family":"Xiang","sequence":"additional","affiliation":[{"name":"Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dazhong","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liming","family":"Xia","sequence":"additional","affiliation":[{"name":"Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,2,4]]},"reference":[{"key":"2026021804252804300_ehf215237-bib-0001","doi-asserted-by":"publisher","first-page":"3503","DOI":"10.1093\/eurheartj\/ehad194","article-title":"2023 ESC guidelines for the management of cardiomyopathies","volume":"44","author":"Arbelo","year":"2023","journal-title":"Eur Heart J"},{"key":"2026021804252804300_ehf215237-bib-0002","doi-asserted-by":"publisher","first-page":"655","DOI":"10.1056\/NEJMra1710575","article-title":"Clinical course and management of hypertrophic cardiomyopathy","volume":"379","author":"Maron","year":"2018","journal-title":"N Engl J Med"},{"key":"2026021804252804300_ehf215237-bib-0003","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1093\/eurheartj\/ehab724.1735","article-title":"All-cause mortality and cardiovascular death in 52 091 patients with hypertrophic cardiomyopathy. 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