BACKGROUND:Timely diagnosis of impaired systolic function and left ventricular hypertrophy (LVH) remains a clinical challenge. Routine electrocardiography provides limited diagnostic accuracy for detecting early or subtle structural abnormalities. Vectorcardiography (VCG), which captures the spatial and temporal characteristics of cardiac electrical activation and repolarization, may offer a rapid, scalable, and cost-effective alternative for screening structural heart disease. OBJECTIVE:To evaluate the diagnostic performance of VCG for identifying impaired systolic function and left ventricular hypertrophy compared with cardiac magnetic resonance imaging. METHODS:This prospective case-control study included 245 participants undergoing both CMR and VCG. Among 245 participants, 40 had reduced LVEF (<40%) and 208 met CMR criteria for LVH; 34 patients had both conditions. Patients were classified as having impaired systolic function (left ventricular ejection fraction [LVEF] <40%), LVH (indexed left ventricular mass ≥ 55 g/m2), or controls with structurally normal hearts. VCG was obtained using a five‑lead system (cardisiography), and signals were processed by an AI algorithm extracting 583 parameters. Diagnostic performance was evaluated using CMR as reference. RESULTS:The repolarization time-difference ratio (Rpeak-Tonset / QRSend-Tpeak) showed the best diagnostic performance for impaired systolic function, with an area under the curve (AUC) of 0.843, sensitivity of 80.0%, and specificity of 83.9%. In LVH patients, three parameters-T-wave azimuth, T-wave magnitude, and azimuth variability-showed AUCs ranging from 0.739 to 0.791. Overall diagnostic accuracy was 81.7% for impaired systolic function and 78.2% for LVH, and 83.1% for the combined phenotype of reduced LVEF and LVH. CONCLUSION:VCG reliably detects left ventricular systolic dysfunction and hypertrophy. This approach offers a scalable and interpretable screening tool, especially valuable in settings with limited access to advanced cardiac imaging. Future multicenter studies are needed to validate these findings and support clinical implementation.

BACKGROUND:Primary tumors of the pulmonary artery are rare and often mimic thromboembolic disease, leading to delayed diagnosis with potentially serious consequences. CASE SUMMARY:A middle-aged woman with reduced exercise tolerance was found to have a progressive left hilar mass causing near-complete obstruction of the left pulmonary artery. Given high procedural risk, an intracardiac echocardiography (ICE)-guided endovascular biopsy was performed. Tissue sampling was successful and complication free. Histopathology and molecular analysis demonstrated a malignant pleomorphic neoplasm with MDM2 amplification, consistent with pulmonary artery intimal sarcoma. DISCUSSION:ICE-guided biopsy enables safe, real-time tissue acquisition from central pulmonary artery lesions. This technique enables timely histological and molecular diagnosis, especially when conventional biopsy approaches are deemed too risky. TAKE-HOME MESSAGES:Pulmonary artery intimal sarcoma should be differentiated from thromboembolic disease using imaging and clinical progression. ICE-guided biopsy represents a safe diagnostic option in high-risk cases and supports multidisciplinary decision-making.

Aims:Cardiovascular magnetic resonance (CMR) strain imaging allows early detection of subclinical myocardial dysfunction and provides incremental diagnostic and prognostic information. Strain can be derived from dedicated sequences such as fast Strain-ENCoded imaging (fSENC) or from post-processing of cine images using feature tracking (FT) and tissue tracking (TT). However, it remains unclear whether strain values from different approaches are directly comparable, making the definition of universal reference values difficult. This study compared left ventricular (LV) strain assessed by FT, TT, and fSENC. Methods and results:We studied 240 individuals (183 patients recovered from coronavirus disease 2019 [COVID-19] and 57 age- and sex-matched healthy controls), who underwent standardized CMR including cine imaging and fSENC. LV global longitudinal (GLS), circumferential (GCS), and radial strain (GRS) were analysed using FT and TT; fSENC provided GLS and GCS. Global strain values differed significantly between all methods (P < 0.001). Agreement between FT and TT was high for GLS (bias -0.8%, r = 0.77) and moderate for GCS (bias -1.2%, r = 0.63), but poor for GRS (bias -6.0%, r = 0.37). Compared with fSENC, GLS showed moderate agreement for FT (bias 2.3%, r = 0.57) and TT (bias 3.0%, r = 0.59), while agreement for GCS was weaker. All approaches demonstrated excellent reproducibility. Post-COVID-19 patients showed a consistent but mild reduction in GLS compared with controls across all techniques (all P < 0.05). Conclusion:CMR strain imaging provides fast, reliable, and reproducible measurements. However, strain values are not directly interchangeable even between similar post-processing methods or when compared with dedicated sequences, highlighting the need for standardization and method-specific reference values.

BACKGROUND AND AIMS:Patients with a systemic right ventricle (SRV) experience increased morbidity and mortality, highlighting the need for precise assessment of systolic function. Fast Strain-ENCoded imaging (fSENC) is a novel strain measurement method that allows early detection of cardiac impairment and has demonstrated significant diagnostic and prognostic value. This study aimed to evaluate global and regional cardiac function using fSENC in patients with SRV due to transposition of the great arteries following Senning/Mustard repair (TGA) or congenitally corrected TGA (ccTGA). METHODS:In this prospective, single-center study, patients with SRV underwent conventional cardiovascular magnetic resonance (CMR), including feature tracking (FT) strain and fSENC imaging between October 2022 and November 2023. Age- and sex-matched healthy controls were recruited. fSENC was acquired in a single heartbeat per slice to assess global longitudinal and circumferential strain (GLS, GCS) and segmental strains. Laboratory values, including N-terminal pro-hormone brain natriuretic peptide (NT-pro BNP), and a 6-minute walk test (6MWT) were obtained in SRV patients. RESULTS:A total of 26 patients (19 males (73.1%), median age 40 (34 - 49)years) and 26 controls were included. SRV patients had a median NT-pro BNP of 380 (215-667) ng/L and reduced SRV ejection fraction (EF 42.8 ± 8.8%) with chamber dilation. Segmental fSENC strain analysis revealed significantly lower strain values in SRV patients compared with controls, particularly in septal and anterior segments (strain ≥ -17%). Correlation of fSENC-derived GLS and GCS with FT metrics and NT-pro BNP levels was moderate (r = 0.4 for both), whereas EF and 6MWT showed no significant correlation with FT metrics or NT-pro BNP levels. CONCLUSION:This is the first study to comprehensively assess both regional and global strains using fSENC in SRV patients. fSENC enables reproducible assessment of myocardial deformation and shows moderately strong agreement with established strain methods. Its association with NT-pro BNP suggests potential clinical relevance, warranting further studies to evaluate its role in longitudinal monitoring and prognostic assessment.

Importance Current risk prediction guidelines for hypertrophic cardiomyopathy predict only sudden cardiac death and are imperfect, leading to avoidable deaths and unnecessary implantable cardioverter defibrillators. Objective To combine prospectively collected clinical history, imaging, genetic, and biomarker data to improve risk prediction of adverse events in hypertrophic cardiomyopathy. Design, Setting, and Participants A total of 2750 patients with hypertrophic cardiomyopathy were prospectively enrolled in the registry-based study from 44 sites in North America and Europe with expertise in hypertrophic cardiomyopathy and cardiac magnetic resonance (CMR) imaging. Participants were enrolled from April 1, 2014, to April 7, 2017. Exposures Patients underwent a health history questionnaire, blood sampling for biomarkers and genotyping, and contrast-enhanced CMR. Patients were followed up yearly by telephone and through records review regarding event documentation. Main Outcomes and Measures The predefined composite adjudicated primary end point was time to first event for hypertrophic cardiomyopathy-related deaths; nonfatal sustained ventricular arrhythmias (VAs) requiring cardioversion or defibrillation; and left ventricular (LV) assist device implant or heart transplant. A secondary end point was a composite of sudden cardiac death and nonfatal VA events. The elastic-net method identified the most important predictors. Cox proportional hazards regression assessed associations with time to the first end point. Results Of the 2750 prospectively enrolled patients, 2698 (98%) had analyzable data after 9 were excluded because they had hypertrophic cardiomyopathy phenocopies and 43 withdrew. Of these remaining patients, 1919 (71%) were male, mean age was 50 years (SD, 11 years), and 423 (16%) were from underrepresented racial and minority groups. The mean follow-up was 6.9 years (SD, 2.1 years). The primary event model in 104 patients included LV scar as a percentage of LV mass by late gadolinium enhancement (LGE%; hazard ratio [HR], 1.86; 95% CI, 1.58-2.20; P < .001), LV mass index (HR, 1.09; 95% CI, 1.01-1.17; P = .03), LV end-systolic volume index (HR, 1.28; 95% CI, 1.12-1.46; P < .001 ), all per 10-unit increase, history of heart failure at study entry (HR, 2.89; 95% CI, 1.75-4.77; P < .001), and log N-terminal pro-B-type natriuretic peptide (NT-proBNP; HR, 1.41; 95% CI, 1.17-1.70; P < .001) level per log unit, (C index for all, 0.77). An LGE percentage of the LV mass of 9% or higher substantially increased the primary composite event rate (P = .001). The secondary sudden cardiac death and VA risk factor model (in 69 patients) included LGE%, LV mass index, LV ejection fraction, and log(NT-proBNP) (C index, 0.76). Conclusions and Relevance These results provide prospective evidence for incorporating cardiac magnetic resonance and NT-proBNP in the evaluation of patients with hypertrophic cardiomyopathy.

AIMS:We sought to investigate the prevalence of Transthyretin amyloid (ATTR) deposits in the carpal ligament of patients undergoing surgery for carpal tunnel syndrome (CTS) and the frequency of concomitant ATTR-cardiomyopathy (CM) in a prospective study with long-term follow-up. METHODS AND RESULTS:Our prospective exploratory study enrolled 551 patients treated for CTS. All resection specimens of carpal ligament underwent histopathological evaluation. Patients with confirmed amyloid deposits were referred to cardiac evaluation, including cardiac MRI (CMR) scans, as well as follow-up examinations. Amyloid deposits were found in 52 (9%) specimens (1 light chain amyloid, 51 ATTR). Among patients with positive biopsy ATTR-CM was diagnosed in 4 (8%) patients, 1 patient was diagnosed at initial evaluation, and 3 patients were diagnosed during the follow-up. All patients had ATTRwt at an early stage of disease. Extracellular volume (ECV) measured by CMR was significantly higher in amyloid-positive CTS patients compared to healthy controls (30 ± 2 vs. 24 ± 1%, p < .01). CONCLUSION:Histopathological evaluation of resected carpal ligament should be considered in patients at least older than 70 years. Even though absolute numbers were low, cardiac screening of patients with evidence of amyloid deposits in in carpal tunnel tissues might facilitate early diagnosis of ATTR-CM in some patients.

BACKGROUND:There is a growing consensus that screening for subclinical preheart failure (HF) may reduce the burden of symptomatic HF by allowing for timely preventive interventions. However, validated screening algorithms are currently lacking. The aim of this study was to evaluate a fully mobile telemedically supervised cardiac magnetic resonance, as a simple standardized, and ubiquitously applicable screening algorithm for subclinical pre-HF in rural and underresourced regions. METHODS:HERZCHECK was a cross-sectional cohort study conducted at 12 sites across rural and underresourced regions of Germany. Asymptomatic participants (40-69 years) with ≥1 cardiovascular risk factor-obesity, smoking, arterial hypertension, diabetes, hypercholesterolemia, or chronic kidney disease-were enrolled and underwent telemedically supervised contrast-free short cardiac magnetic resonance in mobile screening units. Subclinical pre-HF was diagnosed using a predefined cutoff of global longitudinal strain ≥-15%. A matched and entropy-balanced control cohort constructed from claims data was used to determine the time difference between detection of subclinical pre-HF in HERZCHECK and the first symptom-based diagnosis of HF within the standard of care. RESULTS:Between June 2021 and April 2023, 4666 participants were enrolled in the study, of which 4509 participants were included in the final analysis. The prevalence of subclinical pre-HF in the studied at-risk population was 22.7% (95% CI, 21.5%-23.9%). Global longitudinal strain-based screening identified subclinical pre-HF 6.7 years before the average onset of symptomatic HF within the standard of care (n=8420). CONCLUSIONS:Subclinical pre-HF affects approximately one-fourth of the at-risk population in rural and underresourced regions. The HERZCHECK approach identifies patients suitable for targeted preventive interventions ≈7 years earlier than the standard of care. REGISTRATION:URL: https://www.clinicaltrials.gov; Unique identifier: NCT05122793.

Importance:Current risk prediction guidelines for hypertrophic cardiomyopathy predict only sudden cardiac death and are imperfect, leading to avoidable deaths and unnecessary implantable cardioverter defibrillators. Objective:To combine prospectively collected clinical history, imaging, genetic, and biomarker data to improve risk prediction of adverse events in hypertrophic cardiomyopathy. Design, Setting, and Participants:A total of 2750 patients with hypertrophic cardiomyopathy were prospectively enrolled in the registry-based study from 44 sites in North America and Europe with expertise in hypertrophic cardiomyopathy and cardiac magnetic resonance (CMR) imaging. Participants were enrolled from April 1, 2014, to April 7, 2017. Exposures:Patients underwent a health history questionnaire, blood sampling for biomarkers and genotyping, and contrast-enhanced CMR. Patients were followed up yearly by telephone and through records review regarding event documentation. Main Outcomes and Measures:The predefined composite adjudicated primary end point was time to first event for hypertrophic cardiomyopathy-related deaths; nonfatal sustained ventricular arrhythmias (VAs) requiring cardioversion or defibrillation; and left ventricular (LV) assist device implant or heart transplant. A secondary end point was a composite of sudden cardiac death and nonfatal VA events. The elastic-net method identified the most important predictors. Cox proportional hazards regression assessed associations with time to the first end point. Results:Of the 2750 prospectively enrolled patients, 2698 (98%) had analyzable data after 9 were excluded because they had hypertrophic cardiomyopathy phenocopies and 43 withdrew. Of these remaining patients, 1919 (71%) were male, mean age was 50 years (SD, 11 years), and 423 (16%) were from underrepresented racial and minority groups. The mean follow-up was 6.9 years (SD, 2.1 years). The primary event model in 104 patients included LV scar as a percentage of LV mass by late gadolinium enhancement (LGE%; hazard ratio [HR], 1.86; 95% CI, 1.58-2.20; P < .001), LV mass index (HR, 1.09; 95% CI, 1.01-1.17; P = .03), LV end-systolic volume index (HR, 1.28; 95% CI, 1.12-1.46; P < .001 ), all per 10-unit increase, history of heart failure at study entry (HR, 2.89; 95% CI, 1.75-4.77; P < .001), and log N-terminal pro-B-type natriuretic peptide (NT-proBNP; HR, 1.41; 95% CI, 1.17-1.70; P < .001) level per log unit, (C index for all, 0.77). An LGE percentage of the LV mass of 9% or higher substantially increased the primary composite event rate (P = .001). The secondary sudden cardiac death and VA risk factor model (in 69 patients) included LGE%, LV mass index, LV ejection fraction, and log(NT-proBNP) (C index, 0.76). Conclusions and Relevance:These results provide prospective evidence for incorporating cardiac magnetic resonance and NT-proBNP in the evaluation of patients with hypertrophic cardiomyopathy. Trial Registration:ClinicalTrials.gov Identifier: NCT01915615.

Cardiovascular magnetic resonance (CMR) is widely used to assess cardiac function, but individual cardiac cycles complicate automatic temporal comparison and sub-phase analysis. Accurate cardiac keyframe detection can eliminate this problem. However, automatic methods solely derive end-systole (ES) and end-diastole (ED) frames from left ventricular volume curves, which do not provide a deeper insight into myocardial motion. We propose a self-supervised deep learning method detecting five keyframes in short-axis (SAX) and four-chamber (4CH) cine CMR. Initially, dense deformable registration fields are derived from CMR to compute a 1D motion descriptor encoding global cardiac contraction and relaxation patterns. Keyframes are derived from these characteristic curves with a set of rules. The method was independently evaluated for both views using four databases encompassing multiple centre, vendor and disease. M&Ms-2 (n=360) was used for training and evaluation; M&Ms (n=345) and ACDC (n=100) for repeatability control. Generalisability to patients with rare congenital heart defects was tested using the German Competence Network (GCN) database. A disease-stratified analysis confirmed stable performance across cardiomyopathies and congenital abnormalities. Our method improved detection accuracy by 49%/59% for SAX and 31%/39% for 4CH in ED/ES over the volume-based approach, with mean cyclic frame difference (cFD) below 1.3 and 1.2 frames for SAX and 4CH respectively. Our framework enables temporally aligned inter- and intra-patient analysis of cardiac dynamics, irrespective of cycle or phase lengths for aligned strain analysis or temporal normalisation. Code and annotations are available at: https://github.com/Cardio-AI/cmr-multi-view-phase-detection.git.

High-sensitivity troponin assays detect myocardial injury early, but only a subset reflects coronary plaque rupture requiring invasive therapy. Cardiovascular magnetic resonance (CMR) is the non-invasive reference standard for tissue characterization and functional assessment. Fast Strain-ENCoded imaging (fSENC) enables rapid strain analysis, and layer-specific strain may help identify ischemic causes. In this prospective, single-centre observational study, patients presenting with chest pain and low-to-intermediate pretest probability for major adverse cardiac events (MACE) underwent rapid CMR prior to further therapy. Based on final clinical diagnosis, patients were classified as Healthy, acute coronary syndrome (ACS), or other cardiac abnormality (OCA). Global longitudinal strain (GLS) and the difference between endocardial and epicardial GLS (GLS-Dif) were quantified using fSENC. Follow-up assessed death and MACE. A total of 108 patients (50 female; age 57.5 ± 17.4 years) were included. Total scanning time was 14 ± 3 min. GLS was significantly reduced in ACS (− 17.1

Diffusion models have become a leading approach for high-fidelity medical image synthesis. However, most existing methods for 3D medical image generation rely on convolutional U-Net backbones within latent diffusion frameworks. While effective, these architectures impose strong locality biases and limited receptive fields, which may constrain scalability, global context integration, and flexible conditioning. In this work, we introduce VolDiT, the first purely transformer-based 3D Diffusion Transformer for volumetric medical image synthesis. Our approach extends diffusion transformers to native 3D data through volumetric patch embeddings and global self-attention operating directly over 3D tokens. To enable structured control, we propose a timestep-gated control adapter that maps segmentation masks into learnable control tokens that modulate transformer layers during denoising. This token-level conditioning mechanism allows precise spatial guidance while preserving the modeling advantages of transformer architectures. We evaluate our model on high-resolution 3D medical image synthesis tasks and compare it to state-of-the-art 3D latent diffusion models based on U-Nets. Results demonstrate improved global coherence, superior generative fidelity, and enhanced controllability. Our findings suggest that fully transformerbased diffusion models provide a flexible foundation for volumetric medical image synthesis. The code and models trained on public data are available at https://github.com/Cardio-AI/voldit.

BACKGROUND AND AIMS:Unlike systolic heart function, the assessment of diastolic heart function is often demanding using cardiovascular magnetic resonance (CMR) imaging. This study aims to assess the value of semi-automatic CMR-derived biplane functional parameters in patients with cardiac light chain (AL) and transthyretin (ATTR) amyloidosis or hypertrophic cardiomyopathy (HCM). METHODS:This retrospective, multi-center, multi-vendor study included patients with a diagnosis of HCM or cardiac AL/ATTR amyloidosis. Proven healthy volunteers served as controls. CMRs were assessed semi-automatically to derive atrial functional parameters (volume, long axis strain, ejection fraction [EF] of both atria) and left and right atrioventricular coupling index (LACI, RACI). Subsequently, group differences after adjustment for age, sex, left ventricular (LV) EF, body mass index and presence of atrial fibrillation as well as their correlation with N-terminal pro-B-type natriuretic peptide (NT-proBNP) and New York Heart Association (NYHA) class were calculated. RESULTS:A total of 400 participants were included (94 HCM, 95 AL, 116 ATTR, 95 controls; mean age 58 ± 15 years, 67% male (269/400)). Semi-automated analysis was feasible in all cases (median duration 34 s) with excellent reproducibility. Compared with controls, patients revealed markedly higher LACI values (40.1% vs. 15.2%, p<0.001) and impaired LA function (EF 34.3% vs. 65.2%, strain 11.5% vs. 41.5%, both p<0.001). RACI and RA function, however, distinguished disease groups: RA indices were preserved in HCM but significantly impaired in amyloidosis (RACI 41.8% vs. 20.4%; RA EF 28.8% vs. 52.5%; RA strain 12.3% vs. 34.4%, p<0.001 for all). After adjustment, both LA volume and LACI showed independent associations with NYHA class and NT-proBNP, with LACI demonstrating the strongest correlations and outperforming LVEF. CONCLUSIONS:Semi-automated biplane CMR enables fast and reproducible assessment of atrial function. Combined analysis of LACI and RACI provides clinically relevant diagnostic differentiation between HCM and cardiac amyloidosis and correlates with patient symptom burden more accurately than LVEF.

Background Cardiac computed tomography angiography (CTA) has been shown to be an excellent modality not only to assess the coronary arteries but also the interatrial septum. We aimed to develop a classification system to grade interatrial septal patency with a focus on clinical applicability. Methods Patients who underwent cardiac CTA from January 1st, 2018 to December 31st, 2022 at a specialized imaging center were included into a registry study. Scans were acquired on a third-generation dual-source CT scanner and retrospectively analyzed using a dedicated post-processing software. Results A total of 11053 CT scans were performed of which 10270 were included in the final study. Incorporating septal morphology and patency, a four-level grading system was created classifying interatrial septal patency (IASP) from I to IV. Patients without evidence of interatrial left to right contrast agent (CA) flow had either a smooth septum in 5246 cases (IASP I, 51%) or a closed flap in 2620 cases (IASP II, 26%). An open flap with a clearly detectable CA jet was found in 2086 patients (IASP III, 20%) and a potentially significant shunt in 318 patients (IASP IV, 3%). Applying this grading system to the present study population might have reduced the need for further invasive confirmatory examinations, namely transesophageal echocardiography, by 71% (IASP I and IASP III, respectively). Conclusions Cardiac CTA is a suitable technique for interatrial septum analysis that might help to guide clinical pathways and reduce the rate of additional invasive examinations.

Acute pulmonary embolism (PE) is the third most common acute cardiovascular condition and remains associated with high mortality. To address the need for risk-adapted therapy, new catheter-directed approaches have emerged for patients with severe PE. While clinical benefits have been shown, underlying mechanisms are poorly understood. This study investigated the impact of mechanical thrombectomy using the FlowTriever device in intermediate-high-risk PE on ventricular filling as a key determinant of systemic hypoperfusion. We analysed 26 patients with CT-confirmed intermediate-high-risk PE who underwent mechanical thrombectomy using the FlowTriever device. Only patients with post-interventional cross-sectional imaging were included. Main outcome measures comprised changes in invasively assessed haemodynamic parameters, including pulmonary artery and pulmonary capillary wedge pressures (PAP, PCWP), as well as ventricular septal curvature, three-dimensional biventricular volumes, and Doppler-derived indices of diastolic function. Thrombectomy significantly reduced systolic PAP (baseline 64.4 ± 19.9 mmHg, Δ = − 13.6 mmHg, p < 0.0001) and PCWP (baseline 21.7 ± 6.9 mmHg, Δ = − 4.0 mmHg, p < 0.001). Right ventricular (RV) volumes and septal bowing decreased, whereas left ventricular (LV) volumes and transmitral filling parameters improved (E/e′, p = 0.0002). Septal curvature strongly correlated with sPAP (r = 0.84) and LV filling pressure (r = − 0.51 with E/e′), indicating its potential as a surrogate marker linking RV pressure overload to impaired LV diastolic filling. Mechanical thrombectomy in intermediate-high-risk PE not only relieves RV overload but also enhances LV filling by mitigating ventricular interdependence. These findings provide a mechanistic explanation for improved systemic perfusion and warrant confirmation in prospective studies.

BACKGROUND:The Left Atrioventricular Coupling Index (LACI), calculated as the ratio of left atrial (LA) to left ventricular (LV) end-diastolic volume (EDV) has emerged as a novel imaging biomarker of LA-LV coupling. However, reference thresholds are undefined and its predictive value beyond established clinical and imaging markers remains uncertain, limiting broader clinical implementation. METHODS:Two large datasets were leveraged to 1) investigate demographic variations of LACI in health, 2) establish population-specific reference thresholds, 3) characterise the relationship between LACI and cardiac structure/function, and 4) investigate its incremental predictive value for cardiovascular outcomes. Cardiovascular magnetic resonance (CMR) scans were performed and analysed using standardised protocols. In the Healthy Hearts Consortium (HHC), a large image bank of verified healthy individuals, demographic variations of LACI were examined, and population-specific reference thresholds were calculated using the 95% prediction interval method. Associations between LACI and markers of LA/LV structure and function were assessed using linear regression models. In UK Biobank, associations of LACI with incident outcomes [atrial fibrillation (AF), heart failure (HF), myocardial infarction, cardiovascular death, all-cause death] were examined over a median 5.5 years prospective follow-up, using Cox regression models adjusted for demographic, clinical, and established CMR variables. RESULTS:In the HHC (n=7,111, 54% female, median 61.5 years), a higher LACI was observed in older age, ethnicities other than White, and women (who also had a greater age-related increase in LACI). After adjustment for demographic factors, higher LACI was associated with poorer LA function and higher LV filling pressures. In UK Biobank (n=25,849, 52% female, median 63.0 years), higher LACI was independently predictive of incident AF [HR per 1 standard deviation increase 1.31 (1.19, 1.44)] and HF [HR 1.15 (1.07, 1.24)], in Cox models adjusted for demographic, clinical, and established CMR variables. Applying the newly derived reference thresholds in a population-specific manner to the UKB cohort revealed a significantly higher probability of AF and HF amongst those with a raised LACI. CONCLUSION:LACI is a robust predictor of AF and HF with incremental value over established clinical and imaging markers. The provided population-specific reference thresholds permit its broader clinical application.

The study aimed to assess the prognostic value of left atrioventricular coupling index (LACI), measured by cardiovascular magnetic resonance (CMR), in predicting cardiovascular events in patients with chronic coronary syndrome (CCS). We retrospectively analyzed patients with CCS who underwent CMR stress testing between 2008 and 2018. LACI was defined as the ratio of left atrial end-diastolic volume to left ventricular end-diastolic volume. Additionally, global longitudinal strain was obtained. The primary endpoint was the occurrence of a major adverse cardiovascular event (MACE), including cardiac death and myocardial infarction. Secondary endpoints included hospitalization for heart failure (HFH) and all-cause death. In the cohort of 613 patients (81.2