Abstract
Background
The calculation of the left atrioventricular coupling index (LACI) by the ratio between left atrial (LA) and left ventricular (LV) end‐diastolic volumes reflects the close interaction between LA and LV.
Aim of the Study
The study aimed to assess LACI using echocardiography before and after percutaneous coronary intervention (PCI) compared with LV ejection fraction (LV‐EF) in acute coronary syndrome (ACS).
Subjects and Methods
This retrospective cohort analysis included 193 ACS patients (65.1 ± 12.5 years, 71.6% males), who underwent PCI. Both LACI and LV‐EF were calculated before and after PCI.
Results
At presentation, 156 (80.8%) patients had LV‐EF reduction; mild in 61 (39.1%), moderate in 77 (49.3%) and severe in 18 (11.5%). Using LACI < 25% as the cutoff value for normal, 40 (20.7%) patients had impaired LACI. Out of the 153 patients with normal LACI, 127 (83%) had reduced LV‐EF. Patients were classified into three groups: I: 51 (26.4%) with STEMI, II: 82 (42.5%) with NSTEMI and III: 60 (31.1%) with unstable angina. Baseline LV‐EF and LACI did not show significant differences between the three groups. Over a 12.8 ± 8.2 month follow‐up post PCI, LV‐EF improved in 68 (43.6%) out of 156 patients becoming normal in 28 (17.9%), mildly reduced in 65 (41.7%), moderately reduced in 55 (35.2%) and severely reduced in 8 (5.1%). Post PCI, LACI normalized in 19 (47.5%) out of 40 patients with impaired baseline LACI.
Conclusion
Assessing LACI in ACS provided a better understanding of LA and LV dynamics and its reduction following PCI indicates a better prognosis.
Keywords: acute coronary syndrome, coronary revascularization, left atrio‐ventricular coupling
Abbreviations
- ACS
Acute coronary syndrome
- CAD
Coronary artery disease
- HF
Heart failure
- LA
Left atrium
- LAC
Left atrio‐ventricular coupling
- LACI
Left atrio‐ventricular coupling index
- LV
Left ventricle
- LV‐EF
LV ejection fraction
- MACEs
Major cardiovascular events
- MI
Myocardial infarction
- NSTEMI
Non‐STEMI
- PCI
Percutaneous coronary revacularization intervention
- STEMI
ST elevation MI
- UA
Unstable angina
1. INTRODUCTION
The left atrial (LA) function is closely linked to the left ventricular (LV) function to regulate LV filling and maintain optimal cardiac performance. Adverse remodeling of the LV begins within a few hours of coronary occlusion and continues for nearly a week. In response to LV remodeling, the LA reservoir, conduit, and pump functions, contribute to maintaining LV filling and stroke volume at a normal level despite impaired LV function (Leancă et al., 2022). LA anatomical and functional remodeling occurs within the first week following an acute myocardial infarction (MI) and subsequently progresses gradually over a period of up to 3 months (Pascaud et al., 2023). This remodeling results from the interaction of different pathophysiologic mechanisms, such as increased LV filling pressures, ischemic mitral regurgitation, and atrial ischemia (Thomas and Abhayaratna, 2017). Anatomical LA remodeling is characterized by an increased LA maximal volume. In cases of severe LA dilation, the LA contractile function may decrease, surpassing the optimal Frank–Starling relationship. Therefore, evaluating LA functional remodeling can provide valuable additional information. In acute coronary syndrome (ACS), LA functional remodeling can precede anatomical remodeling due to atrial ischemia affecting the reservoir, conduit and contractile functions (Montero‐Cabezas et al., 2023). Both LV and LA remodeling are strongly related and linked to a poor prognosis. Timely coronary reperfusion is the standard treatment for ACS patients to counteract adverse LA and LV remodeling and promote reverse remodeling, reducing the risk of heart failure (HF) progression and mortality (Grabka et al., 2018; Tangen et al., 2024). Recently, the concept of mechanical left atrio‐ventricular coupling LAC has gained interest as the best expression of hemodynamic synchronization between LA and LV during the cardiac cycle. The LAC index (LACI) calculated as the ratio of LA end‐diastolic volume to LV end‐diastolic volume and expressed as a percentage has shown promise in predicting all‐cause mortality and HF in various cardiovascular conditions including CAD. A high LACI value has been associated with major adverse events in patients with chronic coronary syndrome and following acute MI, enabling the classification of patients into low‐ and high‐risk groups (Haney et al., 2025; Lange et al., 2023a). The aim of this study was to assess the changes in LACI before and after percutaneous coronary revacularization intervention (PCI) in patients with ACS, and to determine the prognostic value of these changes in predicting major cardiovascular events (MACEs).
1.1. Patients and methods
1.1.1. Study population
This retrospective cohort analysis from January 2023 to December 2024 included 193 consecutive patients, who presented for the first time to the emergency room with typical angina and/or angina equivalent symptoms. The diagnosis of ACS was confirmed based on clinical presentation, elevated cardiac enzymes and resting ECG changes All the included patients were treated with PCI at our center. Clinical data were collected from electronic health records by two investigators (Aladnani A and Aoun R) who were unaware of the echocardiographic findings and coronary angiographic results. The data collected included:
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Presenting symptoms either in the emergency room or at the outpatient clinic.
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Risk factor profile in terms of the presence of hypertension, diabetes mellitus, hyperlipidemia, smoking and family history of CAD.
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Resting ECG changes suggesting myocardial ischemia.
1.1.2. Percutaneous coronary interventions (PCI)
All patients underwent coronary angiography to determine the affected vessel, site and severity of the lesion as well as the extent of the distal flow according to TIMI classification. PCI was performed according to standardized guidelines (Byrne et al., 2023). The techniques of PCI (ballooning, stenting, thrombus aspiration, Glycoprotein IIb/IIIa receptor antagonists) were selected based on interventionist's judgment. The coronary angiographic data were collected by Almalki A.
1.1.3. Study definitions
Comprehensive two‐dimensional echocardiographic examinations were conducted before PCI (baseline) and at follow up after PCI following the guidelines and standard recommendations of the American Society of Echocardiography (Mitchell et al., 2019). Offline analysis and measurements were performed by two investigators (Daus W for the baseline studies and Alzahrani B for the follow up studies), both of whom were unaware of the angiographic results and intervention outcome. The following measurements were considered for statistical analysis:
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LV end‐diastolic and end‐systolic volumes obtained from apical 4‐chamber and 2‐chamber views.
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LV ejection fraction (LV‐EF) using the biplane Simpson method for calculation and categorized as: normal (≥54%), mild reduction (41–53%), moderate reduction (30–40%) and severe reduction (<30%) (Lang et al., 2015).
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LACI was calculated by the formula: LA end‐diastolic volume/LV end‐diastolic volume and expressed as a percentage (Figure 1). A LACI ≥25% was used as the cutoff value to differentiate between normal and impaired LACI (Pezel et al., 2023a).
Figure 1.
Two‐dimensional echocardiography images obtained from apical 4‐Chamber and 2‐chamber views with delineation of both LV and LA endocardial border at the end‐diastole. Calculation of LACI as the ratio between LA end‐diastolic volume and LV end‐diastolic volume.
1.1.4. Clinical endpoints and outcome
All‐cause mortality, reinfarction or HF associated with rehospitalization within the first year after ACS were considered MACEs, which were defined as the primary clinical endpoint of this study.
1.2. Statistical analysis
All data were analyzed using SPSS version 25.0 statistical software package (IBM Corporation, Armonk, NY, USA). Continuous variables were expressed as mean ± standard deviation. Categorical data are presented as frequencies (proportion). The Spearman's rank correlation coefficient was used for correlations assessment. Paired t‐test was used for comparison of echocardiographic parameters pre and post PCI. Intergroup comparison of LACI measurements was conducted with independent Student's t‐tests. A p‐value < 0.05 was considered significant.
2. RESULTS
2.1. Baseline characteristics
The study included a total of 193 patients with a mean age of 62.9 ± 11.3 years, of whom 154 (79.8%) were male. All patients were in sinus rhythm with no previous diagnosis of CAD and heart failure. The distribution and incidence of traditional risk factors including smoking, diabetes mellitus, hypertension, dyslipidemia and obesity revealed that the majority of patients (58.5%) had three or more risk factors, 34.2% had two risk factors, while only 7.2% had single risk factor. Hyperlipidemia had the highest incidence with 162 (83.9%) patients, followed by hypertension with 134 (74.1%) patients and diabetes mellitus with 141 (73.1%) (Table 1).
Table 1.
Baseline clinical and echocardiographic data of all patients and among groups.
| Total (n: 193) | Group I (n: 51) | Group II (n: 82) | Group III (n: 60) | |
|---|---|---|---|---|
| Age | 62.9 ± 11.3 | 61.9 ± 11.8 | 65.7 ± 10.8 | 68.5 ± 8.8 |
| Gender | ||||
| Male | 154 (79.8%) | 46 (90.2%) | 60 (73.2%) | 48 (80%) |
| Female | 39 (20.2%) | 5 (9.8%) | 22 (26.8%) | 12 (20%) |
| Risk factors | ||||
| ‐ Smoking | 56 (29.0%) | 22 (43.1%) | 16 (19.5%) | 18 (30%) |
| ‐ Diabetes mellitus | 141 (73.1%) | 33 (64.7%) | 62 (75.6%) | 46 (76.7%) |
| ‐ Dyslipidemia | 162 (83.9%) | 41 (80.4%) | 67 (81.7%) | 54 (90%) |
| ‐ Hypertension | 134 (74.1%) | 29 (56.9%) | 63 (76.3%) | 42 (70%) |
| ‐ Obesity | 15 (7.8%) | 3 (5.9%) | 7 (8.5%) | 5 (8.3%) |
| Number of risk F | ||||
| ‐ Single | 14 (7.2%) | 5 (9.8%) | 5 (6.1%) | 4 (6.7%) |
| ‐ Two | 66 (34.2%) | 23 (45.1%) | 28 (34.1%) | 15 (25%) |
| ‐ Three or more | 113 (58.5%) | 23 (45.1%) | 49 (59.7%) | 41 (68.3%) |
| Echocardiography | ||||
| LV end‐diastolic V (mL) | 122 ± 34.5 | 119.6 ± 37.6 | 126.8 ± 35.8 | 118.6 ± 37.6 |
| LV end‐systolic V (mL) | 67.2 ± 25.9 | 69.6 ± 21.9 | 68.1 ± 25.5 | 63.9 ± 29.3 |
| LV‐ EF (%) | 42.7 ± 10.4 | 51 ± 10.4 | 43.4 ± 9.9 | 45.0 ± 10.3 |
| ‐ Normal | 37 (19.2%) | 4 (7.8%) | 16 (19.5%) | 17 (28.3%) |
| ‐ Mild reduction | 59 (30.6%) | 12 (23.5%) | 29 (35.4%) | 18 (30%) |
| ‐ Moderate reduction | 69 (35.7%) | 22 (43.1%) | 25 (30.5%) | 22 (36.7%) |
| ‐ Severe reduction | 28 (14.5%) | 13 (25.5%) | 12 (14.6%) | 3 (5.0%) |
| LA end‐diastolic V (mL) | 20.6 ± 13.6 | 18.1 ± 9.1 | 22.9 ± 14.8 | 19.5 ± 14.6 |
| LACI (%) | 17.4 ± 9.9 | 15.4 ± 7.9 | 18.2 ± 10.0 | 16.7 ± 11.3 |
| ‐ Normal (<25%) | 153 (79.3%) | 41 (80.4%) | 62 (75.6%) | 50 (83.3%) |
| ‐ Impaired (≥25%) | 40 (20.7%) | 10 (19.6%) | 20 (24.4%) | 10 (16.7%) |
2.2. Patient groups
According to the standard definition of ACS, (Rao et al., 2025) patients were classified into three groups:
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Group I: included 51 (26.4%) patients who presented with ST elevation MI (STEMI).
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Group II: included 82 (42.5%) patients with Non‐STEMI (NSTEMI).
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Group III: included 60 (31.1%) patients with unstable angina (UA).
A comparison between the three groups showed no significant difference in age with a male predominance. The number and distribution of risk factors also showed no significant difference among the three groups. Baseline LV‐EF and LACI did not show significant differences between the three groups. However, the incidence of moderate to severe LV‐EF reduction was significantly higher in Group I than in Group II and III (65.6% vs. 45.1% and 41.7% respectively) (Table 1).
2.3. Baseline LV‐EF and LACI
The mean LV‐EF was 42.7% ± 10.4%. The incidence of reduced LV‐EF was high; 156 patients (80.8%) had reduced LV‐EF, while 37 (19.2%) had normal LV‐EF. According to the grades of abnormality, LV‐EF was mildly reduced in 61 (31.6%) patients, moderately reduced in 77 (39.9%) patients and severely reduced in 18 (9.3%) patients. The baseline LACI was 17.4% ± 9.9%. Using LACI ≥ 25% as the cutoff value to differentiate between normal and impaired LACI, impaired LACI was recorded in 40 (20.7%) patients, while the remaining 153 (79.3%) patients had normal LACI. Among the 153 patients with normal LACI, 127 (83%) had reduced baseline LV‐EF. Among the 40 patients with impaired LACI, 33 (82.5%) had reduced baseline LV‐EF while 7 (17.5%) had normal LV‐EF.
2.4. Coronary angiography and PCI
All participants underwent coronary angiography at initial enrollment. Based on the number of affected coronary arteries, 80 (41.4%) patients had single vessel disease, 88 (45.6%) had two vessel disease and 25 (13%) had three or more vessel disease. The vessel with the highest frequency was LAD, with 123 (61.8%) patients, followed by LCX with 69 (34.7%) patients and RCA with 56 (28.1%) patients.
2.5. Follow up LV‐EF and LACI
Over a follow‐up period of 12.8 ± 8.2 months, there was a significant improvement in mean LV‐EF compared with baseline (45.9% ± 9.2% vs. 42.7% ± 10.4%; p = 0.0015). Out of 156 patients with impaired baseline LV‐EF, 68 (43.6%) patients showed improved LV‐EF post PCI. As shown in Table 2, LV‐EF was normal in 56 (29.0%) patients, mildly reduced in 71 (36.8%) patients, moderately reduced in 58 (30.0%) patients and severely reduced in 8 (4.1%) patients. An analysis of the degree of improvement or worsening according to the baseline LV‐EF categorization is presented in Table 3. The data showed that:
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Out of the 37 patients with normal LV‐EF, 28 (75.7%) maintained normal, 6 (16.2%) reduced to mild and 3 (8.1%) reduced to moderate.
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Out of the 61 patients with mildly reduced LV‐EF, 18 (29.5%) normalized, 34 (55.7%) didn't change and 9 (14.8%) reduced to moderate.
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Out of the 77 patients with moderately reduced LV‐EF, 9 (11.7%) normalized, 29 (37.7%) improved to mild, 37 (48.1%) didn't change and 2 (2.6%) reduced to severe.
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Out of the 18 patients with severely reduced LV‐EF, 1(5.9%) normalized, 2 (11.7%) improved to mild, 9 (47%) improved to moderate and 6 (35.3%) didn't change.
Table 2.
Echocardiographic parameters Pre and post PCI in all patients.
| Pre‐ PCI | Post PCI | p value | |
|---|---|---|---|
| LV end‐diastolic V (mL) | 122 ± 34.5 | 121 ± 38.8 | 0.7 |
| LV end‐systolic V (mL) | 67.2 ± 25.9 | 67.1 ± 21.8 | 0.9 |
| LV‐EF | |||
| ‐ Normal | 37 (19.2%) | 56 (29.0%) | 0.01 |
| ‐ Mild reduction | 61 (31.6%) | 71 (36.8%) | 0.1 |
| ‐ Moderate reduction | 77 (39.9%) | 58 (30.0%) | 0.05 |
| ‐ Severe reduction | 18 (9.3%) | 8 (4.1%) | 0.01 |
| LA end‐diastolic V (mL) | 20.6 ± 13.6 | 21.8 ± 15.4 | 0.4 |
| LACI (%) | |||
| ‐ Normal (<25%) | 153 (79.3%) | 175 (90.7%) | 0.000 |
| ‐ Impaired (≥25%) | 40 (20.7%) | 18 (9.3%) | 0.000 |
Table 3.
Degree of changes of LV‐EF in response to PCI.
| Baseline degree | Improvement | No changes | Reduction |
|---|---|---|---|
| Normal (n: 37) | 0 (0%) | 28 (75.7%) | 9 (24.3%) |
| Mild reduction (n: 61) | 18 (29.5%) | 34 (55.7%) | 9 (14.8%) |
| Moderate reduction (n: 77) | 38 (49.3%) | 37 (48.1%) | 2 (2.6%) |
| Severe reduction (n: 18) | 12 (64.6%) | 6 (35.3%) | 0 (0%) |
The response of LACI to PCI varied depending on the baseline LACI value as follows:
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Out of 153 patients with normal baseline LACI, 133 (86.9%) maintained their normal value and 20 (13.1%) showed impairment of LACI.
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Out of 40 patients with impaired baseline LACI, 21 (52.5%) showed normalization of LACI and 19 (47.5%) did not improve.
The relationship between LACI and LV‐EF response to PCI showed that impaired LV‐EF was associated with 13 (68.4%) patients who had impaired LACI before and after PCI, 15 (75.5%) patients who developed impaired LACI after PCI, and 15 (71.4%) patients who showed improved LACI after PCI.
2.6. Clinical outcome
During the follow up period, there were a total of 75 MACEs, accounting for 38.8% of all included patients. These MACE were categorized as follows: 8 (0.9%) death, 52 (26.9%) re‐infarction and 15 (7.7%) hospitalization due to HF. The incidence of associated moderate to severe reduction of LV‐EF post PCI among patients with MACE was 5 out of 8 (62.5%) deaths, 23 out of 52 (44.2%) re‐infarction cases and 13 out of 15 (86.6%) patients admitted due to HF. The incidence of impaired LACI post PCI was found in 5 out of 8 (62.5%) deaths, 8 out of 52 (15.4%) re‐infarction and 6 out of 15 (40%) hospitalization due to HF (Figure 2). Out of 68 patients with moderate to severe reduction of LV‐EF post PCI, MACEs were 5 out of 8 (62.5%) deaths, 21 out of 52 (40.4%) re‐infarction cases and 13 out of 15 (86.6%) patients admitted due to HF. Out of 39 patients with impaired LACI post PCI, total MACEs were found in 5 out of 8 (62.5%) deaths, 8 out of 52 (15.4%) re‐infarction and 6 out of 15 (40%) hospitalization due to HF.
Figure 2.
Chart display the incidence of moderate to severe reduction of LV‐EF and impaired LACI among patients with major adverse cardiac events.
3. DISCUSSION
The study is the first to examine changes in LACI values compared to LV‐EF in patients with ACS who underwent coronary intervention. The key findings are as follows:
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At the early presentation of ACS, the incidence of impaired LV‐ EF is significantly higher than the incidence of impaired LACI (80.8% vs. 20.7%).
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Following PCI, LV‐EF normalized in 35.9% of patients with impaired baseline LV‐EF, while in patients with impaired LACI, it normalized in 52.5% indicating earlier improvement of LACI before LV‐EF.
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LACI provided prognostic insight in addition to LV‐EF for primary clinical outcome and adverse events.
According to the ischemic cascade during myocardial ischemia, LV diastolic dysfunction is an early indicator before systolic dysfunction and wall motion abnormalities (Maznyczka et al., 2015). During acute ischemia, augmentation of LA function allows for the effect of LV diastolic dysfunction and increased LV filling pressure to be withstood maintaining sufficient stroke volume. Long standing elevation of LV filling pressure can lead to the impairment of LA function at all phases (reservoir, conduit and contraction) (Tangen et al., 2024). Alteration of atrioventricular interaction has been described in patients with MI as detected by impaired LA function at three phases (reservoir, conduit, and contraction) and LV deformation (radial, circumferential and longitudinal) (Liu et al., 2025a). Using volumetric measurement of LACI allows for the simultaneous assessment of LV and LA remodeling during end‐diastole. The clinical value of LACI as a novel biomarker of both LA and LV function has been demonstrated by many studies in various cardiovascular diseases such as atrial fibrillation, HF and CAD (Liu et al., 2025b; Poręba et al., 2025). The normal reference value of LACI using CMR, CT and echocardiography has been described before (Anwar et al., 2025; Pezel et al., 2021, 2023b).
3.1. Changes in LV‐EF in ACS
The incidence and degree of impaired LV‐EF at presentation with ACS vary widely between studies due to the variable effect of myocardial ischemia based on the severity and duration of myocardial injury. A cohort study by Malebranche et al included 8,327 patients with ACS and reported moderate to severe impairment of LV‐EF in 34% while 66% had normal LV‐EF (Malebranche et al., 2021). Abou et al reported prevalence of LV‐EF < 40% at baseline in 13% of patients presented with STEMI (Abou et al., 2018). In our study, normal LV‐EF was observed in 17.1% of patients and more than 50% had moderate to severe impairment of LV‐EF at presentation. In response to successful PCI in ACS, the degree and rate of LV‐EF improvement are linked to the extent of LV damage at presentation. The REVIVED‐BCIS2 trial showed that PCI failed to improve LV‐EF or prognosis compared with optimal medical therapy (Perera et al., 2022). A large recent study included 3,510 acute MI patients who underwent percutaneous coronary intervention. At 1‐year post PCI, LV‐EF improved in 44.5%, remained unchanged in 32.7% and deteriorated in 22.8%. A greater extent of LV‐EF improvement is more pronounced in patients with moderate to severe impairment at baseline (Ndrepepa et al., 2024). On the other hand, the rate of LV‐EF deterioration post PCI has a wide range from 1.1% to 22.8% between studies (Malebranche et al., 2021; Wang et al., 2022). The underlying mechanism is multifactorial including pre‐existing myocardial damage, ongoing oxidative stress, and electrolyte imbalances. In our study, the incidence of LV‐EF improvement post PCI was 43.6%. In accordance with previous studies, the incidence was 64.6% in patients with severe reduction and 49.3% in patients with moderate reduction, while it was 29.5% in patients with mild reduction. The reduction rate of LV‐EF in our patients was 10.3%; 1.0% reduction to severe LV‐EF, 6.2% reduction to moderate LV‐EF and 3.1% reduction to mild. There is cumulative data documenting that lower LV‐EF is an independent predictor of mortality and its improvement post PCI is associated with reduced long‐term mortality, lower hospitalization for HF and lower PCI stratum (Maeder et al., 2025; Ndrepepa et al., 2024; Velagaleti et al., 2022).
3.2. Changes in LACI in ACS
To our knowledge, there is no available data describing the changes in LACI in patients presenting with ACS. Upon presentation, baseline LACI was normal in the majority of our patients (79.3%) despite impaired LV‐EF in 83% of them. This may indicate the compensatory role of LA function at early presentation in ACS to maintain cardiac performance (Leancă et al., 2022). Additionally, patients with impaired baseline LACI had a high incidence (82.5%) of impaired LV‐EF which may indicate remodeling of both LV and LA due to longstanding myocardial ischemia. In patients with normal baseline LACI, it was maintained at its normal value in 86.9% and worsened in 13.1% post PCI, while in patients with impaired baseline LACI, it was improved in 52.5%. In patients with improved LACI post PCI, 71.4% had impaired LV‐EF which may indicate earlier improvement of LACI than LV‐EF. The incidence of worsening LV‐EF and LACI post PCI was the same occurring in 20 (10.4%) patients. The impairment of both LACI and LV‐EF post PCI emphasizes the need to intensify HF medications in these patients.
The prognostic value of LACI for adverse events post PCI was demonstrated by the Lange et al study, which involved 1046 patients (719 had STEMI and 325 had NSTEMI.) Patients who developed major adverse events including death, re‐infarction and HF development within 12 months after MI had significantly higher LACI values than those without. Using cardiac MRI, the LACI cut‐off value of 34.7%, enabled differentiation between high‐ and low‐risk patients with high sensitivity and specificity (Velagaleti et al., 2022). A recent study included 1083 STEMI patients who underwent PCI within 12 h of symptoms. LACI calculated by MRI within 7 days was independently associated with major adverse events (all‐cause death, reinfarction, and hospitalization for HF) (Wu et al., 2025). In patients with chronic coronary syndrome, LACI was a significant predictor for all‐cause death (HR per 1% increment 1.02, 95% CI 1.01–1.03, p < 0.0001) (Lange et al., 2023b). In our study, incidence of major adverse events among patients with impaired LACI post PCI had 62.5% mortality, 40% hospitalization due to HF and 15.4% re‐infarction.
3.3. Clinical perspectives
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Normal LACI at presentation in ACS despite impaired LV‐EF may indicate the compensatory effect of LA performance to maintain cardiac output.
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Impaired LACI at presentation is highly associated with impaired LV‐EF indicating ischemic remodeling of both LA and LV.
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The response of LACI to PCI is variable according to the baseline values. With normal baseline LACI, its value post PCI was maintained in 86.9% and impaired in 13.1%. With impaired baseline LACI, it improved in 52.5% and showed no improvement in 47.5%.
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The incidence of LV‐EF improvement in response to PCI was 43.6%, higher in patients with severe and moderate reduction (64.6% and 49.3% respectively) than in patients with mild reduction (29.5%).
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Improvement of LACI post PCI occurs earlier and with a higher incidence than LV‐EF.
3.4. Study limitation
The main limitations of the study are as follows: First, the study was based on a prospective analysis of archived data from ACS patients who underwent PCI. Second, the study is a single‐center observational study with a possibility of patient selection bias. Third, the follow up period is relatively short for detecting major adverse events.
4. CONCLUSION
LACI represents a promising parameter for describing the effect of myocardial ischemia on both LV and LA dynamics at early presentation in patients with ACS in addition to LV‐EF. In response to culprit lesion PCI, improvement of LACI occurs earlier and with a higher incidence than LV‐EF supporting its use in detecting early recovery of LV.
CONFLICT OF INTEREST STATEMENT
The authors declare no conflicts of interest.
ACKNOWLEDGEMENTS
N/A.
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions. The study collected data from the digital archiving system. The data are available upon request. The methods and results of the study are original and do not reproduce any material from other sources. The discussion section as usual refers to previously published data for comparison.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions. The study collected data from the digital archiving system. The data are available upon request. The methods and results of the study are original and do not reproduce any material from other sources. The discussion section as usual refers to previously published data for comparison.