Normal Values of Echocardiographic Left Atrioventricular Coupling Index and Left Atrial Stiffness Index Reflecting Left Ventricular Diastolic Function: A Multicenter Study

• Published in: Journal of the American Society of Echocardiography Vol. 38; no. 9; pp. 794 - 803
• Main Authors: Dong, Tian-Xin, Li, Shi-Wen, Pan, Xiao-Fang, Wang, Chun-Feng, Liu, Ying, Wu, Jun, Guan, Xiang-Ping, Zhang, Su-Li, Zuo, Peng-Fei, Liu, Yi-Lin, Wang, Li-Yan, Cui, Lei, Liu, Yan, Lai, Yu-Qiong, Ding, Ming-Yan, Lu, Gui-Lin, Tan, Jing, Yang, Xin-Jian, Li, Yi-Hong, Wang, Yong-Huai, Zhang, Xin-Tong, Ren, Wei-Dong, Ma, Chun-Yan
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2025
• Subjects: Adult; Aged; Atrial Function, Left - physiology; Atrioventricular coupling; Cardiovascular; Diastole; Diastolic function; Echocardiography - methods; Echocardiography - standards; Female; Heart Atria - diagnostic imaging; Heart Atria - physiopathology; Heart Ventricles - diagnostic imaging; Humans; Left atrial stiffness; Left ventricle; Male; Middle Aged; Normal values; Reference Values; Reproducibility of Results; Stroke Volume - physiology; Ventricular Function, Left - physiology; LASct; MESA; LASI; LVEF; LVDD; LV; LAVI; Left ventricle; BP; GLS; Diastolic function; EACVI; Normal values; LAScd; ASE; LA; Left atrial stiffness; Atrioventricular coupling; LASr; LACI; LVEDV; BMI; Left atrial stiffness index; European Association of Cardiovascular Imaging; Global longitudinal strain; Left ventricle, ventricular; Body mass index; Left atrium, atrial; Left atrial volume index; Left ventricular ejection fraction; Left atrioventricular coupling index; Blood pressure; Multi-Ethnic Study of Atherosclerosis; Left atrial reservoir strain; Left atrial booster strain; Left atrial conduit strain; American Society of Echocardiography; Left ventricular diastolic dysfunction; Left ventricular end-diastolic volume
• ISSN: 0894-7317; 1097-6795; 1097-6795
• DOI: 10.1016/j.echo.2025.04.011

The left atrioventricular coupling index (LACI) and left atrial stiffness index (LASI) have recently demonstrated significant correlations with left ventricular (LV) diastolic function. However, the absence of reference values limits their widespread use. This study aimed to establish normal reference ranges for LACI and LASI. A total of 1,648 healthy participants from 55 centers were enrolled. The LACI was defined as the ratio of left atrial (LA) minimum volume to LV end-diastolic volume. The LASI was calculated as the ratio of the average E/e' ratio to LA reservoir strain. Both LACI and LASI increased with age in both sexes. The LACI was higher in women than in men (P < .001), whereas no significant sex difference was observed for LASI (P = .868). Age, sex, LV global longitudinal strain (GLS), and LA reservoir strain independently predicted LACI. Age, body mass index, LV GLS, and LA volume index were independently associated with LASI. Elevated LACI and LASI were observed in participants with high-normal blood pressure, overweight status, and indeterminate LV diastolic function. Sex- and age-stratified reference values for LACI and LASI were established. Left ventricular GLS, LA reservoir strain, and LA volume index should be considered when interpreting these parameters. Hypertension, obesity, and LV diastolic dysfunction may significantly affect LACI and LASI, suggesting their potential utility in identifying early cardiac dysfunction. •Women exhibited a higher LACI than men.•No significant sex difference was found in LASI.•Both LACI and LASI are increasing with healthy aging.•Elevated BP and BMI were associated with increases in LACI and LASI.•LACI and LASI increased in subjects with indeterminate LV diastolic function.