Left and right atrioventricular coupling index in patients with beta-thalassemia major

The aim of this cross-sectional study was to investigate the relationship of left atrioventricular coupling index (LACI) and right atrioventricular coupling index (RACI) with demographics, clinical data, cardiovascular magnetic resonance fndings, and cardiac complications (heart failure, arrhythmias, and pulmonary hypertension) in a cohort of patients with beta-thalassemia major (β-TM). We evaluated 292 β-TM patients (151 females, 36.72±11.76 years) consecutively enrolled in the Extension-Myocardial Iron Overload in Thalassemia (E-MIOT) project. Moreover, we assessed 32 sex- and agematched healthy controls (12 females, mean age 40.78±14.35 years). LACI was determined by calculating the ratio of the left atrium end-diastolic volume to the left ventricle end-diastolic volume, while RACI was defned by calculating the ratio of the right atrium end-diastolic volume to the right ventricle end-diastolic volume. Compared to healthy control, β-TM demonstrated increased LACI (22.99±13.58% vs. 16.05±5.28%; p<0.0001) and RACI (27.84±10.30% vs. 17.06±5.03%; p<0.0001). Aging, diabetes, splenectomy, and the presence of late gadolinium enhancement (LGE) showed a signifcant positive association with both LACI and RACI. In stepwise regression analysis, the presence of LGE was found to be an independent predictor of both impaired LACI and RACI (β coefcient=0.244, p<0.0001 and β coefcient=0.218, p=0.003; respectively). LACI and RACI were not correlated with myocardial iron overload. Patients with cardiac complications had signifcantly higher LACI and RACI than patients without cardiac complications. In patients with β-TM, LACI and RACI were signifcantly associated with the presence of LV LGE. In addition, patients with cardiac complications had impaired LACI and RACI.