Left Atrioventricular Coupling Index: An Echocardiographic Index of Atrioventricular Dysfunction in Dogs with Myxomatous Mitral Valve Disease

The close physiological relationship between the left atrium (LA) and left ventricle (LV) suggests that an index assessing both the cardiac chambers simultaneously could provide useful information about disease severity. Consequently, investigators have proposed the atrioventricular coupling index (LACi), and demonstrated its utility in predicting the likelihood of atrial fibrillation, heart failure, and other cardiovascular events in humans. No studies have been reported in veterinary medicine. Therefore, we measured the LACi in healthy dogs and dogs affected by myxomatous mitral valve disease (MMVD). Two hundred and thirty-three dogs (105 healthy dogs and 128 dogs with MMVD) were retrospectively included in the study. The LACi (LA volume/LV volume*100) at LV end-diastole (LACi-ED) and LV end-systole (LACi-ES) of each dog was measured using a monoplane Simpson’s Method of Discs from the left apical four-chamber view. In healthy dogs, LACi-ED and LACi-ES showed no relationship with bodyweight, heart rate and age (R2 < 0.03, for all variables). In MMVD dogs, LACi-ED and LACi-ES differed between ACVIM stages (P < 0.00 and P < 0.02, for all stages). The LACi-ED and LACi-ES had similar accuracy in identifying MMVD dogs with congestive heart failure (area under the curve of 0.920 and 0.906, respectively). Our data suggest that LACi can be useful in assessing left atrioventricular function in dogs with MMVD but the diagnostic accuracy in identifying dogs with congestive heart failure was not superior to left-atrial-to-aortic ratio. Prospective studies are needed to evaluate the predictive value of this new echocardiographic index in dogs affected by MMVD.