Association between Triglyceride-Glucose Index and Clinical Outcome in Patients with Acute Decompensated Heart Failure with Preserved Ejection Fraction

  1. Katsuomi Iwakura
  2. Atsunori Okamura
  3. Yoshitaka Iwanaga
  4. Yasushi Koyama
  5. Nobuaki Tanaka
  6. Masato Okada
  7. Masahiro Seo
  8. Takahisa Yamada
  9. Masamichi Yano
  10. Takaharu Hayashi
  11. Yoshio Yasumura
  12. Yusuke Nakagawa
  13. Shunsuke Tamaki
  14. Akito Nakagawa
  15. Katsuki Okada
  16. Yohei Sotomi
  17. Shungo Hikoso
  18. Daisaku Nakatani
  19. Yasushi Sakata
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Abstract

Background

Although insulin resistance (IR) is associated with a higher risk of incident heart failure (HF), it is not fully understood whether IR could affect clinical outcomes in patients with established HF. We investigated the relationship between the triglyceride-glucose (TyG) index, a simple surrogate marker for IR, and clinical outcomes in patients with HF with preserved ejection fraction (HFpEF).

Methods

This retrospective analysis from the PURSUIT-HFpEF registry included 917 patients hospitalized for decompensated HFpEF. The TyG index was calculated at discharge as ln(triglyceride [mg/dL] × fasting blood glucose [mg/dL]/2). The primary outcomes were all-cause death and major adverse cardiovascular events (MACEs; a composite of all-cause death, heart failure hospitalization, and stroke).

Results

The median age of patients was 83 years, 44.7% was male, and 39.2% had diabetes. The median BMI was 21.5 kg/m², with 20.9% having BMI <18.5 kg/m ². During a median follow-up of 387 days, 168 deaths and 343 MACEs occurred. A stepwise Cox hazard model revealed that higher TyG index was independently associated with lower risk of all-cause death (HR 0.53, 95% CI 0.38-0.75) and MACEs (HR 0.77, 95% CI 0.61-0.97). When patients were divided into quartiles based on TyG index, the incidences of both outcomes were significantly lower in higher TyG quartiles (all-cause death; p=0.0003, MACEs; p=0.007 by log-rank).

Conclusions

In this predominantly elderly, low BMI cohort with established HFpEF, higher TyG index was paradoxically associated with better clinical outcomes. These findings imply a complex relationship between IR and HFpEF outcomes.

Clinical Perspective

1)

What is new?

  • The triglyceride-glucose (TyG) index is a novel, easily calculated surrogate marker for insulin resistance (IR) using only serum triglyceride and fasting blood glucose levels.

  • A higher TyG index, reflecting greater IR, was paradoxically associated with a lower incidence of all-cause mortality and major adverse cardiovascular events in patients hospitalized with heart failure with preserved ejection fraction (HFpEF) over approximately one year of follow-up.

  • This association remained consistent across various subgroups stratified by age, sex, BMI, diabetes status, and other risk factors.

2)

What are the clinical implications?

  • A paradoxical relationship between IR and clinical outcomes may exist in predominantly older, low-BMI Japanese patients with established HFpEF.

  • The prognostic impact of IR in established heart failure appears complex and may vary depending on patient characteristics.

Article activity feed

  1. Version published to 10.1101/2025.05.13.25327566v1 on medRxiv