School of Medicine, Nankai University, No.94 Weijin Road, Nankai District, Tianjin, 300071, China.
Medical Big Data Research Center, Medical Innovation Research Department of PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing, 100853, China.
Cardiovasc Diabetol. 2023 Jul 7;22(1):171. doi: 10.1186/s12933-023-01895-4.
The triglyceride-glucose (TyG) index has been demonstrated to be a reliable surrogate marker of insulin resistance (IR) and an effective predictive index of cardiovascular (CV) disease risk. However, its long-term prognostic value in patients with chronic heart failure (CHF) remains uncertain.
A total of 6697 consecutive patients with CHF were enrolled in this study. Patients were divided into tertiles according to their TyG index. The incidence of primary outcomes, including all-cause death and CV death, was recorded. The TyG index was calculated as ln [fasting triglycerides (mg/dL) × fasting blood glucose (mg/dL)/2].
During a median follow-up of 3.9 years, a total of 2158 (32.2%) all-cause deaths and 1305 (19.5%) CV deaths were documented. The incidence of primary events from the lowest to the highest TyG index tertiles were 50.61, 64.64, and 92.25 per 1000 person-years for all-cause death and 29.05, 39.40, and 57.21 per 1000 person-years for CV death. The multivariate Cox hazards regression analysis revealed hazard ratios for all-cause and CV deaths of 1.84 (95% CI 1.61-2.10; P for trend < 0.001) and 1.94 (95% CI 1.63-2.30; P for trend < 0.001) when the highest and lowest TyG index tertiles were compared. In addition, the predictive ability of the TyG index against all-cause death was more prominent among patients with metabolic syndrome and those with heart failure with preserved ejection fraction phenotype (both P for interaction < 0.05). Furthermore, adding the TyG index to the established model for all-cause death improved the C‑statistic value (0.710 for the established model vs. 0.723 for the established model + TyG index, P < 0.01), the integrated discrimination improvement value (0.011, P < 0.01), the net reclassification improvement value (0.273, P < 0.01), and the clinical net benefit (probability range, 0.07-0.36).
The TyG index was significantly associated with the risk of mortality, suggesting that it may be a reliable and valuable predictor for risk stratification and an effective prognostic indicator in patients with CHF.
三酰甘油-葡萄糖（TyG）指数已被证明是胰岛素抵抗（IR）的可靠替代标志物，也是心血管（CV）疾病风险的有效预测指标。然而，其在慢性心力衰竭（CHF）患者中的长期预后价值仍不确定。
本研究共纳入 6697 例连续 CHF 患者。根据 TyG 指数将患者分为三分位。记录主要结局（包括全因死亡和 CV 死亡）的发生率。TyG 指数的计算方法为 ln[空腹三酰甘油（mg/dL）×空腹血糖（mg/dL）/2]。
在中位随访 3.9 年期间，共发生 2158 例（32.2%）全因死亡和 1305 例（19.5%）CV 死亡。最低至最高 TyG 指数三分位的全因死亡发生率分别为 50.61、64.64 和 92.25/1000 人年，CV 死亡发生率分别为 29.05、39.40 和 57.21/1000 人年。多变量 Cox 风险回归分析显示，与最低 TyG 指数三分位相比，全因死亡和 CV 死亡的风险比分别为 1.84（95%CI 1.61-2.10；P<0.001）和 1.94（95%CI 1.63-2.30；P<0.001）。此外，在患有代谢综合征和射血分数保留型心力衰竭表型的患者中，TyG 指数对全因死亡的预测能力更为显著（两者 P 值均<0.05）。此外，将 TyG 指数加入全因死亡的既定模型中，可提高 C 统计量（既定模型为 0.710，加入 TyG 指数后为 0.723，P<0.01）、综合判别改善值（0.011，P<0.01）、净重新分类改善值（0.273，P<0.01）和临床净效益（概率范围为 0.07-0.36）。
TyG 指数与死亡率风险显著相关，表明其可能是一种可靠且有价值的风险分层预测指标，也是 CHF 患者的有效预后指标。
