Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
Laboratory of Cardiac Structure and Function, Institute of Cardiovascular Diseases, West China Hospital, Sichuan University, Chengdu, China.
Cardiovasc Diabetol. 2024 Aug 24;23(1):312. doi: 10.1186/s12933-024-02414-9.
The triglyceride glucose (TyG) index, as a reliable marker of insulin resistance, is associated with the incidence and poor prognosis of various cardiovascular diseases. However, the relationship between the TyG index and clinical outcomes in patients with severe aortic stenosis (AS) who underwent transcatheter aortic valve replacement (TAVR) remains unclear.
This study consecutively enrolled 1569 patients with AS underwent TAVR at West China Hospital of Sichuan University between April 2014 and August 2023. The outcomes of interest included all-cause mortality, cardiovascular mortality, and major adverse cardiovascular events (MACE). Multivariate adjusted Cox regression and restricted cubic splines (RCS) regression analyses were used to assess the associations between the TyG index and the clinical outcomes. The incremental prognostic value of the TyG index was further assessed by the time-dependent Harrell's C-index, integrated discrimination improvement (IDI) and the net reclassification improvement (NRI).
During a median follow-up of 1.09 years, there were 146, 70, and 196 patients experienced all-cause death, cardiovascular death, and MACE, respectively. After fully adjusting for confounders, a per-unit increase of TyG index was associated with a 441% (adjusted HR: 5.41, 95% CI: 4.01-7.32), 385% (adjusted HR: 4.85, 95% CI: 3.16-7.43), and 347% (adjusted HR: 4.47, 95% CI: 3.42-5.85) higher risk of all-cause mortality, cardiovascular mortality and MACE, respectively. The RCS regression analyses revealed a linear association between TyG index and endpoints (all P for non-linearity > 0.05) with 8.40 as the optimal binary cutoff point. Furthermore, adding TyG index to the basic risk model provided a significant incremental value in predicting poor prognosis (Time-dependent Harrell's C-index increased for all the endpoints; All-cause mortality, IDI: 0.11, P < 0.001; NRI: 0.32, P < 0.001; Cardiovascular mortality, IDI: 0.043, P < 0.001; NRI: 0.37, P < 0.001; MACE, IDI: 0.092, P < 0.001; NRI: 0.32, P < 0.001).
In patients with severe AS receiving TAVR, there was a positive linear relationship between TyG index and poor prognosis, with 8.4 as the optimal bivariate cutoff value. Our findings suggest TyG index holds potential value for risk stratification and guiding therapeutic decisions in patients after TAVR.
三酰甘油-葡萄糖（TyG）指数作为胰岛素抵抗的可靠标志物，与各种心血管疾病的发病率和不良预后相关。然而，在接受经导管主动脉瓣置换术（TAVR）的重度主动脉瓣狭窄（AS）患者中，TyG 指数与临床结局之间的关系尚不清楚。
本研究连续纳入了 2014 年 4 月至 2023 年 8 月期间在四川大学华西医院接受 TAVR 的 1569 例 AS 患者。主要终点包括全因死亡率、心血管死亡率和主要不良心血管事件（MACE）。多变量调整 Cox 回归和限制性立方样条（RCS）回归分析用于评估 TyG 指数与临床结局之间的关系。通过时间依赖性 Harrell's C 指数、综合判别改善（IDI）和净重新分类改善（NRI）进一步评估 TyG 指数的增量预后价值。
在中位随访 1.09 年期间，分别有 146、70 和 196 例患者发生全因死亡、心血管死亡和 MACE。在充分调整混杂因素后，TyG 指数每增加一个单位，全因死亡率、心血管死亡率和 MACE 的风险分别增加 441%（调整 HR：5.41，95%CI：4.01-7.32）、385%（调整 HR：4.85，95%CI：3.16-7.43）和 347%（调整 HR：4.47，95%CI：3.42-5.85）。RCS 回归分析显示 TyG 指数与终点之间呈线性关系（所有非线性 P 值均>0.05），8.40 为最佳二分类截断点。此外，在基本风险模型中加入 TyG 指数可显著提高预测不良预后的增量价值（所有终点的时间依赖性 Harrell's C 指数均增加；全因死亡率，IDI：0.11，P<0.001；NRI：0.32，P<0.001；心血管死亡率，IDI：0.043，P<0.001；NRI：0.37，P<0.001；MACE，IDI：0.092，P<0.001；NRI：0.32，P<0.001）。
在接受 TAVR 的重度 AS 患者中，TyG 指数与不良预后呈正线性关系，8.4 为最佳双变量截断值。这些发现表明 TyG 指数在 TAVR 后患者的风险分层和治疗决策指导方面具有潜在价值。
