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

BackgroundAlthough 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). MethodsThis 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] x 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). ResultsThe median age of patients was 83 years, 44.7% was male, and 39.2% had diabetes. The median BMI was 21.5 kg/m{superscript 2}, with 20.9% having BMI <18.5 kg/m {superscript 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). ConclusionsIn 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 Perspective1) What is new?O_LIThe triglyceride-glucose (TyG) index is a novel, easily calculated surrogate marker for insulin resistance (IR) using only serum triglyceride and fasting blood glucose levels. C_LIO_LIA 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. C_LIO_LIThis association remained consistent across various subgroups stratified by age, sex, BMI, diabetes status, and other risk factors. C_LI 2) What are the clinical implications?O_LIA paradoxical relationship between IR and clinical outcomes may exist in predominantly older, low-BMI Japanese patients with established HFpEF. C_LIO_LIThe prognostic impact of IR in established heart failure appears complex and may vary depending on patient characteristics. C_LI