Reply to the Letter to the Editor: “Concerns Regarding the Interpretation of Triglyceride- Glucose Index as a Protective Factor in Hypertrophic Cardiomyopathy”

Q: What is the clinical evidence from this study?

Study design: Letter. Population: Hypertrophic cardiomyopathy (HCM) and heart failure with preserved ejection fraction (HFpEF). Intervention: Triglyceride-glucose (TyG) index. Primary outcome: All-cause and cardiovascular mortality.

Y Zheng; L Liu; Li X; Tong Liu

doi:10.14744/anatoljcardiol.2026.6221

January 1, 2026The Anatolian Journal of CardiologyOpen Access

Reply to the Letter to the Editor: “Concerns Regarding the Interpretation of Triglyceride- Glucose Index as a Protective Factor in Hypertrophic Cardiomyopathy”

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Key result

The triglyceride-glucose index is associated with a more favorable prognosis in patients with hypertrophic cardiomyopathy and heart failure with preserved ejection fraction.

Why the study?

Does the triglyceride-glucose (TyG) index predict prognosis in patients with hypertrophic cardiomyopathy and heart failure with preserved ejection fraction?

Key Points

To address clinical concerns regarding the paradoxical protective association between the triglyceride-glucose index and prognosis in patients with hypertrophic cardiomyopathy and heart failure with preserved ejection fraction.
Evaluated the relationship between baseline triglyceride-glucose index and all-cause and cardiovascular mortality in hypertrophic cardiomyopathy with heart failure with preserved ejection fraction.
Performed mediation analysis evaluating N-terminal pro B-type natriuretic peptide alongside multivariable-adjusted competing risk models.
The association between elevated triglyceride-glucose index and lower all-cause and cardiovascular mortality remained consistent across multiple adjusted models and competing risk analysis.
Mediation analysis demonstrated that N-terminal pro B-type natriuretic peptide served as a significant mediator of the observed association.
Statistical power was limited for sudden cardiac death analysis due to a low event rate in this cohort.

Structured PICO

Does the triglyceride-glucose (TyG) index predict prognosis in patients with hypertrophic cardiomyopathy and heart failure with preserved ejection fraction?

P

Population

Patients with hypertrophic cardiomyopathy (HCM) and heart failure with preserved ejection fraction (HFpEF)

I

Intervention

Triglyceride-glucose (TyG) index

O

Outcome

Prognosis (all-cause and cardiovascular mortality)hard clinical

Limitations

Lack of genetic data
Limited power for the sudden cardiac death analysis due to the low event rate
Potential limitation of the N-terminal pro B-type natriuretic peptide cutoff in HCM
Limited power for sudden cardiac death analysis due to low event rate
Potential limitation of NT-proBNP cutoff in HCM

Implication

The authors argue that the counterintuitive association between the TyG index and prognosis in HCM-HFpEF may reflect a compensatory metabolic shift rather than solely a marker of dysfunction.

Abstract

†These authors contributed equally. *Joint senior authors.

Discussion

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Cite This Study

Zheng et al. (2026) conducted a letter in Hypertrophic cardiomyopathy (HCM) and heart failure with preserved ejection fraction (HFpEF). Triglyceride-glucose (TyG) index was evaluated on All-cause and cardiovascular mortality. The triglyceride-glucose index is associated with a more favorable prognosis in patients with hypertrophic cardiomyopathy and heart failure with preserved ejection fraction.

synapsesocial.com/papers/69e865d76e0dea528ddea41f https://doi.org/10.14744/anatoljcardiol.2026.6221

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Reply to the Letter to the Editor: “Concerns Regarding the Interpretation of Triglyceride- Glucose Index as a Protective Factor in Hypertrophic Cardiomyopathy”

Key Points

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Reply to the Letter to the Editor: “Concerns Regarding the Interpretation of Triglyceride- Glucose Index as a Protective Factor in Hypertrophic Cardiomyopathy”

Key Points

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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