November 28, 2022Cardiovascular DiabetologyOpen Access

Association between triglyceride glucose index and worsening heart failure in significant secondary mitral regurgitation following percutaneous coronary intervention

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Why the study?

Patients with secondary mitral regurgitation often experience progressive deterioration of cardiac function, and the relationship between the triglyceride glucose index and worsening heart failure in significant secondary mitral regurgitation following PCI was unknown.

Does an elevated triglyceride glucose index predict worsening heart failure in patients with significant secondary mitral regurgitation following percutaneous coronary intervention?

Structured PICO

Does an elevated triglyceride glucose index predict worsening heart failure in patients with significant secondary mitral regurgitation following percutaneous coronary intervention?

Population

922 patients with significant secondary mitral regurgitation (grade ≥ 2) following percutaneous coronary intervention, mean age 64.1 years, 79.6% male.

Intervention

Highest tertile of triglyceride glucose (TyG) index (> 8.98)

Comparator

Lowest tertile of triglyceride glucose (TyG) index (≤ 8.51)

Outcome

Worsening heart failure including unplanned rehospitalization or unscheduled physician office/emergency department visit due to HF and unplanned mitral valve surgerycomposite

An elevated preprocedural triglyceride glucose index is an independent predictor of worsening heart failure in patients with significant secondary mitral regurgitation undergoing PCI.

Implication

May support TyG-based risk stratification post-PCI in secondary MR; leaves open whether targeting TyG improves HF outcomes.

Abstract

BACKGROUND: The triglyceride glucose (TyG) index is an alternative to insulin resistance (IR) as an early indicator of worsening heart failure (HF). Patients with secondary mitral regurgitation (sMR) often experience progressive deterioration of cardiac function. This study aimed to investigate the relationship between the TyG index and worsening of HF in significant sMR (grade ≥ 2) following percutaneous coronary intervention (PCI). METHODS: This study enrolled participants with significant sMR following PCI from a multicenter cohort study. The patients were divided into the following 3 groups according to tertiles of TyG index: T1, TyG ≤ 8.51; T2, TyG > 8.51 to ≤ 8.98; and T3, TyG > 8.98. The main clinical outcome was worsening HF including unplanned rehospitalization or unscheduled physician office/emergency department visit due to HF and unplanned mitral valve surgery. RESULTS: A total of 922 patients (mean ± SD age, 64.1 ± 11.0 years; 79.6% male) were enrolled. The incidence of worsening HF was 15.5% in T1, 15.7% in T2, and 26.4% in T3. In the multivariable model, the highest TyG tertile (T3 group) was more strongly correlated with worsening HF than the lowest tertile (T1 group) after adjusting for confounders (adjusted hazard ratio, 2.44; 95% confidence interval, 1.59-3.72; P < 0.001). The addition of TyG to risk factors such as N-terminal pro brain natriuretic peptide and clinical models improved the predictive ability of TyG for worsening HF. CONCLUSIONS: Elevated preprocedural TyG index is a significant and independent risk factor for worsening HF in sMR following PCI that can be used for risk stratification.