Triglyceride–glucose index is independently associated with left ventricular outflow tract obstruction in hypertrophic cardiomyopathy

Q: What are the key findings of this study?

The triglyceride-glucose (TyG) index was independently associated with left ventricular outflow tract obstruction in patients with hypertrophic cardiomyopathy (per 0.1-unit increase: OR 1.84, 95% CI 1.40-2.42, p<0.001).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Hypertrophic cardiomyopathy (HCM) (n=124). Intervention: Triglyceride-glucose (TyG) index (per 0.1-unit increment) vs. Non-obstructive HCM (LVOT gradient <30 mmHg). Primary outcome: Left ventricular outflow tract (LVOT) obstruction (resting or provoked gradient ≥30 mmHg) (OR 1.84, 95% CI 1.40-2.42, p=<0.001).

Q: What does this research mean for the field?

The triglyceride–glucose (TyG) index is independently associated with left ventricular outflow tract obstruction in patients with hypertrophic cardiomyopathy. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate the association between the triglyceride-glucose (TyG) index, a surrogate marker of insulin resistance, and left ventricular outflow tract (LVOT) obstruction in adult patients with hypertrophic cardiomyopathy (HCM).

Tolga Kunak; Özkan Kayhan; Ayşegül Ülgen Kunak

doi:10.17305/bb.2026.14428

July 1, 2026Biomolecules and BiomedicineOpen Access

Triglyceride–glucose index is independently associated with left ventricular outflow tract obstruction in hypertrophic cardiomyopathy

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Key result

Higher TyG index linked to ~84% higher odds of LVOT obstruction in HCM per 0.1-unit increase.

OR 1.84
95% CI 1.40-2.42
P<0.001
n=124

Why the study?

The relationship between the triglyceride-glucose index, a simple surrogate marker of insulin resistance, and left ventricular outflow tract obstruction in hypertrophic cardiomyopathy patients remains underexplored.

Is a higher triglyceride-glucose (TyG) index independently associated with left ventricular outflow tract (LVOT) obstruction in adult patients with hypertrophic cardiomyopathy?

Key Points

To evaluate the association between the triglyceride-glucose (TyG) index, a surrogate marker of insulin resistance, and left ventricular outflow tract (LVOT) obstruction in adult patients with hypertrophic cardiomyopathy (HCM).
Conducted a retrospective observational cohort study of 124 adult HCM patients (66 non-obstructive and 58 obstructive).
Defined LVOT obstruction as a resting or provoked gradient of ≥30 mmHg based on systematic echocardiographic assessment.
Calculated the TyG index from fasting triglyceride and glucose levels, evaluating independent associations using multivariable logistic regression per 0.1-unit increment and discriminatory ability using ROC curve analysis.
Patients with obstructive HCM had significantly higher TyG index levels than those without obstruction (9.07 ± 0.25 vs. 8.76 ± 0.21, p<0.001).
The TyG index was independently associated with LVOT obstruction in multivariable analysis (per 0.1-unit increase: OR 1.84, 95% CI 1.40-2.42, p<0.001), along with CRP (OR 1.54, 95% CI 1.25-1.90, p<0.001).
The TyG index correlated moderately with resting (r=0.519, p<0.001) and provoked (r=0.557, p<0.001) LVOT gradients and showed good discriminatory ability (AUC: 0.826, 95% CI: 0.752-0.901; cut-off 8.75, sensitivity 87.9%, specificity 47.0%).

Study Design

Type

Cohort (n=124)

Blinding

Experienced cardiologists were blinded to the TyG index values at the time of image analysis

Multicenter

No

Structured PICO

Is a higher triglyceride-glucose (TyG) index independently associated with left ventricular outflow tract (LVOT) obstruction in adult patients with hypertrophic cardiomyopathy?

P

Population

124 adult patients (≥18 years) with hypertrophic cardiomyopathy (maximum LV wall thickness ≥15 mm), free of prior septal reduction therapy, advanced CKD (eGFR <30 mL/min/1.73 m2), or active systemic inflammatory/infectious disease.

E

Exposure

Triglyceride-glucose (TyG) index evaluation, calculated as ln [fasting triglycerides (mg/dL) × fasting plasma glucose (mg/dL) / 2], scaled per 0.1-unit increment.

O

Outcome

Left ventricular outflow tract (LVOT) obstruction, defined as a peak LVOT gradient ≥30 mmHg at rest or during provocation (predominantly Valsalva maneuver and/or exercise) on two-dimensional transthoracic echocardiography.surrogate

Main Result

Odds Ratio: 1.84 (95% CI 1.4–2.42)

Absolute Event Rate: 9.07% vs 8.76%

p-value: p=<0.001

Limitations

Retrospective observational design restricts causal inference and may introduce selection bias and residual confounding
Relatively modest sample size (n=124) without external validation, and limited number of obstructive cases relative to multivariable covariates raising the possibility of model overfitting
Direct measurements of insulin resistance (fasting insulin, HOMA-IR, HbA1c, or clamp testing) were not assessed
Advanced imaging parameters (myocardial strain, CMR-derived fibrosis) and key HCM characteristics (genotype, septal morphology, mitral valve anatomy, NYHA class) were unavailable
Provocation testing for LVOT obstruction was not fully standardized across all patients and medication status was not uniformly controlled before testing
Retrospective observational cross-sectional design restricts causal inference and may introduce selection bias and residual confounding.
Relatively modest sample size without internal or external validation of the ROC cut-off threshold, and a limited number of obstructive cases relative to covariates raising the possibility of model overfitting.
Direct measurements of insulin resistance (fasting insulin, HOMA-IR, HbA1c, hyperinsulinemic-euglycemic clamp) were not assessed.
Advanced imaging parameters (myocardial strain analysis, cardiac MRI-derived fibrosis assessment) and important HCM-related characteristics (genotype status, septal morphology, mitral valve anatomy, NYHA class) were unavailable.
Provocation testing was not fully standardized across all patients, and medication status was not uniformly controlled before testing.

Implication

In patients with hypertrophic cardiomyopathy, a higher triglyceride-glucose (TyG) index is independently associated with LVOT obstruction and moderately correlates with resting and provoked LVOT gradients, primarily driven by elevated triglyceride levels.

Abstract

Insulin resistance and metabolic dysregulation are increasingly recognized as contributors to myocardial remodeling and phenotypic heterogeneity in hypertrophic cardiomyopathy (HCM). While the triglyceride-glucose (TyG) index offers a simple surrogate marker of insulin resistance, its relationship with left ventricular outflow tract (LVOT) obstruction in HCM patients remains underexplored. This study aimed to investigate the association between the TyG index and LVOT obstruction in a retrospective observational cohort of 124 adult HCM patients. LVOT obstruction was defined as a resting or provoked gradient of ≥30 mmHg. Clinical, laboratory, and echocardiographic data were systematically evaluated. The TyG index was computed from fasting triglyceride and glucose levels. Multivariable logistic regression analysis, with the TyG index scaled per 0.1-unit increment, was used to assess independent associations. Receiver operating characteristic (ROC) curve analysis determined discriminatory performance. Patients with obstructive HCM exhibited significantly higher TyG index values compared to those without obstruction (9.07 ± 0.25 vs. 8.76 ± 0.21, p<0.001). The TyG index maintained an independent association with LVOT obstruction after adjusting for relevant clinical and echocardiographic covariates (per 0.1-unit increase: OR 1.84, 95% CI 1.40-2.42, p<0.001). Furthermore, the TyG index demonstrated moderate correlations with both resting (r=0.519, p<0.001) and provoked (r=0.557, p<001) LVOT gradients. ROC analysis indicated good discriminatory performance (AUC: 0.826, 95% CI: 0.752-0.901), with a cut-off value of 8.75 yielding 87.9% sensitivity and 47.0% specificity. In conclusion, the TyG index was independently associated with LVOT obstruction in HCM patients, with higher values observed in those with the obstructive phenotype. This suggests a potential link between metabolic status and disease manifestation in HCM. Given its cost-effectiveness and accessibility, the TyG index may offer valuable complementary clinical insights. However, this association requires cautious interpretation, and prospective studies are essential to establish its clinical and prognostic utility.

Discussion

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Cite This Study

Kunak et al. (2026) conducted a cohort in Hypertrophic cardiomyopathy (HCM) (n=124). Triglyceride-glucose (TyG) index (per 0.1-unit increment) vs. Non-obstructive HCM (LVOT gradient <30 mmHg) was evaluated on Left ventricular outflow tract (LVOT) obstruction (resting or provoked gradient ≥30 mmHg) (OR 1.84, 95% CI 1.40-2.42, p=<0.001). The triglyceride-glucose (TyG) index was independently associated with left ventricular outflow tract obstruction in patients with hypertrophic cardiomyopathy (per 0.1-unit increase: OR 1.84, 95% CI 1.40-2.42, p<0.001).

synapsesocial.com/papers/6a4752405c29257aa25790f0 https://doi.org/10.17305/bb.2026.14428

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Triglyceride–glucose index is independently associated with left ventricular outflow tract obstruction in hypertrophic cardiomyopathy

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Triglyceride–glucose index is independently associated with left ventricular outflow tract obstruction in hypertrophic cardiomyopathy

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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