Triglyceride-glucose index and subclinical left ventricular dysfunction across cardiovascular-kidney-metabolic syndrome stages: a 7-year retrospective cohort study.

BACKGROUND

The triglyceride-glucose (TyG) index is associated with cardiovascular disease risk, but its role in identifying subclinical myocardial dysfunction and predicting heart failure (HF) in asymptomatic adults remains unclear.

OBJECTIVES

To assess the association between TyG index and left ventricular global longitudinal strain (GLS), define a threshold for subclinical left ventricular dysfunction (SLVD), and evaluate its link to incident HF hospitalization.

METHODS

In this retrospective cohort study included, 4,784 asymptomatic adults aged 18-86 years from a Taiwan community and health check-up cohort without lipid-lowering therapy were included. SLVD was defined as GLS ≥-18%. Multivariable logistic and Cox regression analyses examined the relationship between TyG index, SLVD, and HF risk with covariates adjustment.

RESULTS

A TyG index ≥8.64 optimally discriminated individuals with SLVD, with an area under the receiver operating characteristic curve of 0.70. The prevalence of SLVD was 4.9% (130/2,656) among those with a normal TyG index and 12.9% (268/2,067) among those with an elevated TyG index. An elevated TyG index was independently associated with SLVD [odds ratio 1.62; 95% confidence interval (CI): 1.25-2.09], with stronger associations in those with stage B HF or cardiovascular-kidney-metabolic (CKM) syndrome. The proportion of individuals with an elevated TyG index increased markedly across CKM stages, from 3.5% (23/665) at stage 0 to 14.9% (148/991) at stage 1, 62.6% (1,849/2,955) at stage 2, and 42.0% (47/112) at stage 3. Over a median follow-up of 7.43 years, 61 participants experienced HF hospitalization. Individuals with both SLVD and a high TyG index had a substantially higher risk of HF hospitalization (hazard ratio 7.26; 95% CI: 3.44-15.35) compared with those without either condition.

CONCLUSIONS

TyG index is a simple, accessible marker for early myocardial dysfunction and future HF risk, particularly when combined with SLVD or early-stage HF.