Triglyceride-glucose index and all-cause mortality in patients with chronic severe heart failure

doi:10.4330/wjc.123414

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World Journal of Cardiology

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1949-8462

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Cardiol. Sep 26, 2026; 18(9): 123414
Published online Sep 26, 2026. doi: 10.4330/wjc.123414

Triglyceride-glucose index and all-cause mortality in patients with chronic severe heart failure

Xiao-Feng Li, Xin Wang, Yuan Zhang, Jia Liu, Jia-Mei Liu, Mu-Lei Chen, Lin Zhao, Lin-Ying Shi

Xiao-Feng Li, Pingfang Community Health Service Center, Beijing 100123, China

Xin Wang, Yuan Zhang, Jia Liu, Jia-Mei Liu, Mu-Lei Chen, Lin Zhao, Lin-Ying Shi, Heart Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China

Co-first authors: Xiao-Feng Li and Xin Wang.

Co-corresponding authors: Lin Zhao and Lin-Ying Shi.

Author contributions: Li XF and Wang X contributed to data curation and writing-original draft; Zhang Y and Liu J contributed to formal analysis and methodology; Liu JM and Chen ML contributed to investigation and data curation; Zhao L and Shi LY contributed equally as corresponding authors to this work and contributed to conceptualization, supervision, and writing-review & editing. Li XF and Wang X contributed equally to this work. We respectfully request that Zhao L and Shi LY be designated as co-corresponding authors for this manuscript. This request is not intended merely to acknowledge their individual contributions, but rather to accurately reflect their distinct and complementary responsibilities in the conception, execution, interpretation, and future communication of this interdisciplinary study. Zhao L served as the lead clinical investigator and was primarily responsible for the clinical aspects of the work, including the clinical conception of the study, patient recruitment and management, clinical data acquisition, interpretation of the findings in the context of clinical practice, and responses to questions related to patient selection, clinical procedures, and clinical implications. Shi LY served as the lead methodological and analytical investigator and was primarily responsible for the methodological framework, statistical analysis, verification of results, manuscript preparation and revision, and responses to questions regarding study methodology, data analysis, reproducibility, and the submission/revision process. Because this study combines clinical investigation with methodological and statistical analysis, inquiries from readers, reviewers, or future collaborators may involve either clinical interpretation or analytical validity. No single corresponding author can fully represent all aspects of post-publication responsibility as appropriately as the two authors together. Both Zhao L and Shi LY have agreed to remain available for post-publication correspondence and to take responsibility for issues related to data integrity, clinical interpretation, methodology, reproducibility, and future academic communication. Therefore, we believe that designating Zhao L and Shi LY as co-corresponding authors is appropriate, justified, and necessary to ensure accurate and timely communication regarding all major aspects of the study.

AI contribution statement: The authors declare that no AI tools were used in the preparation, writing, or revision of this manuscript. All content is the original work of the authors.

Supported by Noncommunicable Chronic Diseases-National Science and Technology Major Project, No. 2024ZD0522006.

Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Beijing Chaoyang Hospital.

Informed consent statement: Written informed consent was waived by the Ethics Committee of Beijing Chaoyang Hospital due to the retrospective nature of this study. All patient data were anonymized and handled in strict accordance with institutional privacy regulations and the Declaration of Helsinki.

Conflict-of-interest statement: All authors declare that they have no conflicts of interest related to this manuscript. There are no financial or personal relationships that could inappropriately influence this work.

Data sharing statement: The data that support the findings of this study are available from the corresponding author upon reasonable request. The data are not publicly available due to privacy and ethical restrictions related to patient confidentiality.

Corresponding author: Lin-Ying Shi, Heart Center, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongti South Road, Chaoyang District, Beijing 100020, China. sly197965@sina.cn

Received: May 19, 2026
Revised: July 26, 2026
Accepted: September 21, 2026
Published online: September 26, 2026
Processing time: 127 Days and 15.4 Hours

Abstract

BACKGROUND

Chronic severe heart failure is associated with high long-term mortality. The triglyceride-glucose (TyG) index is a simple surrogate marker of insulin resistance, but its prognostic significance in patients with chronic severe heart failure remains unclear.

AIM

To evaluate the association between the TyG index and 5-year all-cause mortality in patients with chronic severe heart failure.

METHODS

This retrospective cohort study included 261 consecutive patients with chronic severe heart failure hospitalized between January 2011 and June 2013. Patients were stratified into low- and high-TyG groups according to the median TyG index of 6.885. The primary endpoint was 5-year all-cause mortality. Survival was assessed using Kaplan-Meier curves and compared with the log-rank test. Cox regression models were used to evaluate the association between the TyG index and mortality. Subgroup analyses and receiver operating characteristic curve analyses were performed.

RESULTS

During 5 years of follow-up, 135 patients died. Patients in the high-TyG group had significantly higher 5-year all-cause mortality than those in the low-TyG group (59.5% vs 43.8%, P = 0.011). Kaplan-Meier analysis showed significantly poorer survival in the high-TyG group. In the fully adjusted Cox model, each 1-unit increase in the TyG index was associated with an increased risk of 5-year all-cause mortality [hazard ratio = 1.33, 95% confidence interval (CI): 1.01-1.76, P = 0.041]. This association was generally consistent across clinically relevant subgroups, with no significant interaction by diabetes status. The TyG index alone showed modest discriminative ability for 5-year mortality prediction [area under the curve (AUC) = 0.577, 95%CI: 0.507-0.646], whereas N-terminal pro-brain natriuretic peptide (NT-proBNP) showed better performance (AUC = 0.713, 95%CI: 0.651-0.775). Adding the TyG index to NT-proBNP resulted in only a small, non-significant increase in AUC (AUC = 0.722; ΔAUC = 0.009; DeLong P = 0.318).

CONCLUSION

In this single-center retrospective cohort of patients with chronic severe heart failure, a higher TyG index was independently associated with increased 5-year all-cause mortality. However, its standalone discriminative ability was limited, and its incremental value beyond NT-proBNP was small. The TyG index may serve as an adjunctive metabolic risk marker, but further prospective validation is required.

Keywords: Triglyceride-glucose index; Chronic severe heart failure; All-cause mortality; Insulin resistance; N-terminal pro-brain natriuretic peptide; Prognosis

Core Tip: In patients with chronic severe heart failure, the triglyceride-glucose (TyG) index independently predicts 5-year mortality but has only modest discriminative ability (area under the curve = 0.577). It adds minimal prognostic value beyond N-terminal pro-brain natriuretic peptide (NT-proBNP) and should not replace it in well-resourced settings. However, in resource-limited settings where NT-proBNP is unavailable, the TyG index may serve as a low-cost metabolic alert signal.