Triglyceride Glucose Index as a screening tool for subclinical heart failure with preserved ejection fraction in type 2 diabetes mellitus in resource-limited settings.

Abstract

Diabetic cardiomyopathy is an entity with a multifactorial pathophysiology, in which insulin resistance plays a key role. It increases the risk of heart failure with preserved ejection fraction (HFpEF) in type 2 diabetes mellitus (T2DM). The Triglyceride-Glucose Index (TGI) is a novel measure of insulin resistance which is simple to use and may serve as an accessible marker for subclinical HFpEF. To evaluate the association between TGI and subclinical HFpEF in asymptomatic patients with T2DM and assess its diagnostic performance. This was a cross-sectional observational analytic study in which 274 asymptomatic T2DM patients aged 18-60 years were enrolled. Patients with known cardiovascular disease, hypertension, macro- and microvascular complications, and other major comorbidities were excluded. TGI was calculated, and all participants underwent 2D echocardiography to assess left ventricular diastolic function. LV diastolic dysfunction (LVDD) was detected in 62.4% of participants. TGI was significantly higher in patients with LVDD (mean 9.69 ± 0.49) versus those without (mean 9.23 ± 0.63), <i>P</i> < 0.001. ROC analysis identified a TGI cutoff of 9.34 as optimal for detecting LVDD, yielding a sensitivity of 80%, a specificity of 63%, and an AUROC of 0.734. To achieve high sensitivity (100%) and NPV (100%), the cutoff of 8.32 is best for screening for LVDD. TGI demonstrates fair diagnostic accuracy for identifying subclinical HFpEF in T2DM. Given its simplicity and cost-effectiveness, it may be considered a valuable screening tool in resource-limited settings.