Predictive Value of the Triglyceride-Glucose Index (TyG Index) for Major Cardiac Events in Patients With Chronic Heart Failure and Type 2 Diabetes: A Prospective Observational Study

INTRODUCTION: Chronic heart failure (CHF) with coexisting type 2 diabetes mellitus (T2DM) confers a markedly elevated risk of major adverse cardiac events (MACEs). Insulin resistance plays a central pathophysiological role in this excess risk, yet direct assessment remains impractical in routine care. The triglyceride-glucose (TyG) index, a straightforward surrogate indicator of insulin resistance derived from fasting glucose and triglyceride levels, has emerged as a potential prognostic tool. This study evaluated the predictive value of the TyG index for MACE in patients with CHF and T2DM. METHOD: This prospective observational study was conducted at a tertiary care cardiology center in Bangladesh from July 2023 to August 2024. Eighty-three adults with confirmed CHF and T2DM were enrolled and followed for six months. Baseline clinical, echocardiographic, and biochemical parameters were recorded, and the TyG index was calculated using a validated formula. Major adverse cardiac events, including cardiovascular death, heart-failure-related hospitalization, and ischemic cardiac events, were adjudicated by blinded cardiologists. Group comparisons, quartile analysis, and receiver operating characteristic (ROC) curve analysis were performed to evaluate the prognostic performance. RESULTS: Major adverse cardiac events occurred in 69 (83.1%) of patients, predominantly due to heart-failure-related hospitalization in 67 (80.7%). The TyG index was significantly higher in patients with MACE compared with those without MACE (6.8 ± 0.7 vs. 5.8 ± 0.6; p=0.001). Higher TyG quartiles were significantly associated with mortality and heart-failure hospitalization (p