Correlation between triglycerides glucose index and left ventricular global longitudinal strain in prediction of heart failure in patients with NSTE-ACS

Background: Insulin resistance is central to the development of atherosclerosis and cardiac dysfunction. The triglyceride-glucose (TyG) index is a simple, reliable marker of insulin resistance. Global longitudinal strain (GLS), assessed via speckle-tracking echocardiography, sensitively detects subclinical left ventricular (LV) systolic dysfunction. In non-ST elevation acute coronary syndrome (NSTE-ACS) patients, early identification of those at risk of heart failure (HF) remains challenging. This study aimed to evaluate the impact of the TyG index on GLS in NSTE-ACS patients using speckle tracking echocardiography. Methods: This prospective, single-center cohort study included 315 NSTE-ACS patients admitted to Benha University Hospital from November 2023 to November 2024. Patients were divided into two groups: Group I (TyG index ˂ 8.47) and Group II (TyG index ≥ 8.47). All underwent history taking, clinical examination, and standard lab and imaging tests. Results: The TyG index showed significant associations with echocardiographic parameters. It had a strong negative correlation with GLS (r = -0.673, P < 0.001), suggesting higher TyG levels indicate worse myocardial deformation. It also showed moderate negative correlations with STE 3D-EF (r = -0.445, P < 0.001) and conventional EF% (r = -0.401, P < 0.001). Multivariate logistic regression revealed TyG index as a significant predictor of in-hospital composite MACE, independent of age, gender, BMI, smoking, HTN, DM, and comorbidities (OR = 12.861, 95% CI = 4.03 - 41.043, P < 0.001). Conclusion: A high TyG index in NSTE-ACS patients may be linked to more pronounced LV dysfunction. Monitoring TyG levels could help mitigate adverse outcomes.