YÜKSEK TRİGLİSERİD GLUKOZ İNDEKSİ KALP YETMEZLİĞİ VARLIĞIYLA İLİŞKİLİDİR

Yıl 2022, Cilt: 85 Sayı: 1, 51 - 58, 25.01.2022

Sara Çetin Şanlıalp , Gokay Nar , Mehmet Guven Gunver

https://doi.org/10.26650/IUITFD.898541

Öz

Amaç: Önceki çalışmalar, farklı yöntemler kullanılarak ölçülen insülin direnci (IR) ile kalp yetmezliği (KY) arasında önemli bir ilişki olduğunu göstermiştir. Son yıllarda, trigliserid glukoz (TyG) indeksi IR’ni ölçmek için kullanılmaktadır ve TyG indeksinin, metabolik sendrom (MetS) ve aterosklerotik süreç gibi durumları gösterdiğine dair birkaç rapor vardır. Ancak TyG indeksinin KY ile ilişkisini araştıran herhangi bir çalışma yoktur. Bu nedenle, biz bu çalışmada TyG indeksinin KY varlığındaki rolünü ve KY şiddeti ile ilişkisini değerlendirmeyi amaçladık. Gereç ve Yöntem: Yaş ve cinsiyet uyumlu 69 hasta geriye dönük olarak incelendi. IR’ni ölçmek için TyG indeksi kullanıldı ve Ln [açlık trigliseridleri (mg/dl) x açlık glikozu (mg/dl)/2] formülüyle hesaplandı. KY’nin şiddeti, New York Kalp Derneği (NYHA) fonksiyonel sınıfı, sol ventriküler ejeksiyon fraksiyonu (LVEF) ve N-terminal prohormon beyin natriüretik peptidi (NT-proBNP) ile değerlendirildi. Bulgular: KY hastaları daha yüksek TyG indeksine sahipti (9,11±0,59’a karşı 8,55±0,55; p<0,001). Ancak NYHA fonksiyonel sınıfı, LVEF, NT-proBNP ile tanımlanan KY şiddeti ile TyG indeksi arasında herhangi bir korelasyon yoktu. ROC eğrisi, KY’nin belirlenmesinde TyG indeksinin kesme noktasını %71 duyarlılık ve %51 özgüllük ile 9,19 olarak gösterdi (AUC:0,745, p<0,001). Sonuç: TyG indeksi, KY tanısı için yararlı bir belirteç olabilir ancak KY ciddiyeti ile ilişkili değildir.

Anahtar Kelimeler

Kalp yetmezliği, insülin direnci, trigliserid glukoz indeksi

ELEVATED TRIGLYCERIDE GLUCOSE INDEX IS RELATED TO THE PRESENCE OF HEART FAILURE

Öz

Objective: Previous studies have shown a significant association between insulin resistance (IR) measured by using different methods and heart failure (HF). In recent years, the triglyceride glucose (TyG) index has been used to measure IR, and there are several reports showing that the TyG index indicates conditions such as metabolic syndrome (MetS) and atherosclerotic process. However, there is no study investigating the association of the TyG index with HF. Therefore, we aimed to evaluate the role of the TyG index in HF presence and its relationship with HF severity in this study. Material and Method: Sixty-nine subjects matched for age and gender were analyzed retrospectively. The TyG index was used to measure IR and was calculated by the formula Ln [fasting triglycerides (mg/dl) x fasting glucose (mg/dl)/2]. The severity of HF was assessed by New York Heart Association (NYHA) functional class, left ventricular ejection fraction (LVEF) and N- terminal prohormone brain natriuretic peptide (NT-proBNP). Results: HF patients had higher TyG index (9.11±0.59 vs. 8.55±0.55; p<0.001) but there was no correlation between TyG index with HF severity identified by NYHA functional class, LVEF and NT-proBNP. The ROC curve showed the cut-off point of the TyG index in determining HF as 9.19 with 71% sensitivity and 51% specificity (AUC:0.745, p<0.001). Conclusion: TyG index may be a useful marker for diagnosis of HF, but is not correlated with HF severity.

Anahtar Kelimeler

Heart failure, insulin resistance, triglyceride glucose index

Kaynakça

• 1. Fu F, Zhao K, Li J, Xu J, Zhang Y, Liu C, et al. Direct Evidence that Myocardial Insulin Resistance following Myocardial Ischemia Contributes to Post-Ischemic Heart Failure. Sci Rep 2015;5:17927. [CrossRef]
• 2. Udell JA, Cavender MA, Bhatt DL, Chatterjee S, Farkouh ME, Scirica BM. Glucose lowering drugs or strategies and cardiovascular outcomes in patients with or at risk for type 2 diabetes: A meta-analysis of randomised controlled trials. Lancet Diabetes Endocrinol 2015;(3):356-366. [CrossRef]
• 3. Irace C, Carallo C, Scavelli FB, De Franceschi MS, Esposito T, Tripolino C, et al. Markers of insulin resistance and carotid atherosclerosis. A comparison of the homeostasis model assessment and triglyceride glucose index Int J Clin Pract 2013;67(7):665-72. [CrossRef]
• 4. Wang L, Cong H, Zhang J, Hu Y, Wei A, Zhang Y, et al. Triglyceride-glucose index predicts adverse cardiovascular events in patients with diabetes and acute coronary syndrome. Cardiovasc Diabetol 2020;19(1):80. [CrossRef]
• 5. da Silva A, Silva Caldas APS, Miranda HHH, Bersch-Ferreira AC, Ragne TC, Weber B, et al. Triglyceride-glucose index is associated with symptomatic coronary artery disease in patients in secondary care. Cardiovasc Diabetol 2019;18(1):89. [CrossRef]
• 6. Simental-Mendía LE, Rodríguez-Morán M, Guerrero- Romero F. The product of fasting glucose and triglycerides as surrogate for identifying insulin resistance in apparently healthy subjects. Metab Syndr Relat Disord 2008;6(4):299- 304. [CrossRef]
• 7. Chalmers J, MacMahon S, Mancia G, Whitworth J, Beilin L, Hansson L, et al. 1999 World Health Organization- International Society of Hypertension Guidelines for the management of hypertension. Guidelines sub-committee of the World Health Organization. Clin Exp Hypertens. 1999;21(5-6):1009-60. [CrossRef]
• 8. American Diabetes Association. 2. Classification and diagnosis of diabetes: Standards of Medical Care in Diabetes-2019. Diabetes Care 2019;42(Supplement 1):S13- 28. [CrossRef]
• 9. Executive summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001;285(19):2486-97. [CrossRef]
• 10. Reaven GM. Banting lecture 1988. Role of insulin resistance in human disease. Diabetes 1988;37(12):1595-607. [CrossRef]
• 11. Ormazabal V, Nair S, Elfeky O, Aguayo C, Salomon C, Zuñiga FA. Association between insulin resistance and the development of cardiovascular disease. Cardiovasc Diabetol 2018;17(1):122. [CrossRef]
• 12. Chapman MJ, Ginsberg HN, Amarenco P, Andreotti F, Borén J, Catapano AL, et al. European Atherosclerosis Society Consensus Panel. Triglyceride-rich lipoproteins and high-density lipoprotein cholesterol in patients at high risk of cardiovascular disease: evidence and guidance for management. Eur Heart J 2011;32(11):1345-61. [CrossRef]
• 13. Paolisso G, De Riu S, Marrazzo G, Verza M, Varricchio M, D’Onofrio F. Insulin resistance and hyperinsulinemia in patients with chronic congestive heart failure. Metabolism 1991;40(9):972-7. [CrossRef]
• 14. Aroor AR, Mandavia CH, Sowers JR. Insulin resistance and heart failure: molecular mechanisms. Heart Fail Clin 2012;8(4):609-17. [CrossRef]
• 15. Coats AJ, Anker SD. Insulin Resistance in Chronic Heart Failure. J Cardiovasc Pharmacol 2000;35(7):9-14. [CrossRef]
• 16. Marín-Royo G, Ortega-Hernández A, Martínez-Martínez E, Jurado-López R, Luaces M, Islas F, et al. The Impact of Cardiac Lipotoxicity on Cardiac Function and Mirnas Signature in Obese and Non-Obese Rats with Myocardial Infarction. Sci Rep 2019;9(1):444. [CrossRef]
• 17. Banerjee D, Biggs ML, Mercer L, Mukamal K, Kaplan R, Barzilay J et al. Insulin resistance and risk of incident heart failure: Cardiovascular Health Study. Circ Heart Fail 2013;6(3):364-70. [CrossRef]
• 18. Vardeny O, Gupta DK, Claggett B, Burke S, Shah A, Loehr L, et al. Insulin resistance and incident heart failure the ARIC study (Atherosclerosis Risk in Communities). JACC Heart Fail 2013;1(6):531-6. [CrossRef]
• 19. Suskin N, McKelvie RS, Burns RJ, Latini R, Pericak D, Probstfield J et al. Glucose and insulin abnormalities relate to functional capacity in patients with congestive heart failure. Eur Heart J 2000;21(16):1368-75. [CrossRef]
• 20. Swan JW, Anker SD, Walton C, Godsland IF, Clark AL, F. Leyva, et al. Insulin resistance in chronic heart failure: relation to severity and etiology of heart failure J Am Coll Cardiol 1997;(30):2:527-32. [CrossRef]
• 21. Anker SD, Swan JW, Volterrani M, Chua TP, Clark AL, Poole-Wilson PA, et al. The influence of muscle mass, strength, fatiguability and blood flow on exercise capacity in cachectic and non-cachetic patients with chronic heart failure. Eur Heart J 1997;18(2):259-69. [CrossRef]
• 22. ALZadjali MA, Godfrey V, Khan F, Choy AM, Doney AS, Wong AK, et al. Insulin resistance is highly prevalent and is associated with reduced exercise tolerance in nondiabetic patients with heart failure. J Am Coll Cardiol 2009;53(9):747- 53. [CrossRef]
• 23. Luchner A, Hense HW, Jougasaki M, Burnett JC Jr, Riegger GA, Schunkert H. Augmentation of natriuretic peptides by beta receptor antagonism: Evidence from a population based study. J Am Coll Cardiol 1998;32(7):1839-44. [CrossRef]
• 24. Chang HR, Hsieh JC, Hsu BG, Wang LY, Chen MYC, Wang JH. Inverse Association of N-Terminal Pro-B-Type Natriuretic Peptide with Metabolic Syndrome in Patients with Congestive Heart Failure. PLoS ONE 2013;8(11):e79096. [CrossRef]