TyG-BMI Can Help Predict In-Hospital Mortality in HFmrEF With Hypertension

A new metric could help better predict in-hospital mortality among hypertensive patients with heart failure with mildly reduced ejection fraction (HFmrEF), according to the authors of a new study published in Lipids in Health and Disease.¹ Incorporating triglyceride-glucose-body mass index (TyG-BMI) into prediction models may help strengthen the models’ accuracy and thereby offer a practical tool for identifying patients at the highest risk of in-hospital mortality.

The authors explained that HFmrEF is a relatively new subtype in heart failure guidelines.

“Its clinical characteristics and pathophysiological mechanisms lie between those of heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF), representing significant heterogeneity and distinct prognostic features,” they wrote.²

Patients with HFmrEF have similar rehospitalization and mortality rates to people with other HF phenotypes, the investigators explained, including a substantially higher risk of adverse outcomes when the patient also has hypertension.¹ Yet, they said there are not yet evidence-based risk-management protocols for this particular subgroup of patients.

One place to look to help create those guidelines might be metabolic risk indicators, they said. TyG-BMI, for instance, offers a strong indication of insulin resistance and has previously been linked with the risk of cardiovascular events. The investigators wondered whether this metric might be a useful tool to enhance risk stratification in patients with HFmrEF. They noted that such an evaluation had not yet been conducted to their knowledge.

The authors decided to look at a cohort of 2550 people with HFmrEF who were hospitalized at a single tertiary healthcare center between 2012 and 2023 with hypertension. They randomly assigned 1785 patients to a training cohort and 765 patients to a validation cohort.

A total of 157 patients (6.16%) died in-hospital, and a multivariate analysis identified old age (≥ 75 years; OR, 2.79; 95% CI, 1.55-5.03), TyG-BMI per 100-unit increase (OR, 4.47; 95% CI, 2.99-6.68), and C-reactive protein ≥ 10 mg/L (OR, 3.83; 95% CI, 1.33-11.03) as the top 3 independent risk factors. Other independent risk factors included N-terminal pro-B-type natriuretic peptide (NT-proBNP) elevation, diabetes, and cerebral infarction.

Protective factors included using angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor-neprilysin inhibitors (ACEI/ARB/ARNI), or using sodium-glucose cotransporter-2 inhibitors (SGLT2i), the authors said.

The investigators also performed a restricted cubic spline (RCS) analysis to better understand the dose-dependent relationship between TyG-BMI and mortality risk. It showed a non-linear relationship between the 2 factors (P for non-linearity < .001), but it also found that patients who had a TyG-BMI above 300 had a sharply increased risk of mortality. They said their model demonstrated good discrimination and calibration for both the training and validation cohorts, suggesting it could provide a meaningful benefit in the clinical setting.

The authors said their findings are important because TyG-BMI can offer a more holistic understanding of risk by incorporating the synergistic cardiovascular risk caused by metabolic syndrome.

“Unlike traditional risk assessment metrics primarily focused on hemodynamic burden, TyG-BMI captures metabolic status and provides complementary information for risk stratification, thereby further improving predictive performance beyond established biomarkers such as NT-proBNP,” the authors wrote.

The investigators said their study suggests TyG-BMI should be incorporated into models used to identify patients with HFmrEF and hypertension who are at the highest risk of in-hospital mortality. Doing so, they said, can help offset the limitations of traditional risk-prediction models. They said further work, including multicenter, prospective studies, should be undertaken to further validate their findings.

References

1. Guo Q, Wei M, Shang S, et al. A novel risk prediction model incorporating triglyceride-glucose-body mass index for in-hospital mortality in hypertensive patients with HFmrEF. Lipids Health Dis. Published online February 11, 2026. doi:10.1186/s12944-026-02886-6

2. Lam CSP, Solomon SD. Classification of Heart Failure According to Ejection Fraction: JACC Review Topic of the Week. J Am Coll Cardiol. 2021;77(25):3217-3225. doi:10.1016/j.jacc.2021.04.070