The Triglycerides, Total Cholesterol and Body Weight Index (TCBI) in acute heart failure - a post-hoc analysis of a prospective cohort study

BACKGROUND AND AIMS: The triglycerides, total cholesterol and body weight index (TCBI) is a novel nutritional marker that has shown prognostic value in various cardiovascular conditions, with low TCBI indicating poor nutritional status and being associated with adverse outcomes. However, limited data exist on the relationship between TCBI and cardiac function and outcomes in patients hospitalized with acute heart failure (AHF). This study aimed to investigate whether low TCBI is associated with impaired cardiac function and adverse outcomes in AHF.

METHODS AND RESULTS: We performed a post-hoc analysis of a prospective, dual-center observational cohort study of patients admitted with AHF (2022-2024). Transthoracic echocardiography, lung ultrasound and laboratory testing were performed shortly after admission. Outcomes evaluated were all-cause mortality and the composite of all-cause mortality or heart failure (HF) readmission. Unadjusted and adjusted Cox regression and Fine-Gray analyses were conducted to assess the relationship between TCBI and outcomes. The study included 487 patients, stratified into TCBI tertiles (T1: TCBI<949.6, T2: 949.6≤TCBI≤1690, T3: TCBI>1690). Low TCBI was associated with echocardiographic signs of higher filling pressures, impaired right ventricular function, higher pulmonary pressure and more B-lines on LUS. Low TCBI was associated with a higher risk of all-cause mortality compared with moderate TCBI (T1 vs T2: HR 1.54, 95 % CI [1.06-2.24], p = 0.024). Low TCBI was not independently associated with HF readmission and the composite of all-cause mortality or HF readmission.

CONCLUSION: Low TCBI is associated with greater signs of congestion and increased all-cause mortality risk.