{
  "abstract": "Objective: Heart failure (HF) patients with type 2 diabetes mellitus (T2DM) are at high risk of short-term major adverse cardiovascular events (MACE). Insulin resistance (IR) is a key shared mechanism, yet simple prognostic markers remain limited. This multicenter retrospective cohort study compared three IR surrogate indices (SPISE-IR, METs-IR, and TyG) for predicting 18-month post-discharge MACE in hospitalized HF-T2DM patients, aiming to identify practical tools for risk stratification.\n\nMethods: A total of 477 hospitalized HF-T2DM patients from two tertiary hospitals in Zhejiang (2018–2024) were enrolled according to unified criteria. Baseline clinical, laboratory, echocardiographic, and medication data were collected to calculate SPISE-IR, METs-IR, and TyG. The primary outcome was 18-month post-discharge composite MACE. Associations were evaluated using Cox regression and RCS, while predictive performance was assessed by ROC and PR curves, DCA, NRI, IDI, and subgroup analyses.\n\nResults: Of 477 patients, 191 (40.04%) experienced MACE over 18 months, including 3 cardiovascular deaths. Patients with MACE were older, had lower LVEF, worse renal function, and higher NT-proBNP (all p < 0.05). On multivariable analysis, SPISE-IR (HR 9.31, 95% CI 5.96–14.55, p < 0.001) and METs-IR (HR 1.07, 95% CI 1.05–1.09, p < 0.001) were associated with MACE, whereas TyG was not (HR 1.19, 95% CI 0.95–1.49, p = 0.127). SPISE-IR and METs-IR showed significant nonlinear dose–response relationships and yielded AUCs of 0.790 and 0.801, respectively, versus 0.539 for TyG. Higher SPISE-IR and METs-IR quartiles were associated with progressively higher cumulative event risk (log-rank p < 0.001), whereas no significant between-quartile difference was observed for TyG. Adding either index to the baseline model significantly improved NRI and IDI (all p < 0.05); SPISE-IR showed numerically larger NRI and IDI improvements than METs-IR. Subgroup analyses showed a consistent SPISE-IR association, whereas METs-IR exhibited effect modification by age, sex, smoking status, and hypertension; TyG remained largely non-significant. Heart failure rehospitalization accounted for 138 of 191 MACE (72.3%). After exclusion of 24 recurrent-angina events, SPISE-IR (HR 10.83, 95% CI 6.71–17.45) and METs-IR (HR 1.07, 95% CI 1.06–1.09) remained associated with the strict MACE endpoint (both p < 0.001). After 1,000 bootstrap resamples, optimism-corrected AUCs were 0.818 for the clinical + SPISE-IR model and 0.806 for the clinical + METs-IR model. In center-based external validation, their AUCs were 0.804 and 0.806, respectively.\n\nConclusion: SPISE-IR and METs-IR are associated with 18-month MACE risk in hospitalized HF-T2DM patients and show better predictive performance than TyG. These indices may provide additional value for risk stratification in this population.",
  "abstract_shown": true,
  "affiliations": [
    "Second Affiliated Hospital, Zhejiang Chinese Medical University , ,"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Haoxuan Deng"
    },
    {
      "affs": [
        0
      ],
      "name": "Qiyue Zhu"
    },
    {
      "affs": [
        0
      ],
      "name": "Changjin Lin"
    },
    {
      "affs": [
        0
      ],
      "name": "Wei Qiu"
    },
    {
      "affs": [
        0
      ],
      "name": "Yunyan Zhang"
    },
    {
      "affs": [
        0
      ],
      "name": "Junyi Hua"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/7qbcvhp2jpcnf.bib",
  "cited_by": 0,
  "doi": "10.3389/fnut.2026.1938459",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13719381/?tool=EBI",
  "id": "7qbcvhp2jpcnf",
  "issns": [
    "2296-861X"
  ],
  "landing_url": "https://europepmc.org/article/PMC/PMC13719381",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Original Research"
    ],
    [
      "openalex",
      "2705|Heart Failure Treatment and Management"
    ]
  ],
  "openalex": "W7222425120",
  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13719381/pdf/?tool=EBI",
  "pmcid": "PMC13719381",
  "pmid": "42964174",
  "published": "2026-10-16",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/7qbcvhp2jpcnf.ris",
  "sources": [
    {
      "first_seen": "2026-10-31T12:21:36Z",
      "native_id": "PMC:PMC13719381",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13719381"
    },
    {
      "first_seen": "2026-11-02T12:23:21Z",
      "native_id": "PMC13719381",
      "source": "pmc",
      "url": "https://doi.org/10.3389/fnut.2026.1938459"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2705|Heart Failure Treatment and Management",
      "subfield": "cardiovascular"
    }
  ],
  "title": "Study on the correlation between SPISE-IR, METs-IR, TyG and short-term adverse cardiovascular events in patients with heart failure and diabetes mellitus",
  "title_text": "Study on the correlation between SPISE-IR, METs-IR, TyG and short-term adverse cardiovascular events in patients with heart failure and diabetes mellitus",
  "type": "peer-reviewed",
  "updated_at": "2026-11-03T12:20:27Z",
  "url": "https://research.draconitic.com/paper/7qbcvhp2jpcnf",
  "venue": "Frontiers in nutrition",
  "versions": []
}