Joint assessment of metabolic and functional indices for coronary burden: a real-world study in patients undergoing angiography for chest pain
Objective To investigate the associations of composite glucose–lipid metabolic indices and echocardiographic parameters with coronary heart disease (CHD), and to determine whether integrating metabolic burden and cardiac function could improve pre-angiographic risk stratification and reflect coronary lesion severity. Methods This cross-sectional study consecutively enrolled 1,061 patients with chest pain who underwent coronary angiography at the First Hospital of Shanxi Medical University. CHD was defined as ≥50% stenosis in at least one major epicardial coronary artery. Composite metabolic indices, including the triglyceride-glucose index (TyG), TyG-BMI, METS-IR, atherogenic index of plasma, remnant cholesterol, and lipoprotein combine index, were evaluated together with echocardiographic parameters. Multivariable logistic regression was used to identify independent correlates of CHD. Tertile analysis and restricted cubic spline models were applied to assess dose-response patterns and potential non-linearity. ROC curves were used to compare discriminatory ability, and Spearman's correlation together with the Gensini score was used to evaluate coronary atherosclerotic burden. Results Among 1,061 participants, 522 had CHD. After multivariable adjustment, TyG (OR = 1.588, 95% CI: 1.269–1.995) and left ventricular ejection fraction (LVEF; OR = 0.958, 95% CI: 0.943–0.973) remained the two strongest independent indicators of CHD (both P < 0.001). TyG showed an approximately linear positive association with CHD risk, whereas LVEF showed a non-linear inverse association. Adding both measures to the base clinical model increased the AUC from 0.655 to 0.694, with decision-curve analysis indicating a modest incremental net benefit, although overall discrimination remained moderate. The high-TyG/low-LVEF group had the highest estimated CHD probability and greatest angiographic disease burden, as quantified by the Gensini score. Conclusion TyG and LVEF are routinely available, complementary measures of metabolic burden and systolic function. Both were independently associated with angiographically defined CHD, while the high-TyG/low-LVEF phenotype showed greater coronary burden. Their joint assessment modestly improved discrimination and may inform exploratory pre-angiographic evaluation in chest-pain patients.