{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T16:38:31Z","timestamp":1783528711370,"version":"3.55.0"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T00:00:00Z","timestamp":1780876800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The C-reactive protein-triglyceride-glucose index (CTI) is a novel biomarker integrating inflammation and insulin resistance. Its prognostic value for all-cause mortality in patients with chronic heart failure (CHF) across the ejection fraction (EF) spectrum remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients were categorized into low- and high-CTI groups based on a restricted cubic spline-derived cutoff. Kaplan\u2013Meier curves were used to compare survival, and Cox proportional hazards models were used to assess the association between CTI and all-cause mortality. Receiver operating characteristic (ROC) analysis and subgroup analyses were performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 1,130 patients with CHF were included. Kaplan\u2013Meier survival analysis showed that patients with elevated CTI levels had a significantly higher risk of all-cause mortality compared to those with lower CTI levels. Multivariable-adjusted Cox proportional hazards analysis further confirmed that CTI levels were independently associated with increased all-cause mortality. Subgroup analysis demonstrated that elevated CTI levels were associated with higher all-cause mortality in patients with heart failure with reduced ejection fraction (HFrEF) and mildly reduced ejection fraction (HFmrEF).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>CTI is an independent prognostic marker for all-cause mortality in patients with CHF across different EF subtypes and may serve as a useful risk stratification biomarker.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1808481","type":"journal-article","created":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T05:36:22Z","timestamp":1780896982000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["The influence of C-reactive protein-triglyceride-glucose index (CTI) on the prognosis of heart failure patients with different ejection fractions"],"prefix":"10.3389","volume":"13","author":[{"given":"Xinuo","family":"Ma","sequence":"first","affiliation":[{"name":"Department of Cardiology, First Affiliated Hospital of Kunming Medical University","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Pathogenic Biology and Immunology, Kunming Medical University","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dajin","family":"Liu","sequence":"additional","affiliation":[{"name":"Medical Records and Statistics Department, First Affiliated Hospital of Kunming Medical University","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Li","sequence":"additional","affiliation":[{"name":"Internal Medicine Department for Officials, First Affiliated Hospital of Kunming Medical University","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ping","family":"Xia","sequence":"additional","affiliation":[{"name":"Department of Cardiology, First Affiliated Hospital of Kunming Medical University","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunyun","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, First Affiliated Hospital of Kunming Medical University","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Han","family":"Xia","sequence":"additional","affiliation":[{"name":"Department of Cardiology, First Affiliated Hospital of Kunming Medical University","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yujuan","family":"Peng","sequence":"additional","affiliation":[{"name":"Department of Cardiology, First Affiliated Hospital of Kunming Medical University","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lixing","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, First Affiliated Hospital of Kunming Medical University","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,8]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1186\/s40364-025-00728-8","article-title":"Global, regional, and national burden of heart failure and its underlying causes, 1990\u20132021: results from the global burden of disease study 2021","volume":"13","author":"Ran","year":"2025","journal-title":"Biomark Res"},{"key":"B2","doi-asserted-by":"publisher","first-page":"717","DOI":"10.1038\/s41569-024-01046-6","article-title":"Global epidemiology of heart failure","volume":"21","author":"Khan","year":"2024","journal-title":"Nat Rev Cardiol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"e008406","DOI":"10.1161\/CIRCHEARTFAILURE.121.008406","article-title":"Prevalence and incidence of heart failure among urban patients in China: a national population-based analysis","volume":"14","author":"Wang","year":"2021","journal-title":"Circ Heart Fail"},{"key":"B4","doi-asserted-by":"publisher","author":"McDonagh","year":"","DOI":"10.1093\/eurheartj\/ehad195"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1324","DOI":"10.1016\/j.jacc.2020.01.014","article-title":"Inflammation in heart failure: JACC state-of-the-art review","volume":"75","author":"Murphy","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1007\/s11306-021-01837-9","article-title":"The verification of the reliability of a triglyceride-glucose index and its availability as an advanced tool","volume":"17","author":"Jeong","year":"2021","journal-title":"Metabolomics"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1151","DOI":"10.1161\/CIRCRESAHA.116.306206","article-title":"Insulin signaling and heart failure","volume":"118","author":"Riehle","year":"2016","journal-title":"Circ Res"},{"key":"B8","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1093\/cvr\/cvn093","article-title":"Insulin signalling in the heart","volume":"79","author":"Bertrand","year":"2008","journal-title":"Cardiovasc Res"},{"key":"B9","doi-asserted-by":"publisher","first-page":"E781","DOI":"10.1152\/ajpendo.00573.2003","article-title":"Insulin stimulates fatty acid transport by regulating expression of FAT\/CD36 but not FABPpm","volume":"287","author":"Chabowski","year":"2004","journal-title":"Am J Physiol Endocrinol Metab"},{"key":"B10","doi-asserted-by":"publisher","first-page":"2191","DOI":"10.1161\/01.CIR.0000127959.28627.F8","article-title":"Effect of obesity and insulin resistance on myocardial substrate metabolism and efficiency in young women","volume":"109","author":"Peterson","year":"2004","journal-title":"Circulation"},{"key":"B11","doi-asserted-by":"publisher","first-page":"664","DOI":"10.1056\/NEJMoa031314","article-title":"Impaired mitochondrial activity in the insulin-resistant offspring of patients with type 2 diabetes","volume":"350","author":"Petersen","year":"2004","journal-title":"N Engl J Med"},{"key":"B12","doi-asserted-by":"publisher","first-page":"851941","DOI":"10.3389\/fendo.2022.851941","article-title":"Endothelial dysfunction and diabetic cardiomyopathy","volume":"13","author":"Wang","year":"2022","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B13","doi-asserted-by":"publisher","first-page":"2453","DOI":"10.1161\/01.CIR.98.22.2453","article-title":"Insulin induces upregulation of vascular AT1 receptor gene expression by posttranscriptional mechanisms","volume":"98","author":"Nickenig","year":"1998","journal-title":"Circulation"},{"key":"B14","doi-asserted-by":"publisher","first-page":"172","DOI":"10.2174\/187152909789007034","article-title":"Role of PI3K\/AKT, cPLA2 and ERK1\/2 signaling pathways in insulin regulation of vascular smooth muscle cells proliferation","volume":"9","author":"Isenovi\u0107","year":"2009","journal-title":"Cardiovasc Hematol Disord Drug Targets"},{"key":"B15","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1186\/1475-2840-9-63","article-title":"Insulin resistance and glycemic abnormalities are associated with deterioration of left ventricular diastolic function: a cross-sectional study","volume":"9","author":"Dinh","year":"2010","journal-title":"Cardiovasc Diabetol"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1015","DOI":"10.1002\/ejhf.317","article-title":"Insulin resistance in heart failure: differences between patients with reduced and preserved left ventricular ejection fraction","volume":"17","author":"Scherbakov","year":"2015","journal-title":"Eur J Heart Fail"},{"key":"B17","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1016\/j.jcmg.2016.02.033","article-title":"Association of insulin resistance and glycemic metabolic abnormalities with LV structure and function in middle age: the CARDIA study","volume":"10","author":"Kishi","year":"2016","journal-title":"JACC Cardiovasc Imaging"},{"key":"B18","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1373\/clinchem.2008.108886","article-title":"The evolving role of C-reactive protein in atherothrombosis","volume":"55","author":"Devaraj","year":"2009","journal-title":"Clin Chem"},{"key":"B19","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1038\/s41569-019-0315-x","article-title":"Reappraising the role of inflammation in heart failure","volume":"17","author":"Adamo","year":"2020","journal-title":"Nat Rev Cardiol"},{"key":"B20","doi-asserted-by":"publisher","first-page":"414","DOI":"10.1016\/j.jacc.2023.05.035","article-title":"C-reactive protein and risk of incident heart failure in patients with cardiovascular disease","volume":"82","author":"Burger","year":"2023","journal-title":"J Am Coll Cardiol"},{"key":"B21","doi-asserted-by":"publisher","first-page":"913","DOI":"10.1161\/01.CIR.0000029802.88087.5E","article-title":"A self-fulfilling prophecy: C-reactive protein attenuates nitric oxide production and inhibits angiogenesis","volume":"106","author":"Verma","year":"2002","journal-title":"Circulation"},{"key":"B22","doi-asserted-by":"publisher","first-page":"318","DOI":"10.1016\/j.atherosclerosis.2008.02.034","article-title":"Impaired endothelial function in C-reactive protein overexpressing mice","volume":"201","author":"Teoh","year":"2008","journal-title":"Atherosclerosis"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1486","DOI":"10.1161\/01.CIR.0000057810.48709.F6","article-title":"Inflammatory markers and risk of heart failure in elderly subjects without prior myocardial infarction: the Framingham Heart study","volume":"107","author":"Vasan","year":"2003","journal-title":"Circulation"},{"key":"B24","doi-asserted-by":"publisher","first-page":"410","DOI":"10.1186\/s12933-025-02960-w","article-title":"The relationship between C-reactive protein-triglyceride-glucose index and cardiovascular disease: insights from the China health and retirement longitudinal study (CHARLS)","volume":"24","author":"Zhang","year":"2025","journal-title":"Cardiovasc Diabetol"},{"key":"B25","doi-asserted-by":"publisher","author":"Reinhardt","year":"","DOI":"10.3390\/jcm13175151"},{"key":"B26","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1186\/s12933-022-01658-7","article-title":"Triglyceride-glucose index and the risk of heart failure: evidence from two large cohorts and a Mendelian randomization analysis","volume":"21","author":"Li","year":"2022","journal-title":"Cardiovasc Diabetol"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.3390\/jcm15041660","article-title":"Pan-immune-inflammatory value (PIV) and HALP score as independent prognostic indicators in acute coronary syndrome patients","author":"Eyiol","year":"2026","journal-title":"J Clin Med"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.3390\/biomedicines14020483","article-title":"Aortic elastic properties and albumin-based inflammatory indices in dyspneic third-trimester pregnant women: a prospective observational study","author":"Ertekin","year":"2026","journal-title":"Biomedicines"},{"key":"B29","doi-asserted-by":"publisher","first-page":"905266","DOI":"10.3389\/fendo.2022.905266","article-title":"A novel inflammation and insulin resistance related indicator to predict the survival of patients with cancer","volume":"13","author":"Ruan","year":"2022","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B30","doi-asserted-by":"publisher","first-page":"890","DOI":"10.1186\/s12888-024-06336-4","article-title":"Association between C-reactive protein-triglyceride glucose index and depressive symptoms in American adults: results from the NHANES 2005 to 2010","volume":"24","author":"Huang","year":"2024","journal-title":"BMC Psychiatry"},{"key":"B31","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1186\/s12933-025-02835-0","article-title":"Association of C-reactive protein-triglyceride glucose index with the incidence and mortality of cardiovascular disease: a retrospective cohort study","volume":"24","author":"Sun","year":"2025","journal-title":"Cardiovasc Diabetol"},{"key":"B32","doi-asserted-by":"publisher","first-page":"102476","DOI":"10.1016\/j.jacadv.2025.102476","article-title":"Heart failure with mildly reduced ejection fraction: a call for a precision medicine approach","volume":"5","author":"Wu","year":"2026","journal-title":"JACC Adv"},{"key":"B33","doi-asserted-by":"publisher","first-page":"2336","DOI":"10.1002\/ehf2.13921","article-title":"Five-year mortality of heart failure with preserved, mildly reduced, and reduced ejection fraction in a 4880 Chinese cohort","volume":"9","author":"Chen","year":"2022","journal-title":"ESC Heart Fail"},{"key":"B34","doi-asserted-by":"publisher","first-page":"2476","DOI":"10.1016\/j.jacc.2017.08.074","article-title":"Heart failure with preserved, borderline, and reduced ejection fraction: 5-year outcomes","volume":"70","author":"Shah","year":"2017","journal-title":"J Am Coll Cardiol"},{"key":"B35","doi-asserted-by":"publisher","first-page":"651","DOI":"10.1002\/ejhf.1091","article-title":"Predictors and outcomes of heart failure with mid-range ejection fraction","volume":"20","author":"Bhambhani","year":"2017","journal-title":"Eur J Heart Fail"},{"key":"B36","doi-asserted-by":"publisher","first-page":"43","DOI":"10.36628\/ijhf.2025.0061","article-title":"Acute heart failure across the ejection fraction Spectrum: phenotypes, management, and outcomes from nationwide KorHF III registry","volume":"8","author":"Lee","year":"2025","journal-title":"Int J Heart Fail"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1808481\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T05:36:25Z","timestamp":1780896985000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1808481\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,8]]},"references-count":36,"alternative-id":["10.3389\/fcvm.2026.1808481"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2026.1808481","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,8]]},"article-number":"1808481"}}