Cardiovascular

SPISE for predicting the presence of atrial fibrillation in patients with coronary artery disease: a comparative analysis with TyG index.

Zhang M, Wang D, Xiong Z, Qi C • Frontiers in endocrinology • 2026

PubMed 42921267 DOI 10.3389/fendo.2026.1962511
TL;DR

SPISE index represents an independent correlate of prevalent AF in CHD patients, and compared with the TyG index, this convenient insulin sensitivity biomarker possesses superior screening value for identifying CHD individuals with concomitant AF.

Key Findings

Results

SPISE index levels were significantly higher in CHD patients without AF than in those with AF.

  • Intergroup comparison of SPISE index between non-AF and AF groups gave P < 0.001.
  • Patients were stratified into AF and non-AF groups by baseline cardiac rhythm.
  • SPISE and TyG were calculated from baseline clinical and laboratory data.
Results

After full covariate adjustment, SPISE index was independently and inversely associated with prevalent AF in CHD patients.

  • Multivariate logistic regression: OR = 0.627, 95% CI 0.528-0.746, P < 0.001.
  • Univariate and multivariate logistic regression models were used to identify independent correlates of AF.
  • The design was cross-sectional (prevalent AF at baseline), so the association does not establish causation.
Results

The association between SPISE index and AF was nonlinear, with a distinct inflection point.

  • Restricted cubic spline modeling combined with segmented regression identified a significant nonlinear association.
  • The abstract does not report the numerical inflection value.
Results

SPISE index had better discriminative performance for AF than the TyG index, although both were modest.

  • ROC AUC was 0.646 for SPISE index versus 0.566 for TyG index.
  • The AUC difference was statistically significant by DeLong's test.
  • Both AUC values are modest.
Results

The inverse association between SPISE index and prevalent AF was consistent across predefined subgroups.

  • Subgroups: sex, age, smoking status, alcohol consumption, hypertension, diabetes mellitus, and BMI.
  • The inverse correlation remained stable across all strata, indicating no meaningful effect modification.
Conclusions

The authors conclude SPISE has superior screening value over TyG for identifying CHD patients with concomitant AF.

  • SPISE is described as a convenient insulin sensitivity biomarker.
  • Insulin resistance is proposed as a shared pathogenic mediator of CHD and AF.
  • SPISE and TyG are both readily available laboratory surrogates for insulin resistance.

What This Means

This study looked at whether two simple blood-test-based measures of insulin resistance could help identify which patients with coronary heart disease also have atrial fibrillation (AF), an irregular heart rhythm. The two measures were the SPISE index and the triglyceride-glucose (TyG) index. Patients were grouped by whether they had AF at the time of their baseline heart rhythm assessment. Patients without AF had higher SPISE values, which indicate better insulin sensitivity, than those with AF. After accounting for other factors, a higher SPISE index was linked to lower odds of having AF (odds ratio 0.627). The relationship was not a straight line, and the pattern held across subgroups defined by sex, age, smoking, alcohol use, hypertension, diabetes, and body mass index. When the two measures were compared on how well they distinguished patients with AF from those without, SPISE performed better than TyG (AUC 0.646 vs. 0.566), though both were modest. This research suggests SPISE might be a convenient screening aid in people with coronary disease, but it is not accurate enough on its own to diagnose AF. Because the study captured AF at a single point in time, it cannot show that insulin resistance causes AF.

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Citation

Zhang M, Wang D, Xiong Z, Qi C. (2026). SPISE for predicting the presence of atrial fibrillation in patients with coronary artery disease: a comparative analysis with TyG index.. Frontiers in endocrinology. https://doi.org/10.3389/fendo.2026.1962511