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Total brachial artery reactivity and incident heart failure and heart failure subtypes: multi-ethnic study of atherosclerosis

Heart and Vessels volume 37, pages 411–418 (2022)Cite this article

Abstract

Endothelial dysfunction may be a phenotypic expression of heart failure (HF). Total brachial artery reactivity (TBAR) is a non-invasive measurement of endothelial function that has been associated with increased risk of cardiovascular outcomes. Limited information is currently available on the impact of TBAR on incident HF and its subtypes. The aim of this study was to investigate whether TBAR is associated with overall incident HF, and the two HF subtypes, HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF) in a community-based study. The sample included 5499 participants (45–84 years of age) from the Multi-Ethnic Study of Atherosclerosis who were free of cardiovascular disease at baseline. Brachial artery was imaged via ultrasound after five minutes of cuff occlusion at the right forearm. TBAR was calculated as the difference between maximum and minimum brachial artery diameters following cuff release, divided by the minimum diameter multiplied by 100%. A dichotomous TBAR variable was created based on the median value (below or above 7.9%). Participants with EF ≤ 40% were considered HFrEF and those with EF ≥ 50% were considered HFpEF. Cox proportional hazards regression models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI). Over a mean follow-up period of 12.5 years, incident HF was diagnosed in 250 participants: 98 classified as HFrEF, 106 as HFpEF, and 46 with unknown or borderline EF (41–49%). Crude analysis revealed that those with TBAR below the median had a significantly greater risk of HF (HR 1.46; 95% CI 1.13–1.88, p < 0.01) and HFrEF (HR 1.61; 95% CI 1.07–2.43, p < 0.05). Following adjustment for known HF risk factors (e.g., age, sex, race, blood pressure), the strength of these relationships was attenuated. Borderline significant results were revealed in those with HFpEF (HR 1.43; 95% CI 0.97–2.12, p = 0.06). Kaplan–Meier curves suggest significantly lower risks of developing HF and HFrEF in those with TBAR above the median (log-rank p ≤ 0.05 for both). When examined as a continuous variable, with a cut point of 50% for EF, every 1-standard deviation (9.7%) increase in TBAR resulted in a 19 and 29% decrease in risk of HF (p < 0.05) and HFrEF (p = 0.05), respectively. Lower TBAR values were associated with higher rates of incident HF and HFrEF, suggesting a possible role of endothelial dysfunction in HF pathogenesis. The impact of other known HF risk factors may mediate this relationship, thus further research is warranted.

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Authors and Affiliations

  1. Department of Clinical and Applied Movement Sciences, Brooks College of Health, University of North Florida, 1 UNF Drive/Bldg 39, Jacksonville, FL, 32224-2673, USA

    Daniela Charry, M. Ryan Richardson & James R. Churilla

  2. Department of Health Administration, Brooks College of Health, University of North Florida, 1 UNF Drive/Bldg 39, Jacksonville, FL, 32224-2673, USA

    Jasper Xu

  3. Department of Kinesiology and Health Education, The University of Texas at Austin, San Jacinto Blvd/Bellmont Hall 822F, 2109, Austin, TX, 78712, USA

    Hirofumi Tanaka

  4. Department of Exercise Science, Syracuse University, 900 South Crouse Ave/210B Women’s Building, Syracuse, NY, 13244, USA

    Kevin S. Heffernan

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  1. Daniela Charry
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  2. Jasper Xu
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Charry, D., Xu, J., Tanaka, H. et al. Total brachial artery reactivity and incident heart failure and heart failure subtypes: multi-ethnic study of atherosclerosis. Heart Vessels 37, 411–418 (2022). https://doi.org/10.1007/s00380-021-01933-9

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  • DOI: https://doi.org/10.1007/s00380-021-01933-9

Keywords

  • Endothelial dysfunction
  • Heart failure
  • HFrEF
  • HFpEF

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