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.

内皮功能障碍可能是心力衰竭 (HF) 的表型表达。肱动脉总反应性 (TBAR) 是一种内皮功能的非侵入性测量，与心血管结局风险增加有关。目前关于 TBAR 对 HF 事件及其亚型的影响的信息有限。本研究的目的是在一项基于社区的研究中调查 TBAR 是否与整体发生的 HF 以及两种 HF 亚型，射血分数降低的 HF (HFrEF) 和射血分数保留的 HF (HFpEF) 相关。该样本包括来自动脉粥样硬化多种族研究的 5499 名参与者（45-84 岁），他们在基线时没有心血管疾病。在右前臂袖带闭塞五分钟后，通过超声对肱动脉进行成像。TBAR 计算为袖带释放后最大和最小肱动脉直径之差除以最小直径乘以 100%。基于中值（低于或高于 7.9%）创建了一个二分 TBAR 变量。EF ≤ 40% 的参与者被认为是 HFrEF，而 EF ≥ 50% 的参与者被认为是 HFpEF。Cox 比例风险回归模型用于计算风险比 (HR) 和 95% 置信区间 (CI)。在 12.5 年的平均随访期内，250 名参与者被诊断为 HF：98 名被归类为 HFrEF，106 名被归类为 HFpEF，46 名 EF 未知或临界 (41-49%)。粗略分析显示，TBAR 低于中位数的患者发生 HF 的风险显着增加（HR 1.46；95% CI 1.13–1.88，基于中值（低于或高于 7.9%）创建了一个二分 TBAR 变量。EF ≤ 40% 的参与者被认为是 HFrEF，而 EF ≥ 50% 的参与者被认为是 HFpEF。Cox 比例风险回归模型用于计算风险比 (HR) 和 95% 置信区间 (CI)。在 12.5 年的平均随访期内，250 名参与者被诊断为 HF：98 名被归类为 HFrEF，106 名被归类为 HFpEF，46 名 EF 未知或临界 (41-49%)。粗略分析显示，TBAR 低于中位数的患者发生 HF 的风险显着增加（HR 1.46；95% CI 1.13–1.88，基于中值（低于或高于 7.9%）创建了一个二分 TBAR 变量。EF ≤ 40% 的参与者被认为是 HFrEF，而 EF ≥ 50% 的参与者被认为是 HFpEF。Cox 比例风险回归模型用于计算风险比 (HR) 和 95% 置信区间 (CI)。在 12.5 年的平均随访期内，250 名参与者被诊断为 HF：98 名被归类为 HFrEF，106 名被归类为 HFpEF，46 名 EF 未知或临界 (41-49%)。粗略分析显示，TBAR 低于中位数的患者发生 HF 的风险显着增加（HR 1.46；95% CI 1.13–1.88，Cox 比例风险回归模型用于计算风险比 (HR) 和 95% 置信区间 (CI)。在 12.5 年的平均随访期内，250 名参与者被诊断为 HF：98 名被归类为 HFrEF，106 名被归类为 HFpEF，46 名 EF 未知或临界 (41-49%)。粗略分析显示，TBAR 低于中位数的患者发生 HF 的风险显着增加（HR 1.46；95% CI 1.13–1.88，Cox 比例风险回归模型用于计算风险比 (HR) 和 95% 置信区间 (CI)。在 12.5 年的平均随访期内，250 名参与者被诊断为 HF：98 名被归类为 HFrEF，106 名被归类为 HFpEF，46 名 EF 未知或临界 (41-49%)。粗略分析显示，TBAR 低于中位数的患者发生 HF 的风险显着增加（HR 1.46；95% CI 1.13–1.88，p  < 0.01) 和 HFrEF (HR 1.61; 95% CI 1.07–2.43, p  < 0.05)。在对已知的 HF 风险因素（例如，年龄、性别、种族、血压）进行调整后，这些关系的强度减弱了。HFpEF 患者显示临界显着结果（HR 1.43；95% CI 0.97–2.12，p  = 0.06）。Kaplan-Meier 曲线表明 TBAR 高于中位数的患者发生 HF 和 HFrEF 的风险显着降低（两者的对数秩p  ≤ 0.05）。当作为一个连续变量检查时，EF 的切点为 50%，TBAR 每增加 1 个标准差 (9.7%) 导致 HF ( p  < 0.05) 和 HFrEF ( p = 0.05），分别。较低的 TBAR 值与较高的 HF 和 HFrEF 发生率相关，表明内皮功能障碍可能在 HF 发病机制中发挥作用。其他已知 HF 风险因素的影响可能会调节这种关系，因此需要进一步研究。