Relationship between retinal arteriolar narrowing and myocardial perfusion: multi-ethnic study of atherosclerosis

Retinal arteriolar narrowing is a marker of chronic hypertension. Myocardial perfusion reflects microvascular processes in the heart. The relationship between these 2 measures has not been studied previously and is examined in 212 men and women aged 45 to 84 years and free of cardiovascular disease diagnoses. Retinal caliber was measured through fundus photography and presented as central retinal arteriolar and venular caliber equivalents. Myocardial blood flow was measured using MRI during rest and adenosine-induced hyperemia. Among subjects with no coronary artery calcification (n=98), smaller retinal arteriolar caliber was associated with lower hyperemic myocardial blood flow and perfusion reserve (calculated as the ratio of hyperemic:resting blood flow). Mean hyperemic blood flow (3.43, 3.28, 3.26, and 3.09 mL/min per gram; P(linear)=0.006) and mean perfusion reserve (3.52, 3.37, 3.19, and 3.10; P(linear)=0.01) progressively decreased across decreasing quartiles of retinal arteriolar caliber. These associations remained significant after adjusting for age, gender, and race/ethnicity but were no longer significant after additionally adjusting for other cardiovascular risk factors. In contrast, among subjects with coronary calcification (n=114), retinal arteriolar caliber was not associated with hyperemic myocardial blood flow (P(linear)=0.73) or perfusion reserve (P(linear)=0.79). There were no associations between retinal venular caliber and perfusion measurements. We conclude that narrower retinal arterioles were associated with lower hyperemic myocardial blood flow and perfusion reserve in asymptomatic adults with no coronary calcification, which is partially mediated by traditional cardiovascular risk factors. This finding suggests that retinal arteriolar narrowing may serve as a marker of coronary microvascular disease.