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Updated: Jun 17, 2026

Fundus Photography as a Convenient Tool to Study Microvascular Responses to Cardiovascular Disease Risk Factors in Epidemiological Studies
Published on: October 22, 2014
Microvascular retinal changes in patients presenting with acute coronary syndromes
S Kralev1, E Zimmerer, P Buchholz
11(st) Medical Department, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany. stefan.kralev@umm.de
Insights
Patients with acute coronary syndromes (ACS) show more retinal microaneurysms and dot bleedings compared to stable coronary artery disease (CAD). Retinal examination may aid in assessing cardiovascular risk profiles.
Area of Science:
- Ophthalmology
- Cardiology
- Vascular Medicine
Background:
- Retinal microvascular changes are known predictors of cardiovascular outcomes.
- The specific retinal manifestations in patients with acute coronary syndromes (ACS) versus stable coronary artery disease (CAD) require further elucidation.
Purpose of the Study:
- To investigate and compare the prevalence of specific retinal changes in patients with ACS and stable CAD.
- To assess the potential role of retinal fundus examination in identifying patients at higher cardiovascular risk.
Main Methods:
- Retinal fundus photography was performed within 48 hours post-coronary angiography in 43 ACS patients and 19 stable CAD patients.
- Assessment included retinopathy, arteriolar narrowing, and arterio-venous ratio (AVR).
- Clinical and laboratory cardiovascular risk factors were systematically recorded.
Main Results:
- Patients with ACS exhibited a significantly higher incidence of retinal microaneurysms and dot bleedings compared to stable CAD patients (40% vs. 5%, p=0.006).
- This association remained significant after multivariate analysis (OR 20.5, p=0.019).
- While arteriovenous nicking was more frequent in CAD patients, this finding lacked statistical significance post-multivariate analysis.
Conclusions:
- Acute coronary syndrome patients more frequently present with specific retinal findings like dot bleedings and microaneurysms.
- Retinal fundus examination shows promise as a tool to augment cardiovascular risk stratification.
- These findings suggest enhanced patient monitoring and care for individuals identified through retinal assessment.
Background:
Retinal microvascular changes predict cardiovascular morbidity and mortality independent of classical risk factors. However, it is unclear which retinal changes characterize patients with established coronary artery disease (CAD), and in particular, with acute coronary syndromes (ACS). The aim of the present preliminary study was to assess retinopathy in these patients.
Methods:
43 consecutive patients with ACS and 19 consecutive patients with stable CAD were investigated. Among the patient group with ACS, 20 patients presented with ST-Elevation Myocardial Infarction (STEMI) and 23 patients presented with Non-STEMI (NSTEMI). Standardized protocols were used and retinal fundus photography was taken within 48 h post-coronary angiography to assess retinopathy and general arteriolar narrowing as arterio-venous ratio (AVR). Clinical and laboratory cardiovascular risk factors were recorded.
Results:
Despite comparable age and comparable frequency of diabetes and hypertension, patients with ACS had a much higher likelihood for retinal microaneurysms and dot bleedings than patients with stable CAD (17 (40%) vs. 1 (5%) patients, OR 11.77; 95%CI 1.43-96.59; p=0.006). Performing multivariate analysis, this association remains significant (OR 20.5, 95%CI 1.6-255, p=0.019). CAD patients presented more often with focal signs of arteriovenous nicking / focal vasoconstriction (10 (53%) vs. 9 (21%) patients, OR 4.2; 95%CI 1.31-13.4; p=0.018), however after multivariate analysis this association lost significance. The AVR was comparably low in both groups.
Conclusion:
Patients with ACS present more often with dot bleedings and microaneurysms. These findings provide preliminary evidence that retinal fundus examination may be useful to contribute to the risk profile of patients, enabling a more intensive survey and care.
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