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Altered blood vessel responses in the eye and finger in coronary artery disease
Rebekka Heitmar1, Robert P Cubbidge, Gregory Y H Lip
1Aston University, School of Life and Health Sciences, Birmingham, United Kingdom. r.heitmar1@aston.ac.uk
Insights
Coronary artery disease (CAD) is linked to abnormal microvascular function in the retina and nail-fold vessels. Heart rate variability in CAD patients correlates with ocular vessel responses, suggesting a potential surrogate marker.
Area of Science:
- Cardiovascular Medicine
- Ophthalmology
- Vascular Biology
Background:
- Cardiac function, specifically heart rate variability, is known to be altered in coronary artery disease (CAD).
- The relationship between cardiac function and the microvascular function of ocular (retinal) and peripheral (nail-fold) blood vessels in CAD patients remains unclear.
- This study investigates potential differences in microvascular endothelial function between CAD patients and healthy controls.
Purpose of the Study:
- To compare retinal and peripheral microvascular endothelial function with large blood vessel and cardiac function in patients with coronary artery disease (CAD).
- To test the hypothesis that CAD is associated with abnormal retinal and peripheral microvascular endothelial function.
Main Methods:
- Peripheral microcirculatory function was assessed using continuous retinal vessel diameter assessment and nail-fold capillaroscopy.
- Systemic vascular function was evaluated through 24-hour blood pressure monitoring, arterial stiffness measurements, heart rate variability (low and high frequency), ECG, and plasma markers (von Willebrand factor and soluble E selectin).
Main Results:
- Patients with CAD exhibited significantly different nail-fold capillary responses (P = 0.009) and retinal vessel responses (P = 0.034) compared to controls.
- CAD patients showed increased arterial stiffness (P = 0.005), altered heart rate variability (LF: P = 0.004, HF: P = 0.006), and elevated von Willebrand factor levels (P = 0.044).
- In CAD patients, heart rate variability indices (LF and HF) correlated with retinal vessel responses (average baseline corrected flicker response), but not in healthy controls.
Conclusions:
- Microcirculatory abnormalities in the retina and nail-fold vessels are present in patients with coronary artery disease (CAD).
- Heart rate variability indices in CAD patients were found to correlate with ocular vessel responses.
- Ocular vessel response may serve as a surrogate marker for abnormal heart rate variability in the context of CAD.
Purpose:
Cardiac function, such as heart rate variability, is abnormal in coronary artery disease, but its relation with the function of ocular and nail-fold blood vessels is unknown. The hypothesis was that there is abnormal retinal and peripheral microvascular endothelial function compared with large blood vessel and cardiac function. Twenty-four patients with coronary artery disease (CAD) and 30 healthy, age- and sex-matched control subjects were enrolled in the study.
Methods:
Peripheral microcirculatory function was measured with continuous retinal vessel diameter assessment and nail-fold capillaroscopy. Systemic vascular function was evaluated by 24-hour blood pressure, arterial stiffness, low (LF)- and high (HF)-frequency heart rate variability, ECG monitoring, and the plasma markers von Willebrand factor (vWf) and soluble E selectin.
Results:
Peripheral nail-fold capillary (P = 0.009) and retinal vessel (average baseline corrected flicker response [BFR]; P = 0.034) responses and reaction time in response to flicker (P = 0.016) were significantly different in patients compared with controls. Furthermore, patients demonstrated higher arterial stiffness (P = 0.005), LF and HF heart rate variability (P = 0.004, P = 0.006), and vWf level (P = 0.044), but there was no difference in soluble E selectin level (P = 0.278). In the CAD patients, LF and HF heart rate variability both correlated with average BFR (r = 0.58, P = 0.004; r = -0.6, P = 0.003, respectively). There was no such relationship in the healthy controls.
Conclusions:
Microcirculatory abnormalities of the retina and nail-fold vessels are present in CAD. The two indices of heart rate variability correlated with an index of ocular vessel responses. The latter may be a surrogate marker of abnormal heart rate variability in CAD.
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