Aortic coarctation and the retinal microvasculature
Laurianne Le Gloan1, Hadi Chakor1, Lise-Andrée Mercier1
1Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada.
Insights
Adults with repaired aortic coarctation show unique retinal vascular changes, including artery and vein tortuosity that decreases with age. Increased tortuosity is linked to higher cardiovascular risks in older patients.
Area of Science:
- Ophthalmology
- Cardiology
- Vascular Biology
Background:
- Aortic coarctation is linked to generalized vascular disease.
- Retinal vascular patterns in adults with aortic coarctation are not well understood.
- This study investigates retinal vascular changes and their long-term implications.
Purpose of the Study:
- To characterize retinal vascular disease in adults with repaired aortic coarctation.
- To explore age-related effects on these vascular patterns.
- To identify associations between retinal vascular changes and cardiovascular outcomes.
Main Methods:
- Prospective, cross-sectional study of 60 adults with repaired aortic coarctation.
- Data collection included questionnaires, imaging, laboratory tests, and nonmydriatic digital funduscopy.
- Retinal images were analyzed for arterial and venous tortuosity.
Main Results:
- No hypertensive retinopathy was observed.
- A distinct pattern of bilateral, symmetric arterial and venous tortuosity was found in most patients.
- Arterial tortuosity decreased with age and was associated with increased cardiovascular risk in patients 45 years and older. Venous tortuosity also correlated with cardiovascular complications.
Conclusions:
- Repaired aortic coarctation is associated with a unique retinal vascular pattern of increased arterial and venous tortuosity.
- This tortuosity diminishes with age.
- Elevated tortuosity, particularly in older adults, predicts adverse cardiovascular outcomes.
Background:
Aortic coarctation has been associated with generalized vascular disease, yet little is known about retinal vascular patterns and their changes over time.
Objectives:
The aim of this study is to characterize the nature and extent of retinal vascular disease in adults with aortic coarctation, and explore age-related effects and associations with cardiovascular outcomes.
Methods:
A prospective cross-sectional seroepidemiological study was conducted on 60 consecutive adults with repaired aortic coarctation, age 42.4±14.1 years, 61.7% male. In addition to detailed questionnaires, imaging studies, and laboratory testing, high-quality retinal images were acquired by 45° nonmydriatic digital funduscopy.
Results:
No patient had evidence of hypertensive retinopathy. A distinctive vascular pattern characterized by bilaterally symmetric tortuosity of retinal arteries and veins was observed. Arterial tortuosity was abnormal in 98.3% of patients and decreased with age (P=0.0005). In patients≥45 years, a 1-point increase in the arterial tortuosity score was associated with a 1.5-fold higher risk of cardiovascular complications (i.e., acute coronary syndrome, stroke, cerebral aneurysm, aortic dissection/rupture) [odds ratio 1.50, 95% CI (1.01, 2.24), P=0.0496]. Abnormal venous tortuosity was present in 75.0% of patients and non-significantly correlated with higher levels of serum inflammatory markers (C-reactive protein, fibrinogen, interleukin-6, and tumor necrosis factor-alpha). A higher venous tortuosity score was likewise associated with an increased risk of cardiovascular complications [odds ratio 1.86, 95% CI (1.03, 3.35), P=0.0392].
Conclusions:
Adults with repaired aortic coarctation exhibit a unique retinal vascular pattern characterized by excessive arterial and venous tortuosity that regresses with age. Greater tortuosity is associated with adverse cardiovascular outcomes in patients≥45 years.
