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Retinal microvascular dysfunction in patients with coronary artery disease with and without heart failure: a
Jens Barthelmes1, Matthias P Nägele1,2, Silviya Cantatore1
1Department of Cardiology, University Hospital Zurich, University Heart Center, Zurich, Switzerland.
Insights
Retinal microvascular function is impaired in coronary artery disease (CAD) patients, with a more significant decline observed in those with ischaemic heart failure (IHF). This suggests a continuum of microvascular damage linked to cardiac function.
Area of Science:
- Ophthalmology
- Cardiology
- Vascular Biology
Background:
- Dynamic retinal vessel analysis offers a non-invasive method to assess microvascular function.
- Coronary artery disease (CAD) affects macrovascular and microvascular systems.
- Ischaemic heart failure (IHF) represents a severe manifestation of CAD-related cardiac dysfunction.
Purpose of the Study:
- To investigate retinal microcirculation impairment in stable CAD patients compared to those with IHF.
- To assess differences in retinal microvascular function between CAD, IHF, and healthy controls (HC).
Main Methods:
- Prospective study of 150 adults assessing micro- and macrovasculature.
- Primary outcome: flicker-induced arterial dilatation (FIDa) in CAD (n=40), IHF (n=40), and HC (n=70) groups.
- Secondary outcomes: arterial stiffness, flow-mediated dilatation, biomarkers, and ergospirometry.
Main Results:
- Patients with CAD showed impaired FIDa, which was more pronounced in IHF patients (CAD: 1.93% vs. IHF: 0.41% vs. HC: 3.69%).
- Increased pulse wave velocity and reduced flow-mediated dilatation were observed in both CAD and IHF groups compared to HC.
- FIDa correlated negatively with N-terminal pro-B-type natriuretic peptide and high-sensitivity troponin T, and positively with metabolic equivalents.
Conclusions:
- Retinal arterial function declines in CAD patients, with a more significant reduction in those with IHF.
- This suggests a continuum of microvascular damage associated with reduced left ventricular ejection fraction.
- Retinal vessel analysis may serve as a potential indicator of systemic microvascular health in cardiovascular disease.
Aims:
Dynamic retinal vessel analysis is a novel, non-invasive method to assess microvascular function. The primary aim of this study was to investigate whether retinal microcirculation is impaired in patients with stable coronary artery disease (CAD) compared to patients with heart failure due to CAD (ischaemic heart failure, IHF).
Methods And Results:
A total of 150 adults were enrolled to prospectively assess micro- and macrovasculature. The pre-defined primary outcome was flicker-induced arterial dilatation (FIDa) in patients with CAD [n = 40; median age 63 years, interquartile range (IQR) 53-70] and IHF (n = 40; median age 63 years, IQR 59-71) compared to healthy controls (HC, n = 70; median age 57 years, IQR 41-69). Secondary outcomes included arterial stiffness, flow-mediated dilatation, biomarkers, and ergospirometry parameters. Patients with CAD demonstrated impairment in FIDa that was even more pronounced in patients with IHF (CAD: 1.93 ± 0.28% vs. IHF: 0.41 ± 0.28%, P < 0.001; FIDa in HC: 3.69 ± 0.21%, both P < 0.001) adjusting for age, sex, concomitant medication, and co-morbidities. While pulse wave velocity was increased and flow-mediated dilatation reduced in CAD and IHF patients (both P < 0.001 compared to HC), neither differed between CAD and IHF patients. N-terminal pro-B-type natriuretic peptide (r = -0.49, P < 0.001,) and high-sensitivity troponin T (r = -0.28, P = 0.003) correlated with FIDa. Intriguingly, mean metabolic equivalents (5.3 ± 2.3 kcal/kg/h, n = 39) showed a positive correlation with FIDa (r = 0.58, P < 0.001).
Conclusion:
This study demonstrates a decline of retinal arterial function in CAD patients that is significantly more pronounced in the presence of reduced left ventricular ejection fraction, suggesting a continuum of microvascular damage.
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