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The Impact of Chronic Heart Failure on Retinal Vessel Density Assessed by Optical Coherence Tomography Angiography in
Klaudia Rakusiewicz1, Krystyna Kanigowska1, Wojciech Hautz1
1Department of Ophthalmology, Children's Memorial Health Institute, 04-730 Warsaw, Poland.
Insights
Children with chronic heart failure (CHF) show reduced retinal vessel density (VD) in the superficial capillary plexus (SP) layer. Optical coherence tomography angiography (OCTA) may aid in diagnosing pediatric CHF due to dilated cardiomyopathy (DCM).
Area of Science:
- Ophthalmology and Cardiology
- Medical Imaging and Diagnostics
Background:
- Chronic heart failure (CHF) in children, often due to dilated cardiomyopathy (DCM), can lead to systemic complications.
- Assessing microvascular changes in pediatric CHF is crucial for understanding disease progression and potential diagnostic markers.
- Optical coherence tomography angiography (OCTA) offers a non-invasive method to visualize retinal microvasculature.
Purpose of the Study:
- To evaluate retinal vessel density (VD) in the superficial capillary plexus (SP) and deep capillary plexus (DP) layers in children with CHF due to DCM.
- To compare OCTA findings between children with CHF and a healthy control group.
- To explore the potential of OCTA as a diagnostic tool for pediatric CHF.
Main Methods:
- Thirty children with CHF (due to DCM, LVEF ≤ 55%) and 30 age/gender-matched controls underwent OCTA.
- OCTA parameters measured included foveal avascular zone (FAZ), superficial and deep vessel densities (wsVD, fsVD, psVD, wdVD, fdVD, pdVD), and retinal thickness (WT, FT, PFT).
- Transthoracic echocardiography (for LVEF) and NT-proBNP levels were assessed.
Main Results:
- Children with CHF exhibited significantly lower superficial capillary plexus (SP) vessel density (wsVD, fsVD, psVD) compared to controls.
- Retinal thickness parameters (WT, FT, PFT) were also significantly reduced in the CHF group.
- No significant differences in deep capillary plexus (DP) VD or FAZ were observed between groups.
Conclusions:
- Significantly decreased retinal VD in the SP layer is observed in children with CHF due to DCM.
- OCTA measurements, particularly SP VD, show potential as a non-invasive diagnostic marker for pediatric CHF.
- Further research with larger cohorts and long-term follow-up is warranted to validate OCTA's role in managing pediatric CHF.
Abstract:
(1) Introduction: The aim of this study is to assess retinal vessel density (VD) in the superficial capillary plexus layer (SP) and deep capillary plexus layer (DP) in children with chronic heart failure (CHF) in the course of dilated cardiomyopathy (DCM) using optical coherence tomography angiography (OCTA). (2) Methods: Thirty children with CHF due to DCM lasting more than six months, with an enlarged left ventricle and impaired left ventricular systolic function (left ventricular ejection fraction (LVEF) ≤ 55%), were enrolled to have both their eyes assessed for this study. Mean age of the children was 9.9 ± 3.57 years. The control group consisted of an additional 30 children without CHF (mean age 11.27 ± 3.33 years) matched for age and gender against the study group. All participants underwent transthoracic echocardiography to measure LVEF using Simpson method. Blood serum was tested for N-terminal-pro-brain natriuretic peptide (NT-proBNP) marker value. All children underwent OCTA with evaluation of the foveal avascular zone (FAZ), whole superficial vessel density (wsVD), foveal superficial vessel density (fsVD), parafoveal superficial vessel density (psVD), whole deep vessel density (wdVD), foveal deep vessel density (fdVD), parafoveal deep vessel density (pdVD), whole thickness (WT), foveal thickness (FT), and parafoveal thickness (PFT). (3) Results: Retinal VD in SP was significantly lower in children with CHF as compared to the controls. The following SP parameters in the study group were statistically significantly lower than these same measurements for the control group. Details, with study group findings quantified first, include wsVD (46.2% vs. 49.83%, p < 0.05), fsVD (18.07% vs. 24.15%, p < 0.05), and psVD (49.24% vs. 52.51%, p < 0.05). The WT (311.03 micrometers (μm) vs. 323.55 μm, p < 0.05), FT (244.57 μm vs. 256.98 μm, p < 0.05), and PFT (320.63 μm vs. 332.02 μm, p < 0.05). No significant differences in DP retinal VD were found between the two groups. No statistically significant differences in the FAZ were found. The fsVD and FT were correlated with biometry and the age of the study participants. There was a correlation between FAZ and FT (p < 0.001). There were no correlations between retinal VD in both plexuses and refractive error, sex, NT-proBNP, and LVEF. (4) Conclusions: In children with CHF in the course of DCM as compared to the control group, significantly decreased retinal VD in SP was observed. The results of our study indicate that measurements of the OCTA may be a useful diagnostic method in children with chronic heart failure, but it is necessary to conduct further studies in larger groups of participants and long-term observation of these patients.
