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Published on: October 22, 2014
Identification of Subclinical Microvascular Biomarkers in Coronary Heart Disease in Retinal Imaging
Julia Aschauer1,2, Stefan Aschauer3, Andreas Pollreisz1,2
1Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria.
Insights
Retinal microvascular imaging can detect subclinical signs of coronary heart disease (CHD). This non-invasive approach may help identify individuals at risk for cardiovascular disease, aiding in early diagnosis and management.
Area of Science:
- Ophthalmology
- Cardiology
- Medical Imaging
Background:
- Coronary heart disease (CHD) is a leading global cause of mortality.
- Early detection of CHD risk factors is crucial for effective cardiovascular disease management.
- Non-invasive imaging techniques offer potential for early disease identification.
Purpose of the Study:
- To investigate the utility of multimodal retinal imaging in identifying microvascular features associated with coronary angiography (CA)-confirmed CHD.
- To define subclinical retinal microvascular changes in patients with and without CHD.
Main Methods:
- Prospective, cross-sectional pilot study involving adult patients undergoing elective CA for suspected CHD.
- Utilized widefield fundus photography, optical coherence tomography angiography (OCTA), and adaptive optics imaging.
- Measured retinal vessel density (VD), arteriolar lumen diameter (LD), total diameter (TD), and wall-to-lumen ratio (WLR).
Main Results:
- 45 patients included; 27 confirmed with CHD.
- Prevalent retinal pathologies included arteriovenous nickings, arterial narrowings, and microaneurysms.
- Lower VD in superficial, deep, and choriocapillaris plexuses observed in CHD patients; a trend toward higher WLR in CHD patients was noted.
Conclusions:
- High-resolution retinal microvascular phenotyping may serve as a valuable subclinical indicator of coronary artery impairment in cardiovascular risk populations.
- Larger clinical trials are necessary to validate these findings.
- Subclinical retinal changes can act as non-invasive biomarkers for CHD risk stratification.
Purpose:
Cardiovascular disease and foremost coronary heart disease (CHD) are the worldwide leading causes of death. The aim of this study was to use non-invasive, multimodel retinal imaging to define microvascular features in patients with and without coronary angiography (CA)-confirmed CHD.
Methods:
In this prospective, cross-sectional pilot study we included adult patients who presented to a tertiary referral center for elective CA due to suspected CHD. All patients underwent widefield fundus photography for retinopathy grading. Optical coherence tomography angiography was used to measure vessel density (VD) of the individual capillary plexuses in 6 × 6-mm macular volume scans. Adaptive optics imaging was performed to assess the first-order arteriolar lumen diameter (LD), total diameter (TD), wall-to-lumen ratio (WLR), and wall cross-section area, as well as to qualitatively describe vessel morphology.
Results:
Of the included 45 patients (13 females; 65 ± 10 years old), 27 were confirmed with CHD in elective CA. The most prevalent retinal vascular pathologies were arteriovenous nickings, focal arterial narrowings, and microaneurysms. VD in the superficial capillary plexus, deep capillary plexus, and choriocapillaris was lower in CHD patients, although the odds ratios were not significantly different from 1 (P = 0.06-0.92). Median arterial LD, TD, and WLR values were 98.3 µm (interquartile range [IQR] = 13.0), 122.9 µm (IQR = 17.6), and 0.26 µm (IQR = 0.07), respectively, with a trend toward a higher WLR in CHD patients.
Conclusions:
In a cardiovascular risk population, high-resolution quantitative and qualitative microvascular phenotyping in the retina may provide valuable subclinical indicators for coronary artery impairment, although larger clinical trials are needed.
Translational Relevance:
Subclinical retinal microvascular changes may serve as non-invasive, cost-effective biomarkers for risk stratification of patients with CHD.
