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A stronger association of diabetes mellitus with impaired hyperaemia using a novel ECG-gated device compared with
Anchal Lal1,2,3,4, Neha Dave5, Michael Anthony Barry6
1Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia, 2145. alal2824@alumni.sydney.edu.au.
Insights
Diabetes mellitus impairs flicker-stimulated retinal arteriolar calibre change more than reactive hyperaemia. This study highlights retinal vascular response as a key indicator for diabetes mellitus risk assessment.
Area of Science:
- Ophthalmology and Cardiovascular Research
- Vascular Biology and Diabetes Mellitus
Background:
- Digital reactive hyperaemia and retinal vascular response are established cardiovascular disease risk markers.
- The correlation between these vascular markers and diabetes mellitus requires further investigation.
Purpose of the Study:
- To determine the correlation of digital reactive hyperaemia and flicker-stimulated retinal vascular response with diabetes mellitus.
- To compare a novel flicker-modulated ECG-gated fundoscope with the established EndoPAT2000 system for assessing these risk markers.
Main Methods:
- A cross-sectional study involving 119 controls and 120 participants with diabetes mellitus.
- Assessment of digital reactive hyperaemia using the EndoPAT2000 system and retinal vascular response via a novel flicker-modulated fundoscope.
- Analysis of retinal vessel diameters and receiver operating characteristic curves to establish associations with diabetes mellitus.
Main Results:
- Diabetes mellitus showed a stronger association with flicker-stimulated retinal arteriolar calibre change (AUC 0.81) compared to the reactive hyperaemia index.
- Flicker-stimulated arteriolar calibre change and reactive hyperaemia index were significantly lower in participants with diabetes mellitus.
- High intra- and inter-observer reliability (0.87-0.93) was achieved for retinal vessel diameter measurements.
Conclusions:
- Impaired flicker-stimulated retinal arteriolar calibre change is more strongly correlated with diabetes mellitus than a reduced reactive hyperaemia index.
- The novel flicker-modulated fundoscope demonstrates potential for assessing diabetes mellitus-related vascular dysfunction.
Purpose:
Impaired digital reactive hyperaemia and flicker-stimulated retinal vascular response are commonly reported risk markers of cardiovascular disease. This is the first study to determine the correlation of these risk markers with diabetes mellitus by comparing our novel flicker-modulated ECG-gated fundoscope with the EndoPAT2000 system.
Methods:
In total, 119 controls and 120 participants with diabetes mellitus partook in this cross-sectional study. The EndoPAT2000 system assessed digital reactive hyperaemia under fasting conditions. A mydriatic ECG-gated fundoscope with a novel flicker module acquired digital retinal images of the left eye before, during and after flicker stimulation. An inhouse semi-automated software measured retinal vessel diameters using a validated protocol with two observers repeating measurements in a subset of 10 controls and 10 participants with diabetes mellitus. Intra- and inter-observer reliability analyses occurred by the interclass correlation coefficient. A receiver operating characteristic curve established associations of variables with diabetes mellitus.
Results:
Diabetes mellitus was more strongly associated with flicker-stimulated retinal arteriolar calibre change from baseline (AUC 0.81, 95% CI 0.75-0.87, p < 0.0001) than reactive hyperaemia index. Median flicker-stimulated arteriolar calibre change from baseline (controls: 2.74%, IQR 1.07 vs diabetes mellitus: 1.64%, IQR 1.25, p < 0.0001) and reactive hyperaemia index (controls: 1.87, IQR 0.81 vs diabetes mellitus: 1.60, IQR 0.81, p = 0.003) were lower in diabetes mellitus than controls. Intra- and inter-observer reliability coefficients were high from 0.87 to 0.93.
Conclusions:
Impaired flicker-stimulated retinal arteriolar calibre change from baseline is more highly correlated with diabetes mellitus in this study than a reduced reactive hyperaemia index.
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