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Paracentral Acute Middle Maculopathy and Risk of Cardiovascular Disease, Stroke, and Death: A Longitudinal Study
Celeste Limoli1, Laxmi D Raja2, Siegfried Karl Wagner3
1From the Ophthalmology (C.L.), University of Milan, Milan, Italy; Moorfields Eye Hospital NHS Foundation Trust (C.L., L.D.R., S.K.W., L.N., P.A.K., H.K., J.H.), London, UK.
Insights
Patients with isolated paracentral acute middle maculopathy (iPAMM) face a higher risk of cardiovascular events (CVE), particularly older individuals. Prompt cardiovascular assessment is crucial for managing iPAMM patients and optimizing risk factors.
Area of Science:
- Ophthalmology
- Cardiology
- Retinal Vascular Diseases
Background:
- Paracentral acute middle maculopathy (PAMM) is an emerging retinal vascular condition.
- The association between PAMM and systemic cardiovascular events (CVE) requires further investigation.
- Understanding risk factors and prognosis in PAMM is crucial for patient management.
Purpose of the Study:
- To evaluate the risk of acute cardiovascular events (CVE), including cardiovascular diseases, cerebrovascular diseases, and all-cause mortality in patients with paracentral acute middle maculopathy (PAMM).
- To compare CVE risk between isolated PAMM (iPAMM) and PAMM associated with retinal vascular diseases (PAMM + RVD).
- To identify predisposing factors and assess visual prognosis in different PAMM subgroups.
Main Methods:
- Retrospective cohort study of 43 patients with optical coherence tomography-documented PAMM.
- Patients stratified by age (<50 and ≥50 years) and association with retinal vascular diseases (RVD) or isolated (iPAMM).
- Cardiovascular event (CVE) risk estimated using Kaplan-Meier curves, log-rank test, and Cox regression.
Main Results:
- Older patients with iPAMM had a significantly higher risk of CVE compared to those with PAMM + RVD (P < .001).
- iPAMM showed an earlier peak in peri-PAMM CVE risk (median 1 month) versus PAMM + RVD (median 36 months).
- Adjusted hazard ratio for CVE in iPAMM was 6.37 (95% CI 1.68-24.14, P = .017) compared to PAMM + RVD.
Conclusions:
- Older patients with isolated PAMM (iPAMM) face a substantially elevated risk of cardiovascular events (CVE), especially around the time of onset.
- Younger iPAMM patients exhibited a higher prevalence of predisposing factors, including sickle cell disease.
- Prompt cardiovascular assessment and risk factor optimization are recommended for all PAMM patients, particularly older individuals with iPAMM.
Purpose:
To evaluate the risk of acute cardiovascular events (CVE), including cardiovascular diseases, cerebrovascular diseases, and all-cause mortality in patients with paracentral acute middle maculopathy (PAMM).
Design:
Retrospective cohort study.
Methods:
We studied 43 individuals with optical coherence tomography-documented PAMM attending Moorfields Eye Hospital between January 2014 and June 2021. We excluded patients with preceding (<2 years) major adverse cardiac events. We stratified patients by age (<50 and ≥50 years) and whether associated with retinal vascular diseases (RVD) or isolated (iPAMM). We assessed risk factors, clinical characteristics, and visual prognosis of the patients. CVE risk was estimated using Kaplan-Meier curves, the log-rank test, and Cox proportional hazards regression.
Results:
In young patients with iPAMM patients (n = 12), underlying predisposing factors included six (50%) sickle cell disease and five (41.6%) others, including breakthrough bleeding in pregnancy, migraine, genetic cardiomyopathy, amphetamine use; among those with PAMM + RVD (n = 12) one (9%) had a vascular disorder, and four (44.4%) oral contraceptive use. In the older group of 20 patients, 15 (75%) had at least one coronary risk factor. During a median follow-up of 14 months (range 12-54), older subjects with iPAMM had a higher risk of developing CVE than those with PAMM + RVD (P < .001). Notably, iPAMM displayed a significantly earlier peak in peri-PAMM CVE risk compared to PAMM + RVD (median: one month, range 1-40 months vs 36 months, range 12-54 months). Relative to those with PAMM + RVD, risk of CVE was significantly higher in patients with iPAMM, adjusted for age and sex (hazard ratio: 6.37, 95% confidence interval 1.68-24.14, P = .017). No young patients experienced adverse CVE. At baseline, older iPAMM patients mean best corrected visual acuity of 0.7 (0-1.8) logarithm of the minimum angle resolution, which improved significantly to 0.2 (0-1.30) logarithm of the minimum angle resolution at the latest visit (P = .033).
Conclusions:
Young individuals with iPAMM have a higher prevalence of predisposing factors compared to those presenting with combined PAMM + RVD. Older patients with iPAMM had a higher risk of CVE than those with PAMM + RVD, especially in the peri-onset timeframe. This suggests the need for a prompt cardiovascular assessment to rule out systemic etiologies and optimize cardiovascular risk factors, in addition to ongoing ophthalmology input.
