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Congestive heart failure (CHF) affects a substantial proportion of adults including those without preexisting coronary heart disease. The pathogenesis of CHF is uncertain, but microvascular disease has been hypothesized as a possible factor.
To determine the relationship of retinopathy, a marker of systemic microvascular disease, to risk of CHF.
Po...
Similar publications
Diabetic retinopathy (DR) is a common complication of diabetes mellitus and can lead to irreversible blindness. To date, DR is the leading cause of blindness and visual impairment among working adults globally. However, this blindness can be prevented if DR is detected early. Diabetes mellitus slowly affects the retina by damaging retinal blood ves...
Diabetic Retinopathy (DR) caused by diabetes occurs as a result of changes in the retinal vessels and causes visual impairment. Microaneurysms (MAs) are the early clinical signs of DR, whose timely diagnosis can help detecting DR in the early stages of its development. It has been observed that MAs are more common in the inner retinal layers compar...
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 s...
Diabetic retinopathy (DR) caused by diabetes occurs as a result of changes in the retinal vessels and causes visual impairment. Microaneurysms (MAs) are the early clinical signs of DR, whose timely diagnosis can help detecting DR in the early stages of its development. It has been observed that MAs are more common in the inner retinal layers compar...
The disease diabetes has been thriving on the developing countries with a very fast rate. Prolonged Diabetes serves as the root of many comorbidities such as hypertension, cardiovascular diseases, kidney disorders etc. One of the comorbid condition includes retinal disorder which is commonly known as ‘Diabetic Retinopathy’(DR). In Diabetic retinopa...
Citations
... Both pericytes and endothelial cells have contractile characteristics that control blood flow in the capillary plexus 43 . Endothelial function also affects the occurrence and development of systemic arteriosclerosis 46 . Endothelial dysfunction may result in poor capillary blood flow control, which ultimately causes microcirculation ischemia, resulting in microvascular thinning, with OCTA showing reduced blood vessel density. ...
Myocardial infarction is defined as a sudden decrease or interruption in blood flow to the coronary arteries, causing ischemic necrosis of the corresponding cardiomyocytes. It is unclear whether systemic macrovascular alterations are associated with retinal microvascular changes. This study utilized optical coherence tomography angiography (OCTA) to compare variations in conjunctival vascular density and fundus retinal vessel density between patients with myocardial infarction (MI) and healthy controls. This study recruited 16 patients (32 eyes) with MI and 16 healthy controls (32 eyes). The superficial retinal layer (SRL), deep retinal layer (DRL) and conjunctival capillary plexus in each eye were evaluated by OCTA. Parameters measured included the density of the temporal conjunctival capillary, retinal microvascular (MIR) and macrovascular (MAR) alterations and total MIR (TMI). The microvascular density of each retinal region was evaluated by the hemisphere segmentation (SR, SL, IL, and IR), annular partition (C1, C2, C3, C4, C5 and C6), and modified early treatment of diabetic retinopathy study (R, S, L, and I) methods. In the macular area, the superficial and deep retinal microvascular densities displayed notable variations. In the superficial layers, the superficial TMI, superficial MIR, and superficial MAR, as well as densities in the SL, IL, S, L, C1, C2, C5 and C6 regions, were significantly lower in MI patients (p < 0.05 each). In the deep layers, the deep MIR and deep TMI), as well as densities in the SL, IL, L, C1, C2 and C6 regions were significantly lower in MI patients (p < 0.05 each). In contrast, the conjunctival microvascular density was significantly higher in MI patients than in healthy controls (p < 0.001). The microvascular densities measured in the deep and superficial retinal layers and in the conjunctiva differ in MI patients and healthy controls. OCTA is effective in detecting changes in the ocular microcirculation.
... Several studies have found that different types of heart failure were associated with retinopathy and retinal vascular parameters (e.g. retinal arteriolar calibre, central retinal arteriolar equivalents (CRAE), central retinal venular equivalents (CRVE)) [9][10][11][12] . It has also been demonstrated that some morphological retinal vascular characteristics, such as tortuosity and vasculature fractal, which represent the branching network and complexity of the retinal vasculature, are connected to stroke and cardiovascular disorders [13][14][15] . ...
Aim: To investigate the association of retinal vascular parameters (calibre, tortuosity, fractal dimension and the number of segments) with incident heart failure (HF) in the UK Biobank.
Methods: Participants with fundus images in UK Biobank were included. Retinal vascular parameters were assessed by an artificial intelligence system (RMHAS). Incident HF events were determined by hospital inpatient data, death register records and self-reported medical condition. Cox proportional hazards regression models (CPH) were used to investigate the links between retinal vascular variables and the risk of HF.
Results: We included 56470 individuals. After a median of 10.95-year follow-up, 1062 incident HF events were reported. After adjusting for conventional HF risk factors in CPH, we found larger retinal venular calibre (hazard ratio [HR], 1.54; 95% confidence interval [CI], 1.12-2.14), smaller arteriolar fractal dimension (HR, 1.98; 95% CI, 1.38-2.85), smaller venular fractal dimension (HR, 1.52; 95% CI, 1.09-2.13), the smaller number of arteriolar segments (HR, 2.18; 95% CI, 1.47-3.24) and the smaller number of venular segments (HR, 1.85; 95% CI, 1.29-2.64) were linked to an increased risk of HF. The addition of retinal vessel measurements to traditional HF risk factors increased the discrimination capability for predicting future HF, with C statistics changing from 0.799 to 0.813.
Conclusions: Wider retinal venular calibre, lower vascular fractal dimension and a smaller number of vessel segments were associated with a higher risk of incident HF events. These results point to the potential application of using early retinal vasculature changes to identify people at higher risk of HF.
... The retinal microvasculature is the only directly observable microvasculature in the human body, and studies have shown that changes in the retinal microvasculature correspond to pathological changes in small vessels in other organs (27). Several studies have previously found a link between HTNR and the beginning of coronary heart disease (28), congestive heart failure (29), coronary mortality (30), and cardiovascular mortality (8). ...
Purpose
This study intends to investigate the correlation between blood pressure variability (BPV) levels and the use of optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) to measure retinal microvasculature in hypertensive patients.
Methods
All individuals in the study had 24-hour ambulatory blood pressure monitoring and bilateral OCT and OCTA exams, and only data from the right eye were analyzed statistically.
Results
The study included 170 individuals, with 60 in the control group. The experimental group was separated into two groups based on the average real variability (ARV) median, with 55 in the low ARV group and 55 in the high ARV group. The mean thicknesses of the Retinal Nerve Fiber Layer (RNFL), internal limiting membrane-retinal pigment epithelial cell layer (ILM-RPE), vessel density (VD), and perfusion density (PD) in the high-ARV group were substantially lower in the low-ARV and control groups (p＜0.05). Multiple linear regression analysis revealed that disease duration, age, and 24 h diastolic standard deviation all affected RNFL mean thickness (p＜0.05). VD and PD were influenced by disease duration, systolic-ARV, daytime systolic blood pressure, intraocular pressure(IOP), and best-corrected visual acuity (BCVA) (p＜0.05). And the change in VD was connected to best-corrected visual acuity.
Conclusion
Hypertensive retinopathy is related to BPV. In clinical practice, we can assess the degree of BPV and retinopathy in hypertensive patients to track the progression of hypertension-mediated organ damage (HMOD). Correction of BPV may help treat or postpone the progression of HOMD.
... Coincidentemente, algunos estudios han sugerido que los cambios microvasculares afectan la estructura del microvaso miocárdico, como anomalías en la respuesta microvascular coronaria y el miocardio en pacientes con hipertensión e HVI. (31,32) Estos hallazgos sugieren que el proceso fisiopatológico del daño microvascular está potencialmente relacionado con el desarrollo de la hipertrofia ventricular. Si bien los mecanismos fisiopatológicos exactos siguen sin estar claros, comparten un trasfondo común, los biomarcadores de inflamación y disfunción endotelial se han relacionado con ambas enfermedades, que tienen una participación idéntica de las vías patogénicas que implican el estrés oxidativo y la cascada hormonal reninaangiotensina. ...
Introducción:
La asociación entre la retinopatía hipertensiva y cardiopatías coronarias es un tema de una larga controversia. La retinopatía hipertensiva ha sido definida como un predictor de mortalidad y morbilidad en pacientes hipertensos desde hace mucho tiempo. Además, estudios recientes han demostrado que la microvasculatura retiniana refleja la patología en los pequeños vasos sistémicos, incluida la microcirculación coronaria.
Objetivos:
El objetivo fue realizar una revisión sistemática y un análisis cualitativo y cuantitativo mediante un metanálisis para determinar la asociación entre la retinopatía hipertensiva y cardiopatías coronarias.
Métodos:
Se realizó la búsqueda sistemática de estudios relacionados con el tema. La fuente de búsqueda fue PubMed y Google Scholar. La revisión sistemática y meta-análisis se desarrollaron con las pautas Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA).
Resultados:
Se demostró que existe una asociación entre la retinopatía hipertensiva y la enfermedad de la arteria coronaria. (P=0,01; RR 1,29; IC 95 %: 1,06 a 1,56), se evaluó la hipertrofia ventricular izquierda como desenlace, se encontró un efecto estadísticamente significativo que asocia a la retinopatía hipertensiva con la hipertrofia ventricular izquierda (p=0,03; RR: 1,71; IC 95 %: 1,31 a 2,24).
Conclusiones:
Se encontró asociación entre retinopatía hipertensiva y las cardiopatías coronarias más frecuentes (Enfermedad coronaria e HVI).
... Diabetic Retinopathy (DR) is a harmful disease and the main cause of blindness among the working-age population. Moreover, DR is the most feared complication of diabetes and increases the chance of the onset of other diseases, such as kidney disorders [1], heart disease [2], and mortality [3]. The onset and progression of DR are most significantly associated with three risk factors: an increase in blood pressure, poor glycemic control, and long periods in a diabetic condition [4]. ...
Deep learning (DL) enables the creation of computational models comprising multiple
processing layers that learn data representations at multiple levels of abstraction. In the recent past, the use of deep learning has been proliferating, yielding promising results in applications across a growing number of fields, most notably in image processing, medical image analysis, data analysis, and bioinformatics. DL algorithms have also had a significant positive impact through yielding improvements in screening, recognition, segmentation, prediction, and classification applications across different domains of healthcare, such as those concerning the abdomen, cardiac, pathology, and retina. Given the extensive body of recent scientific contributions in this discipline, a comprehensive
review of deep learning developments in the domain of diabetic retinopathy (DR) analysis, viz., screening, segmentation, prediction, classification, and validation, is presented here. A critical analysis of the relevant reported techniques is carried out, and the associated advantages and limitations highlighted, culminating in the identification of research gaps and future challenges that help to inform the research community to develop more efficient, robust, and accurate DL models for the various challenges in the monitoring and diagnosis of DR.
... We could not rule out that other factors, such as the duration of AH or other processes associated with the HFpEF development, could be responsible for the observed changes in retinal vessels in our study. Previously, it was reported that retinopathy is an independent predictor of HF, even in people without preexisting coronary heart disease, diabetes, or hypertension [32]. This suggests that microvascular disease may play an important role in the development of heart failure in the general population [32]. ...
... Previously, it was reported that retinopathy is an independent predictor of HF, even in people without preexisting coronary heart disease, diabetes, or hypertension [32]. This suggests that microvascular disease may play an important role in the development of heart failure in the general population [32]. These data were confirmed by 18-year-long observational studies of ARIC patients without cardiovascular disease, where structural changes of retinal arterioles such as narrower central retinal arteriolar equivalent was significantly and linearly associated with future incident HF and was a simple, non-invasive test that predicted HF and adverse cardiac structure/function for up to 18 years in the future [33]. ...
Current data indicate that heart failure (HF) is associated with inflammation and microvascular dysfunction and remodeling. These mechanisms could be involved in HF development and progression, especially in HF with preserved ejection fraction (HFpEF). We aimed to compare structural changes in retinal arterioles and carotid arteries between HF patients and patients without heart failure. This preliminary, retrospective, case-control study included 28 participants (14 patients with HFpEF and 14 age- and sex-matched healthy controls). Carotid intima-media thickness to lumen ratio (cIMTLR) was assessed using B-mode ultrasonography. Retinal arterioles wall- to-lumen ratio (rWLR) was assessed by adaptive optics camera rtx1. The HF patients had higher IMTLR (Dmedian [HFpEF–control group] 0.07, p = 0.01) and eWLR (Dmedian 0.03, p = 0.001) in comparison to patients without HF. In the whole study group, rWLR correlated significantly with IMTLR (r = 0.739, p = 0.001). Prevalence of arterial hypertension was similar in both groups, however, patients with HF had a significantly lower office, central and 24-hour ambulatory blood pressure (systolic Dmedian −21 to −18 mmHg; diastolic Dmedian −23 to −10 mmHg). Our data suggests gradual and simultaneous progression of vascular remodeling in both retinal arterioles and carotid arteries in HFpEF patients. This process could be a marker of HF development. Significantly lower blood pressure values in HF group may indicate that vascular remodeling could be independent of BP control. Nevertheless, further and larger prospective studies allowing to reduce the impact of confounding and address temporality are warranted.
... Technologies such as retinal fundus imaging 14 have shown that some retinal microvascular measures (eg, retinopathy, retinal vessel caliber) may predict cardiovascular diseases. [15][16][17][18][19][20] Increasingly, however, newer technologies such as optical coherence tomography angiography (OCTA), 21,22 offer highly accurate, reproducible, 23,24 and relatively inexpensive quantification of the retinal capillary microcirculation. We 25,26 and others [27][28][29][30][31][32][33] have used the OCTA to image patients with hypertension and reported the associations of rarefaction of the retinal capillary network with higher blood pressure and lower kidney function. ...
Background
This study examined the associations between quantitative optical coherence tomography angiography (OCTA) parameters and myocardial abnormalities as documented on cardiovascular magnetic resonance imaging in patients with systemic hypertension.
Methods and Results
We conducted a cross‐sectional study of 118 adults with hypertension (197 eyes). Patients underwent cardiovascular magnetic resonance imaging and OCTA (PLEX Elite 9000, Carl Zeiss Meditec). Associations between OCTA parameters (superficial and deep retinal capillary density) and adverse cardiac remodeling (left ventricular mass, remodeling index, interstitial fibrosis, global longitudinal strain, and presence of left ventricular hypertrophy) were studied using multivariable linear regression analysis with generalized estimating equations. Of the 118 patients with hypertension enrolled (65% men; median [interquartile range] age, 59 [13] years), 29% had left ventricular hypertrophy. After adjusting for age, sex, systolic blood pressure, diabetes, and signal strength of OCTA scans, patients with lower superficial capillary density had significantly higher left ventricular mass (β=−0.150; 95% CI, −0.290 to −0.010), higher interstitial volume (β=−0.270; 95% CI, −0.535 to −0.0015), and worse global longitudinal strain (β=−0.109; 95% CI, −0.187 to −0.032). Lower superficial capillary density was found in patients with hypertension with replacement fibrosis versus no replacement fibrosis (16.53±0.64 mm ‐1 versus 16.96±0.64 mm ‐1 ; P =0.003).
Conclusions
We showed significant correlations between retinal capillary density and adverse cardiac remodeling markers in patients with hypertension, supporting the notion that the OCTA could provide a non‐invasive index of microcirculation alteration for vascular risk stratification in people with hypertension.
... Studies have suggested a link between alterations in the retinal microcirculation and HFpEF; an association was shown between retinal microvascular changes, i.e., decreased arteriolar calibres (vessel widths) and increased venular calibres, and increased LV concentric remodelling [53,54], one of the characteristics for HFpEF [3]. Moreover, it was shown that retinopathy and widening of retinal venular calibres, but not narrowing of arteriole calibres, independently predicted HF incidence in large datasets [54,55]. Finally, an association was found between current and incident HFpEF and (self-)reported retinopathy as a complication of diabetes mellitus [56,57], as well as neuropathy and nephropathy [56]. ...
Heart failure with preserved ejection fraction (HFpEF) is a condition with increasing incidence, leading to a health care problem of epidemic proportions for which no curative treatments exist. Consequently, an urge exists to better understand the pathophysiology of HFpEF. Accumulating evidence suggests a key pathophysiological role for coronary microvascular dysfunction (MVD), with an underlying mechanism of low-grade pro-inflammatory state caused by systemic comorbidities. The systemic entity of comorbidities and inflammation in HFpEF imply that patients develop HFpEF due to systemic mechanisms causing coronary MVD, or systemic MVD. The absence or presence of peripheral MVD in HFpEF would reflect HFpEF being predominantly a cardiac or a systemic disease. Here, we will review the current state of the art of cardiac and systemic microvascular dysfunction in HFpEF (Graphical Abstract), resulting in future perspectives on new diagnostic modalities and therapeutic strategies.
... Furthermore, previous evidence suggested that up to 15% of non-diabetic patients exhibited clinical signs of retinopathy (3)(4)(5)(6)(7). Previous literature has consistently described significant associations between retinopathy and systemic vascular comorbidities, including diabetes mellitus (DM) (5), high blood pressure (HBP) (8), chronic kidney disease (CKD) (6,(9)(10)(11) and cardiovascular disease (CVD) (12)(13)(14)(15). The presence of retinopathy has been reported to be an independent risk factor for mortality (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27). ...
Purpose
To assess the impact of retinopathy and systemic vascular comorbidities on the all-cause mortality in a representative U.S. sample.
Methods
A total of 5703 participants (≥40 years old) from the 2005-2008 National Health and Nutrition Examination Survey. The Early Treatment Diabetic Retinopathy Study grading scale was used to evaluate the retinopathy status. Systemic vascular comorbidities included diabetes mellitus (DM), high blood pressure (HBP), chronic kidney disease (CKD) and cardiovascular disease (CVD). Time to death was calculated as the time from baseline to either the date of death or censoring (December 31st, 2015), whichever came first. Risks of mortality were estimated using Cox proportional hazards models after adjusting for confounders and vascular comorbidities.
Results
After a median follow-up of 8.33 years (IQR: 7.50-9.67 years), there were 949 (11.8%) deaths from all causes. After adjusting for confounders, the presence of retinopathy predicted higher all-cause mortality (hazard ratio (HR), 1.41; 95% confidence interval (CI), 1.08-1.83). The all-cause mortality among participants with both retinopathy and systemic vascular comorbidities including DM (HR, 1.72; 95% CI, 1.21-2.43), HBP (HR, 1.47; 95% CI, 1.03-2.10), CKD (HR, 1.73; 95% CI, 1.26-2.39) and CVD (HR, 1.92; 95% CI, 1.21-3.04) was significantly higher than that among those without either condition. When stratified by diabetic or hypertension status, the co-occurrence of retinopathy and CKD or CVD further increased the all-cause mortality compared to those without either condition.
Conclusions
The co-occurrence of retinopathy and systemic vascular conditions predicted a further increase in the risk of mortality. More extensive vascular risk factor assessment and management are needed to detect the burden of vascular pathologies and improve long-term survival in individuals with retinopathy.
... Our study is one of a few to comprehensively assess the effect of MVD in several territories on HF incidence in individuals with T2DM. Previous studies that assessed the influence of MVD on HF occurrence were limited in several ways, because these included the assessment of only one microvascular bed, [23][24][25][26][27] were not focused on people with T2DM, 24,28 or included samples of mainly White individuals. [29][30][31] Our results are consistent with prior reports from the general population ...
... Microvascular Disease and Heart Failure describing an increased HF risk among individuals with nephropathy [24][25][26][27] or retinopathy. 28 Likewise, our findings corroborate prior studies of people with T2DM, although limited in number, which showed an increased risk of HF associated with retinopathy in a 1021 sample of US adults. 23 Similarly, our results are in agreement with prior reports that found that MVD increased the risk for HF hospitalizations in people with T2DM, although these studies were limited by their inclusion of a majority of White [29][30][31][32] or Asian individuals. ...
... Second, we assessed MVD in multiple vascular territories in contrast to previous studies. [23][24][25][26][27][28] Third, the presence of neuropathy was assessed using the MNSI, a standardized instrument that has been previously shown to have good performance at detecting peripheral neuropathy in diabetes mellitus. 16 Finally, the adjudication of HF events was standardized, and we conducted robust adjustments for relevant cofounders. ...
Background
Microvascular disease (MVD) is a potential contributor to the pathogenesis of diabetes mellitus–related cardiac dysfunction. However, there is a paucity of data on the link between MVD and incident heart failure (HF) in type 2 diabetes mellitus. We examined the association of MVD with incident HF in adults with type 2 diabetes mellitus.
Methods and Results
A total of 4095 participants with type 2 diabetes mellitus and free of HF were assessed for diabetes mellitus–related MVD including nephropathy, retinopathy, or neuropathy at baseline in the Look AHEAD (Action for Health in Diabetes) study. Incident HF events were prospectively assessed and adjudicated using hospital and death records. Cox models were used to generate hazard ratios and 95% CIs for HF. Of 4095 participants, 34.8% (n=1424) had MVD, defined as the presence of ≥1 of nephropathy, retinopathy, or neuropathy at baseline. Over a median of 9.7 years, there were 117 HF events. After adjusting for relevant confounders, participants with MVD had a 2.5‐fold higher risk of incident HF than those without MVD (hazard ratio, 2.54; 95% CI, 1.73–3.75). This association remained significant after additional adjustment for interval development of coronary artery disease (hazard ratio, 2.42; 95% CI, 1.64–3.57). The hazard ratios for HF by type of MVD were 2.22 (95% CI, 1.51–3.27), 1.30 (95% CI, 0.72–2.36), and 1.33 (95% CI, 0.86–2.07) for nephropathy, retinopathy, and neuropathy, respectively.
CONCLUSIONS
MVD is associated with an excess HF risk in individuals with type 2 diabetes mellitus after adjusting for other known risk factors. Our findings underscore the contribution of MVD to the development of diabetes mellitus–related HF.
REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT00017953.
