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Campos AC, Lima EG, Jacobsen PK, Arnould L, Lottenberg S, Maia RM, Conci LS, Minelli T, Morato A, Dantas-Jr RN, Nomura CH, Rissoli P, Pimentel SG, Serrano Junior CV. Association between obstructive coronary disease and diabetic retinopathy: Cross-sectional study of coronary angiotomography and multimodal retinal imaging. J Diabetes Complications 2024; 38:108721. [PMID: 38471431 DOI: 10.1016/j.jdiacomp.2024.108721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/28/2024] [Accepted: 03/03/2024] [Indexed: 03/14/2024]
Abstract
AIMS To investigate the association between diabetic retinopathy (DR) and coronary artery disease (CAD) using coronary angiotomography (CCTA) and multimodal retinal imaging (MMRI) with ultra-widefield retinography and optical coherence tomography angiography and structural domain. METHODS Single-center, cross-sectional, single-blind. Patients with diabetes who had undergone CCTA underwent MMRI. Uni and multivariate analysis were used to assess the association between CAD and DR and to identify variables independently associated with DR. RESULTS We included 171 patients, 87 CAD and 84 non-CAD. Most CAD patients were males (74 % vs 38 %, P < 0.01), insulin users (52 % vs 38 %, p < 0.01) and revascularized (64 %). They had a higher prevalence of DR (48 % vs 22 %, p = 0.01), microaneurysms (25 % vs 13 %, p = 0.04), intraretinal cysts (22 % vs 8 %, p = 0.01) and areas of reduced capillary density (46 % vs 20 %, p < 0.01). CAD patients also had lower mean vascular density (MVD) (15.7 % vs 16.5,%, p = 0.049) and foveal avascular zone (FAZ) circularity (0.64 ± 0.1 vs 0.69 ± 0.1, p = 0.04). There were significant and negative correlations between Duke coronary score and MVD (r = -0.189; p = 0.03) and FAZ circularity (r = -0,206; p = 0.02). CAD, DM duration and insulin use independently associated with DR. CONCLUSIONS CAD patients had higher prevalence of DR and lower MVD. CAD, DM duration and insulin use were independently associated with DR.
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Affiliation(s)
- Andre Chateaubriand Campos
- Clinical Unit of Atherosclerosis, Instituto do Coracao do Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
| | - Eduardo Gomes Lima
- Clinical Unit of Atherosclerosis, Instituto do Coracao do Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Peter Karl Jacobsen
- Cardiology division - Rigshospitalet - University of Copenhagen, Blegdamsvej 9, 2100 Rigshospitalet, Copenhagen, Denmark
| | - Louis Arnould
- Ophthalmology Department, University Hospital, Dijon, France; Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases (PEC2), (EA 7460), Faculty of Health Sciences, Université de Bourgogne Franche-Comté, 21000 Dijon, France
| | - Simao Lottenberg
- Department of Endocrinology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Renata Martins Maia
- Department of Ophtalmology, Hospital das Clinicas HCMFUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Livia Silva Conci
- Department of Ophtalmology, Hospital das Clinicas HCMFUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Tomas Minelli
- Department of Ophtalmology, Hospital das Clinicas HCMFUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Andrea Morato
- Department of Ophtalmology, Hospital das Clinicas HCMFUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Roberto Nery Dantas-Jr
- Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Cesar Higa Nomura
- Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Pedro Rissoli
- Department of Ophtalmology, Hospital das Clinicas HCMFUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Sergio Gianotti Pimentel
- Department of Ophtalmology, Hospital das Clinicas HCMFUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Carlos Vicente Serrano Junior
- Clinical Unit of Atherosclerosis, Instituto do Coracao do Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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Shah K, Natarajan S, Phadke M, Swami OC. Diabetic retinopathy grade as a predictive marker of severity of cardiovascular disease and mortality: DIVERSE Study Group. Int J Diabetes Dev Ctries 2018. [DOI: 10.1007/s13410-018-0699-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Ekezue BF, Laditka SB, Laditka JN, Studnicki J, Blanchette CM. Diabetes complications and adverse health outcomes after coronary revascularization. Diabetes Res Clin Pract 2014; 103:530-7. [PMID: 24440091 DOI: 10.1016/j.diabres.2013.09.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Revised: 02/10/2013] [Accepted: 09/24/2013] [Indexed: 11/15/2022]
Abstract
AIMS To examine effects of diabetes complications on health outcomes following coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI), comparing outcomes for patients with diabetes complications to those without diabetes complications. METHODS Retrospective analysis of discharge data for 61,566 patients with diabetes age 45 or older who had CABG or PCI in 2007 in United States community hospitals, using data from the Nationwide Inpatient Sample. Analysis included propensity score-adjusted logistic regression. RESULTS Of all patients, 21.2% of the weighted sample had diabetes complications. Older patients, Blacks and Hispanics, and those with greater illness severity were more likely to have diabetes complications. Unadjusted rates of in-hospital mortality, postoperative stroke, and renal failure were higher for patients with diabetes complications (rate ratios 2.2, 1.8, and 9.8, respectively; all p<0.0001). In adjusted results, having diabetes complications was associated with higher odds of in-hospital mortality (odds ratio, OR 1.62, 95% confidence interval, CI 1.37-1.91) and renal failure (OR 3.03, CI 1.71-5.39). Compared to CABG, PCI was associated with extra risk of postoperative renal failure for those with diabetes complications. CONCLUSION Among patients with diabetes having revascularization, those with diabetes complications have higher risks of in-hospital death and renal failure irrespective of having CABG or PCI.
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Affiliation(s)
- Bola F Ekezue
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC 28223, United States.
| | - S B Laditka
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC 28223, United States
| | - J N Laditka
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC 28223, United States
| | - J Studnicki
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC 28223, United States
| | - C M Blanchette
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC 28223, United States
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El Demerdash F, Refaie W, Allakany R, Tantawy S, Dawood E. Diabetic retinopathy: A predictor of coronary artery disease. Egypt Heart J 2012. [DOI: 10.1016/j.ehj.2011.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Ohno T, Kinoshita O, Fujita H, Kato S, Hirose A, Sigeeda T, Otomo K, Ando J, Kadowaki T, Araie M, Nagai R, Takamoto S. Detecting occult coronary artery disease followed by early coronary artery bypass surgery in patients with diabetic retinopathy: report from a diabetic retinocoronary clinic. J Thorac Cardiovasc Surg 2009; 139:92-7. [PMID: 19660392 DOI: 10.1016/j.jtcvs.2009.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2008] [Revised: 03/19/2009] [Accepted: 04/01/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVES We hypothesized that a large number of patients with diabetic retinopathy who could benefit greatly from early coronary artery bypass grafting would not be identified. METHODS Patients with diabetic retinopathy receiving ophthalmologic care as outpatients in our hospital in whom coronary artery disease was not previously suspected were referred randomly to the diabetic retinocoronary clinic and were asked to participate in diagnostic tests, including an exercise treadmill test and exercise thallium scintigraphy or coronary computed tomography. Patients who had type 1 diabetes mellitus, required hemodialysis, or both were excluded from this study. A definitive diagnosis of coronary artery disease was confirmed by means of coronary angiography. RESULTS Of 214 patients with diabetic retinopathy, 55 (25.7%) were confirmed as having significant stenotic coronary artery disease. Patients with angiographically confirmed coronary disease were older than those with negative results on diagnostic tests (62.2 + or - 9.8 vs 57.9 + or - 10.3 years, P = .01). Fifteen had 1-vessel disease, 17 had 2-vessel disease, 14 had 3-vessel disease, 1 had left main trunk plus 1-vessel disease, 2 had left main trunk plus 2-vessel disease, and 5 had left main trunk plus 3-vessel disease. Eight patients had left main trunk disease, and 18 patients with non-left main trunk disease had proximal left anterior descending coronary artery (LAD) disease. Forty-two patients showed indications of coronary revascularization (coronary artery bypass grafting in 17 and percutaneous coronary intervention in 25). During the entire follow-up (287.6 + or - 183.2 days) of 39 patients undergoing coronary revascularization, all were alive without myocardial infarction, but 8 experienced vitreous hemorrhage. CONCLUSIONS Approximately 25% of patients with diabetic retinopathy receiving ophthalmologic care as outpatients have a significant stenotic coronary artery disease. Of the total diabetic population, a large number of patients with diabetic retinopathy who show strong indications for early coronary artery bypass grafting might well go unrecognized.
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Affiliation(s)
- Takayuki Ohno
- Department of Cardiothoracic Surgery, University of Tokyo, Tokyo, Japan, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan.
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Masuzawa A, Ohno T, Takamoto S, Motomura N, Ono M, Fujita H, Ando J, Morita T, Hirata Y, Nagai R, Hirose A, Shigeeda T, Kato S, Araie M. In early-stage diabetic retinopathy, risk of cardiac events after implantation of sirolimus-eluting stent is higher than after coronary artery bypass surgery. J Cardiol 2009; 53:86-93. [PMID: 19167643 DOI: 10.1016/j.jjcc.2008.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2008] [Revised: 09/05/2008] [Accepted: 09/11/2008] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patients with diabetic retinopathy (DR) have an increased risk of death from coronary heart disease and myocardial infarction. The purpose of this study was to compare the outcomes of revascularization strategies (sirolimus-eluting stent [SES] and coronary artery bypass surgery [CABG]) in patients with DR according to the stage of retinopathy: non-proliferative retinopathy (NPDR) and proliferative retinopathy (PDR). METHODS From April 2004 until February 2007, 627 patients including 51 NPDR and 62 PDR patients underwent SES implantation. For each retinopathy group, a historical comparison group at the same stages of retinopathy undergoing CABG was selected. Cardiac events were defined as a composite of cardiac death, myocardial infarction, and repeat revascularization. RESULTS The average follow-up from the time of the initial revascularization was 27.7 ± 8.5 months for NPDR-SES patients, 69.6 ± 36.6 months for NPDR-CABG patients, 26.4 ± 9.7 months for PDR-SES patients, and 68.3 ± 44.2 months for PDR-CABG patients; and Kaplan-Meier estimates of the percentages of events at 24 months were 47.0%, 22.8%, 28.5%, and 26.0%. Kaplan-Meier curves for cardiac events differed significantly between the SES group and the CABG group in NPDR patients (p = 0.04), whereas the curves did not differ significantly between the two groups of PDR patients. The adjusted hazard ratio of SES implantation for cardiac events in the entire group of DR patients was 1.75 (95% confidence interval [CI] 1.02-3.00, p = 0.04). CONCLUSIONS SES implantation is not a suitable method of revascularization in DR patients, especially in NPDR patients. CABG may become the first-choice revascularization technique for these patients.
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Affiliation(s)
- Akihiro Masuzawa
- Department of Cardiothoracic Surgery, The University of Tokyo, Bunkyo-Ku, Tokyo, Japan
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Cheung N, Wang JJ, Rogers SL, Brancati F, Klein R, Sharrett AR, Wong TY. Diabetic Retinopathy and Risk of Heart Failure. J Am Coll Cardiol 2008; 51:1573-8. [DOI: 10.1016/j.jacc.2007.11.076] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2007] [Revised: 11/16/2007] [Accepted: 11/21/2007] [Indexed: 11/27/2022]
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Ohno T, Takamoto S, Motomura N. Diabetic Retinopathy and Coronary Artery Disease From the Cardiac Surgeon’s Perspective. Ann Thorac Surg 2008; 85:681-9. [DOI: 10.1016/j.athoracsur.2007.07.066] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2007] [Revised: 07/22/2007] [Accepted: 07/23/2007] [Indexed: 01/22/2023]
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Ohno T, Takamoto S, Motomura N, Ono M, Ando J, Morita T, Fujita H, Hirata Y, Nagai R, Shigeeda T, Hirose A. Coronary Artery Bypass Grafting Versus Coronary Implantation of Sirolimus-Eluting Stents in Patients with Diabetic Retinopathy. Ann Thorac Surg 2007; 84:1474-8. [DOI: 10.1016/j.athoracsur.2007.06.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2007] [Revised: 06/06/2007] [Accepted: 06/07/2007] [Indexed: 10/22/2022]
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Retinopathy as a useful guide for selecting an appropriate coronary revascularization treatment in patients with diabetes mellitus. Am J Cardiol 2007; 100:1330. [PMID: 17920385 DOI: 10.1016/j.amjcard.2007.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2007] [Revised: 06/14/2007] [Accepted: 06/14/2007] [Indexed: 11/22/2022]
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