Influence of cardiac hemodynamic variables on retinal vessel density measurement on optical coherence tomography angiography in patients with myocardial infarction

The relationship between Choroidal Vascular Index and non-invasive ultrasonographic atherosclerosis predictors

BACKGROUND

This study explores the intricate connections between choroidal vascular index (CVI) and non-invasive ultrasonographic atherosclerosis predictors, shedding light on the potential links between ocular vascular dynamics and systemic cardiovascular health.

METHODS

We conducted a cross-sectional analysis of 81 participants, assessing CVI, intima-media thickness (IMT), extra-media thickness (EMT), and the PATIMA index. The presence of coronary artery disease (CAD) was also evaluated. Statistical methods included descriptive statistics, t-tests for group comparisons, Spearman correlation analysis, and receiver operating characteristic (ROC) curve analysis.

RESULTS

Our findings revealed that patients with CAD had lower CVI values compared to those without CAD, underscoring a potential association between CVI and CAD. Significant negative correlations were observed between CVI and IMT, EMT, PATIMA, and CAD. ROC curve analysis identified optimal CVI cutoff values for hypertension and CAD detection, showcasing its potential as a diagnostic marker.

DISCUSSION

Our results align with existing literature on ocular vascular changes, supporting the notion that CVI may be a promising indicator of systemic vascular conditions. The study contributes to the broader understanding of the relationships between ocular and cardiovascular health, providing a foundation for future research and clinical applications.

CONCLUSION

The study suggests that CVI holds clinical relevance as a non-invasive marker for identifying systemic conditions, offering insights into the fields of neurology, physical therapy, and rehabilitation. Addressing its limitations, this research encourages further investigation into the multifaceted connections between CVI and atherosclerosis predictors.

Optical Coherence Tomography Angiography Changes in Patients Diagnosed With Acute Coronary Syndrome: A Systematic Review and Meta-Analysis

We conducted a systematic review and meta-analysis to assess the association between optical coherence tomography angiography (OCTA) parameters and acute coronary syndrome (ACS). Two independent reviewers searched the electronic databases (MEDLINE (Medical Literature Analysis and Retrieval System Online), Scopus, Embase (Excerpta Medica Database), Cochrane Library, ClinicalTrials.gov, and World Health Organization International Clinical Trials Registry Platform) from inception until April 2023. According to the inclusion criteria of this review, eligible were observational studies, randomized control trials, and registry/database studies that included the eyes of adult ACS patients and assessed OCTA parameters within the macula. The pooled standardized mean differences (SMD) between patients diagnosed with ACS and healthy controls with a confidence interval (CI) of 95% were calculated using the Hartung-Knapp-Sidik-Jonkman random-effects method. The heterogeneity was assessed by I2 and the Cochran Q and a random effects model was applied. Seven studies were eligible and included in our systematic review (n = 898), of which three were included in the meta-analysis (n = 341). The pooled SMD in the superficial vascular plexus (SVP), deep vascular plexus (DVP), and foveal avascular zone (FAZ) were -0.46 (95% CI: -0.94 to 0.01, p = 0.05, I2 = 0%, three studies), -0.10 (95% CI: -3.20 to 3.00, p = 0.75, I2 = 67%, two studies), and 0.43 (95% CI: -1.22 to 2.09, p = 0.38, I2 = 92%, three studies), respectively. Our findings suggest that there are no differences in OCTA metrics between ACS patients and healthy individuals.

The Eye as the Window to the Heart: Optical Coherence Tomography Angiography Biomarkers as Indicators of Cardiovascular Disease

Alterations in microvasculature represent some of the earliest pathological processes across a wide variety of human diseases. In many organs, however, inaccessibility and difficulty in directly imaging tissues prevent the assessment of microvascular changes, thereby significantly limiting their translation into improved patient care. The eye provides a unique solution by allowing for the non-invasive and direct visualization and quantification of many aspects of the human microvasculature, including biomarkers for structure, function, hemodynamics, and metabolism. Optical coherence tomography angiography (OCTA) studies have specifically identified reduced capillary densities at the level of the retina in several eye diseases including glaucoma. This narrative review examines the published data related to OCTA-assessed microvasculature biomarkers and major systemic cardiovascular disease. While loss of capillaries is being established in various ocular disease, pilot data suggest that changes in the retinal microvasculature, especially within the macula, may also reflect small vessel damage occurring in other organs resulting from cardiovascular disease. Current evidence suggests retinal microvascular biomarkers as potential indicators of major systemic cardiovascular diseases, including systemic arterial hypertension, atherosclerotic disease, and congestive heart failure.

The association between cardiovascular risk profile and ocular microvascular changes in patients with non-ST elevation myocardial infarction

PURPOSE

We aimed to evaluate the association between ocular microvasculature (vascular density) on optical coherence tomography-angiography (OCT-A) and the cardiovascular risk profile of patients hospitalized for non-ST-elevation myocardial infarction (NSTEMI) patients.

METHODS

Patients admitted to the intensive care unit with the diagnosis of NSTEMI and undergoing coronary angiography were divided into 3 groups as low, intermediate, and high risk according to the SYNTAX score. OCT-A imaging was performed in all three groups. Right-left selective coronary angiography images of all patients were analyzed. The SYNTAX and TIMI risk scores of all patients were calculated.

RESULTS

This study included opthalmological examination of 114 NSTEMI patients. NSTEMI patients with high SYNTAX risk scores had significantly lower deep parafoveal vessel density (DPD) than patients with low-intermediate SYNTAX risk scores (p < 0.001). ROC curve analysis found that a DPD threshold below 51.65 % was moderately associated with high SYNTAX risk scores in patients with NSTEMI. In addition, NSTEMI patients with high TIMI risk scores had significantly lower DPD than patients with low-intermediate TIMI risk scores (p < 0.001).

CONCLUSIONS

OCT-A may be a non-invasive useful tool to assess the cardiovascular risk profile of NSTEMI patients with a high SYNTAX and TIMI score.

Impact of catheter ablation procedure on optical coherence tomography angiography findings in patients with ventricular arrhythmia

OBJECTIVE

Catheter ablation procedure may cause retinal complications associated with the risk of thromboembolism. We aimed to evaluate retina and optic disc microvascularity with optical coherence tomography angiography before and after the catheter ablation process in patients with ventricular arrhythmia.

METHODS

A total of 40 eyes of 21 ventricular arrhythmia patients were included in this cross-sectional study. Demographic characteristics and ophthalmic examination findings of patients were recorded. optical coherence tomography angiography measurements were evaluated before (group 1) and after (group 2) catheter ablation. Optical coherence tomography angiography was applied to all eyes with 6×6 mm sections for the macula and 4.5×4.5 mm sections for the optic nerve head. Foveal retinal thickness, peripapillary retinal nerve fiber layer thickness, vessel density in different parts of the retina, and optic disc were analyzed.

RESULTS

The mean age of ventricular arrhythmia patients was 53.48±13.02 years. In all, 13 (61.9%) of the patients were males and 8 (38.1%) were females. There was no significant difference between the groups in terms of average, inferior, superior, and temporal retinal nerve fiber layer thicknesses, foveal avascular area, flow areas, superficial and deep vessel densities, and optic disc capillary densities of the optic disc. However, when compared with group 1, significantly lower values in foveal retinal thickness and higher values in nasal retinal nerve fiber layer thickness were observed in group 2 (248.42±20.50 vs. 247.20±20.44, p<0.001 and 94.22±18.43 vs. 96.12±20.18, p=0.044, respectively).

CONCLUSION

Although foveal retinal thickness and nasal retinal nerve fiber layer thickness are affected in patients undergoing catheter ablation for ventricular arrhythmia, the stable retinal and optic disc vessel densities can be explained by the administration of effective anticoagulants during the procedure.

Correlation Between Coronary and Retinal Microangiopathy in Patients With STEMI

Purpose

To investigate the morphological and functional correlation between microvascular retinal changes in optical coherence tomography angiography (OCTA) and the microvascular coronary circulation in patients with ST elevation myocardial infarction (STEMI) coronary heart disease (CHD).

Methods

A total of 330 eyes from 165 participants (88 cases and 77 controls) were enrolled and imaged. Superficial capillary plexus (SCP) and deep capillary plexus (DCP) vascular density was measured in the central (1 mm) and perifoveal (1-3 mm) areas and in the superficial foveal avascular zone (FAZ) and choriocapillaris (3 mm). These parameters were then correlated to the left ventricular ejection fraction (LVEF), and the number of affected coronary arteries.

Results

Decreased vessel densities in the SCP and DCP and choriocapillaris were positively correlated to the LVEF values (P = 0.006, P = 0.026, and P = 0.002, respectively). No statistically significant correlation between the SCP and DCP central area or FAZ area was found. Regarding the number of affected vessels, significant negative correlations were revealed for the SCP and DCP central vessel densities (P < 0.001 and P < 0.001, respectively) and the SCP perifoveal vascular density (P = 0.009).

Conclusions

OCTA vascular indices are significantly correlated with morphological and functional parameters in patients with STEMI CHD. SCP vascular density especially seems to be a promising biomarker for the extent of both macrovascular damage (number of affected coronary arteries) and microvascular damage, as mirrored in the decreased LVEF at admission.

Translational Relevance

OCTA vascular indices offer a valuable insight into the microvascular status of coronary circulation.

Retinal microvascular changes in patients with coronary artery disease and apnea

BACKGROUND

Optical coherence tomography angiography (OCT-A) allowed visualization of capillary level of retina; however, the relationship between coronary vascular status and retinal microvascular changes in patients with apnea is not known well. Our aim was to assess the retinal OCT-A parameters in patients with ischemia and angiographically proven microvascular disease and compare them with obstructive coronary disease in patients with apnea.

METHODS

Our observational study included 185 eyes of 185 patients, 123 eyes of patients with apnea (72 eyes from mild OSAS, 51 eyes from moderate to severe OSAS) and 62 eyes from healthy controls. Radial scans of the macula and OCT-A scans of the central macula (superficial (SCP) and deep (DCP) capillary plexuses) were performed on all participants. All participants had documented sleep apnea disorder within 2 years prior to coronary angiography. Patients were grouped by severity of apnea and coronary atherosclerosis (50 % stenosis cut-off value for obstructive coronary artery disease). Patients presented with myocardial ischemia and without coronary artery occlusion (<50 % diameter reduction or FFR > 0.80) constitute the microvascular coronary artery (INOCA) group.

RESULTS

Compared to healthy controls, patients with apnea showed deterioration in vascular density in all regions of the retina, regardless of obstructive or microvascular coronary artery disease on the ischemia background. This study has provided important observations of a high prevalence of INOCA in patients with OSAS and the presence of OSAS was a significant independent predictor of functional coronary artery disease. The relative decreases in vascular densities were more pronounced in the DCP layer according to SCP layer of macula. Only FAZ area values were significantly different according to the severity of OSAS (0.27 (0.11-0.62) and 0.23 (0.07-0.50) (p = 0.012)).

CONCLUSIONS

In patients with apnea, OCT-A can be used as a noninvasive tool to define coronary artery involvement, with similar retinal microvascular changes both in obstructive and microvascular coronary artery group. In patients with OSAS, we observed a high prevalence of microvascular coronary disease, supporting pathophysiological role of OSAS in ischemia of this group of patients.

Quantitative assessment of retinal vessel density and thickness changes in internal carotid artery stenosis patients using optical coherence tomography angiography

OBJECTIVE

To quantitatively assess the retinal features of patients with different degrees of internal carotid artery stenosis (ICAS), particularly mild ICAS patients, utilizing optical coherence tomography angiography (OCTA).

METHODS

Thirty-two mild ICAS patients (mild ICAS group), 34 moderate to severe ICAS patients (nonmild ICAS group), and 40 controls were enrolled in this study. Retinal vessel density was quantitatively measured by OCTA, including radial peripapillary capillary vessel density (RPC-VD), superficial and deep capillary plexus vessel density (SCP/DCP-VD). Structural parameters were collected from optical coherence tomography (OCT), including retinal thickness and subfoveal choroidal thickness (SFCT). Furthermore, LASSO-penalized logistic regression was used to construct the diagnostic model based on retinal parameters. ROC curves and nomogram plots were used to assess the diagnostic ability of this model for ICAS.

RESULTS

The macular SCP-VD of mild ICAS patients was significantly lower than that of controls and lower than that of nonmild ICAS patients (all p < 0.05). However, there was no difference among the three groups in terms of DCP-VD (p > 0.05). RPC-VD could effectively discriminate between the mild ICAS group and the nonmild ICAS group (p = 0.005). For structural OCT, only the SFCT decreased as the ICAS degree increased (p < 0.05). Diagnostic scores based on retinal parameters showed a strong diagnostic capability for mild ICAS (AUC = 0.8656).

CONCLUSION

Mild ICAS patients exhibited distinct retinal features compared to nonmild ICAS patients and control subjects. OCTA potentially represents a promising method for the early detection of ICAS patients and the noninvasive surveillance of haemodynamic changes in those patients.

Associations between Choriocapillaris Flow on Optical Coherence Tomography Angiography and Cardiovascular Risk Profiles of Patients with Acute Myocardial Infarction

We evaluated the association between macular perfusion assessed via optical coherence tomography angiography (OCTA) and the cardiovascular risk profiles of patients with acute myocardial infarction (AMI). Patients with AMI who underwent comprehensive ophthalmological examinations and retinal OCTA were evaluated retrospectively. Retinal OCTA was performed for each patient within 3 days of admission. Quantitative analyses of the vessel density (VD) of the superficial capillary plexus (SCP) layers, deep capillary plexus layers (DCP), and choriocapillaris were performed after image processing. The 10-year risk of atherosclerotic cardiovascular disease (ASCVD), Global Registry of Acute Coronary Events (GRACE) score, reduction of atherothrombosis for continued health (REACH) score, and thrombolysis in myocardial infarction (TIMI) risk score were assessed. Sixty patients were included. VD in SCP and DCP was not associated with a 10-year ASCVD risk; however, choriocapillaris flow void features were significantly correlated with the 10-year ASCVD risk: decreased count, increased average size, and increased signal void area were correlated with increased 10-year ASCVD risk, GRACE score, REACH score, and TIMI risk score. In the multivariate analysis, a 10-year ASCVD risk (adjusted odds ratio [OR], 1.04; 95% confidence interval [CI], 1.01–1.08) and brain natriuretic peptide (adjusted OR, 1.00; 95% CI, 1.00–1.01) were significantly associated with the highest tertile of the average size of the choriocapillaris. Choriocapillaris flow void features measured using OCTA were associated with cardiovascular risk profiles in patients with AMI. OCTA may be used as an indicator of cardiovascular risk profiles and could improve cardiovascular risk assessments.

Optical coherence tomography angiography changes in cardiovascular systemic diseases and risk factors: A Review

Cardiovascular (CV) disease (CVD) is the main cause of death around the world, and assessing a patient's CV risk factors (CVRF) can play a major role in its prevention. Since it has been shown that retinal vascular alterations may reflect several systemic processes such as CVRF, we conducted a systematic review in order to summarize which ocular microvasculature changes can be found using Optical Coherence Tomography Angiography (OCTA) in patients without ocular diseases and with systemic pathologies/conditions that affect the CV system when compared to healthy subjects. We searched on online databases, namely PubMed, Scopus, Cochrane and Web of Science, and obtained additional studies through citation tracking. Case reports and review articles were excluded. A total of 47 articles were included in our review. We describe that patients with hypertension, diabetes mellitus, kidney disease, preeclampsia, coronary artery disease, carotid artery stenosis and obstructive sleep apnoea syndrome have, in general, lower retinal and choroidal Vessel Density (VD) and Length (VL), as well as an increased foveal avascular zone area and perimeter. Additionally, several characteristics and/or conditions in healthy subjects, such as smoking status, hyper or hypoxia conditions, race, among others, are also related to ocular vascular changes and should be accounted for. We concluded that OCTA could be a useful tool to assess a patient's CV risk profile in a non-invasive way, possibly integrating the diagnostic and prognostic algorithms of the most prevalent CV diseases in the future.

Development of a Novel Retina-Based Diagnostic Score for Early Detection of Major Depressive Disorder: An Interdisciplinary View

BACKGROUND

Clinically effective markers for the diagnosis of major depressive disorder (MDD) are lacking. Alterations in retinal features are closely related to the pathophysiological progression of MDD. However, the reliable retina-related diagnostic model for MDD remains to be developed. Thus, our study aimed to quantitatively evaluate retinal vascular and structural changes in MDD patients and to develop a reliable diagnostic model of MDD based on retinal parameters.

METHODS

Seventy-eight patients with MDD and 47 healthy controls (HCs) underwent retinal vessel density and structure examination using optical coherence tomography angiography and visual field examination using perimetry. Independent-sample t test was used to assess the differences in retinal parameters between the groups. Meanwhile, we constructed the corresponding retina-based diagnostic model by LASSO logistic regression. Finally, the diagnostic ability of the model was evaluated by area under the curve (AUC) of receiver operating characteristic curves and calibration plot of nomogram.

RESULTS

MDD patients showed lower retinal vessel density (including radial peripapillary capillary vessel density, superficial and deep capillary plexus vessel density), thinner subfoveal choroidal thickness, and poorer visual fields compared to HCs (all p < 0.05). Furthermore, a retina-based diagnostic model was constructed and shows a strong diagnostic capability for MDD (AUC = 0.9015, p < 0.001).

CONCLUSION

Patients with MDD showed distinct retinal features compared to HCs. The retina-based diagnostic model is expected to be a necessary complement to the diagnosis of MDD.

Assessment of Retinal Capillary Dropout after Transcatheter Aortic Valve Implantation by Optical Coherence Tomography Angiography

Transcatheter aortic valve implantation (TAVI) is an alternative to open heart surgery in the treatment of symptomatic aortic valve stenosis, which is often the treatment of choice in elderly and frail patients. It carries a risk of embolic complications in the whole cerebral vascular bed, which includes the retinal vasculature. The main objective was the evaluation of retinal emboli visible on optical coherence tomography angiography (OCTA) following TAVI. This is a prospective, single center, observational study enrolling consecutive patients over two years. Patients were assessed pre- and post-TAVI. Twenty-eight patients were included in the final analysis, 82.1% were male, median age was 79.5 (range 52–88), median BCVA was 82.5 letters (range 75–93). Eight patients (28.6%) presented new capillary dropout lesions in their post-TAVI OCTA scans. There was no statistically significant change in BCVA. Quantitative analysis of macular or peripapillary OCTA parameters did not show any statistically significant difference in pre- and post-intervention. In conclusion, capillary dropout lesions could frequently be found in patients after TAVI. Quantitative measurements of macular and peripapillary flow remained stable, possibly indicating effective ocular blood flow regulation within the range of left ventricular ejection fraction in our cohort.

OCT Angiography as an Interdisciplinary Diagnostic Tool for Systemic Diseases

In recent years, OCT angiography (OCT-A) has emerged as a well established imaging modality of the retina. This allows non-invasive visualisation of the retinal circulation at a micrometre scale in eye disorders and systemic diseases with potential ocular involvement. This review summarises the current state of this topic.

[Retinal vascular network: Changes with aging and systemic vascular disease (cardiac and cerebral)]

For over 10 years, the description of the retinal microvascular network has benefited from the development of new imaging techniques. Automated retinal image analysis software, as well as OCT angiography (OCT-A), are able to highlight subtle, early changes in the retinal vascular network thanks to a large amount of microvascular quantitative data. The challenge of current research is to demonstrate the association between these microvascular changes, the systemic vascular aging process, and cerebrovascular and cardiovascular disease. Indeed, a pathophysiological continuum exists between retinal microvascular changes and systemic vascular diseases. In the Montrachet study, we found that a suboptimal retinal vascular network, as identified by the Singapore I Vessel Assessment (SIVA) software, was significantly associated with treated diabetes and an increased risk of cardiovascular mortality. In addition, we supplemented our research on the retinal vascular network with the use of OCT-A. In the EYE-MI study, we showed the potential role of quantitative characterization of the retinal microvascular network by OCT-A in order to assess the cardiovascular risk profile of patients with a history of myocardial infarction. A high AHA (American Heart Association) risk score was associated with low retinal vascular density independently of hemodynamic changes. Thus, a better understanding of the association between the retinal microvasculature and macrovascular disease might make its use conceivable for early identification of at-risk patients and to suggest a personalized program of preventative care. The retinal vascular network could therefore represent an indicator of systemic vascular disease as well as an interesting predictive biomarker for vascular events.

The Impact of Chronic Heart Failure on Retinal Vessel Density Assessed by Optical Coherence Tomography Angiography in Children with Dilated Cardiomyopathy

(1) Introduction: The aim of this study is to assess retinal vessel density (VD) in the superficial capillary plexus layer (SP) and deep capillary plexus layer (DP) in children with chronic heart failure (CHF) in the course of dilated cardiomyopathy (DCM) using optical coherence tomography angiography (OCTA). (2) Methods: Thirty children with CHF due to DCM lasting more than six months, with an enlarged left ventricle and impaired left ventricular systolic function (left ventricular ejection fraction (LVEF) ≤ 55%), were enrolled to have both their eyes assessed for this study. Mean age of the children was 9.9 ± 3.57 years. The control group consisted of an additional 30 children without CHF (mean age 11.27 ± 3.33 years) matched for age and gender against the study group. All participants underwent transthoracic echocardiography to measure LVEF using Simpson method. Blood serum was tested for N-terminal-pro-brain natriuretic peptide (NT-proBNP) marker value. All children underwent OCTA with evaluation of the foveal avascular zone (FAZ), whole superficial vessel density (wsVD), foveal superficial vessel density (fsVD), parafoveal superficial vessel density (psVD), whole deep vessel density (wdVD), foveal deep vessel density (fdVD), parafoveal deep vessel density (pdVD), whole thickness (WT), foveal thickness (FT), and parafoveal thickness (PFT). (3) Results: Retinal VD in SP was significantly lower in children with CHF as compared to the controls. The following SP parameters in the study group were statistically significantly lower than these same measurements for the control group. Details, with study group findings quantified first, include wsVD (46.2% vs. 49.83%, p < 0.05), fsVD (18.07% vs. 24.15%, p < 0.05), and psVD (49.24% vs. 52.51%, p < 0.05). The WT (311.03 micrometers (μm) vs. 323.55 μm, p < 0.05), FT (244.57 μm vs. 256.98 μm, p < 0.05), and PFT (320.63 μm vs. 332.02 μm, p < 0.05). No significant differences in DP retinal VD were found between the two groups. No statistically significant differences in the FAZ were found. The fsVD and FT were correlated with biometry and the age of the study participants. There was a correlation between FAZ and FT (p < 0.001). There were no correlations between retinal VD in both plexuses and refractive error, sex, NT-proBNP, and LVEF. (4) Conclusions: In children with CHF in the course of DCM as compared to the control group, significantly decreased retinal VD in SP was observed. The results of our study indicate that measurements of the OCTA may be a useful diagnostic method in children with chronic heart failure, but it is necessary to conduct further studies in larger groups of participants and long-term observation of these patients.

The relationship between retinal microcirculation and right heart catheterization and echocardiography findings in patients with idiopathic pulmonary arterial hypertension

OBJECTIVE

To determine the possible alterations of retinal microcirculation associated with right-sided intracardiac pressures in patients with IPAH.

METHODS

Twenty patients with IPAH and 20 age- and sex-matched healthy controls were included in the study. Hemodynamic data were obtained from the most recent right heart catheterization. Echocardiographic examination was performed within 24 h of ophthalmological examination. For the right eyes of all participants, high-resolution scans of chorioretinal microvascular networks at different depths of the retina were captured via OCT angiography.

RESULTS

The perfusion of the superficial and deep capillary plexus (SCP and DCP), and choriocapillaris (CCP) flow area were significantly lower than those in healthy control subjects (p < .05 for all). In IPAH group, PVR and mPAP were correlated significantly with the perfusion measurements at SCP and DCP (r = .461, r = .626 and r = .625, r =0.730, respectively, p < .05). sPAP and TRV were positively correlated with the perfusion measurements at SCP and DCP (r = .600, r = .662 and r = .670, r = .655 p < .05).

CONCLUSIONS

The positive correlation of retinal perfusion at SCP and DCP with right-sided echocardiographic and hemodynamic measurements unveiled that retinal microcirculation is affected by the pressure alterations in the pulmonary circulation of IPAH patients.

[Optical coherence tomography angiography (OCT-A) : Overview of the technique and the possible clinical and scientific applications]

Optical coherence tomography angiography (OCT-A) is a very promising noninvasive imaging modality. For the first time it enables a precise 3‑dimensional depiction of the retinal microcirculation without the use of contrast medium and can be carried out rapidly and simply. This makes OCT‑A interesting for both scientific and clinical applications. In many ophthalmological diseases, such as glaucoma and diabetic retinopathy, OCT‑A can detect vascular alterations even in the early stages of the disease. These alterations partially correlate with functional parameters. The use of OCT‑A in the clinical routine is currently still limited due to imaging artifacts, high acquisition costs and large amounts of data; however, the scientific interest in this new technology is enormous and from our point of view it will become established in the clinical routine in the future.

Impact of cardiometabolic factors on retinal vasculature: A 3 × 3, 6 × 6 and 8 × 8-mm ocular coherence tomography angiography study

BACKGROUND

Ocular coherence tomography angiography (OCTA) is available in varying size and resolution. We sought to characterise associations of cardiometabolic factors with retinal microvascular changes using 3 × 3, 6 × 6 and 8 × 8-mm OCTA scans to determine differences in detection with varying scan size.

METHODS

Cross-sectional study of 247 cardiovascular patients from a single-centre tertiary-care hospital. Demographic, comorbidity and medication data were obtained. Patients underwent 3 × 3, 6 × 6 and 8 × 8-mm macula OCTA scanning using Carl Zeiss CIRRUS HD-OCT Model 5000. Angioplex and AngioTool software was used to quantify vascular parameters in the superficial capillary plexus.

RESULTS

Increasing age, hypertension, dyslipidaemia, diabetes, chronic kidney disease, coronary artery disease and peripheral vascular disease were associated with reductions in vessel density, vessel perfusion, average vessel length and/or junction density in 3 × 3-mm OCTA (P < .05 for all). Conversely, smoking was associated with increased vessel density, vessel length and junction density in 3 × 3-mm OCTA (P < .05 for all). Associations of vessel abnormalities with cardiometabolic factors were progressively weakened and statistically attenuated in 6 × 6 and 8 × 8-mm OCTA scans. In multivariate analyses, dyslipidaemia remained an independent predictor of reduced vessel density, average vessel length and junction density (P < .05).

CONCLUSIONS

Cardiometabolic factors are associated with multiple retinal microvascular changes in 3 × 3-mm OCTA scans. These associations were weakened and progressively attenuated in OCTA scans of larger 6 × 6 and 8 × 8-mm size. These findings advance our understanding of microcirculatory dysfunction and may have future implications for the screening and management of patients with cardiometabolic risk factors. Additional studies are required to further investigate these important associations.

[Optical coherence tomography angiography and cardiovascular diseases. An overview of the current knowledge]

Hintergrund

Kardiovaskuläre Erkrankungen (KVE) sind die Haupttodesursache weltweit. Die Beobachtbarkeit von Veränderungen der retinalen Gefäße im Zusammenhang mit KVE mittels Fundoskopie ist schon seit Langem bekannt. Ein neuartiges Verfahren zur nichtinvasiven und detaillierten Darstellung und Quantifizierung der retinalen und papillären Gefäße stellt die optische Kohärenztomographie-Angiographie (OCT-A) dar. Durch die OCT‑A ist es möglich, Gefäßveränderungen einfach und gut reproduzierbar zu visualisieren, weswegen ihr Einsatz nicht nur auf augenärztliche Fragestellungen beschränkt ist. In den vergangenen Jahren sind einige experimentelle und klinische Studien zur Darstellbarkeit und Quantifizierung von Gefäßveränderungen durch die OCT‑A bei Erkrankungen des kardiovaskulären Spektrums publiziert worden. In der vorliegenden Übersicht werden die wichtigsten Erkenntnisse aus diesen Studien zusammengefasst.

Methoden

Grundlage dieser Arbeit bilden eine umfassende selektive Literaturrecherche und die Darstellung eigener Daten.

Ergebnisse

Mittlerweile liegen zu vielen Erkrankungen des kardiovaskulären Spektrums OCT-A-Studien vor, die verdeutlichen, dass systemische Gefäßerkrankungen mit Veränderungen der retinalen Mikrozirkulation verbunden sind. Mit der OCT‑A können diese Veränderungen visualisiert und reproduzierbar quantifiziert werden. Oftmals ist es möglich, subklinische Veränderungen aufzuzeigen, bevor die zugrunde liegende Erkrankung anderweitig messbare Veränderungen oder für den Patienten merkbare Symptome verursacht.

Schlussfolgerung

Die OCT‑A ist eine vielversprechende Bildgebungsmethode auf dem Gebiet der KVE in Wissenschaft und klinischer Anwendung. Sie kann zur Diagnostik und Quantifizierung retinaler Gefäßveränderungen eingesetzt werden. Weitere Studien werden zeigen, ob die OCT‑A bei der Einschätzung des individuellen kardiovaskulären Risikoprofils helfen kann.

Vascular density with optical coherence tomography angiography and systemic biomarkers in low and high cardiovascular risk patients

We aimed to compare retinal vascular density in Optical Coherence Tomography Angiography (OCT-A) between patients hospitalized for acute coronary syndrome (ACS) and control patients and to investigate correlation with angiogenesis biomarkers. Patients hospitalized for an acute coronary syndrome (ACS) in the Intensive Care Unit were included in the "high cardiovascular risk" group while patients without cardiovascular risk presenting in the Ophthalmology department were included as "control". Both groups had blood sampling and OCT-A imaging. Retina microvascularization density in the superficial capillary plexus was measured on 3 × 3 mm angiograms centered on the macula. Angiopoietin-2, TGF-β1, osteoprotegerin, GDF-15 and ST-2 were explored with ELISA or multiplex method. Overall, 62 eyes of ACS patients and 42 eyes of controls were included. ACS patients had significantly lower inner vessel length density than control patients (p = 0.004). A ROC curve found that an inner vessel length density threshold below 20.05 mm^-1 was moderately associated with ACS. Significant correlation was found between serum levels of angiopoietin-2 and osteoprotegerin, and retinal microvascularization in OCT-A (R = - 0.293, p = 0.003; R = - 0.310, p = 0.001). Lower inner vessel length density measured with OCT-A was associated with ACS event and was also correlated with higher concentrations of angiopoietin-2 and osteoprotegerin.