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Mayor M, Camafort M, Estruch R. Retinal microvasculature assessment: useful to refine cardiovascular risk. Eur Heart J 2024:ehae422. [PMID: 39016158 DOI: 10.1093/eurheartj/ehae422] [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: 07/18/2024] Open
Affiliation(s)
- Miriam Mayor
- Department of Internal Medicine, Hospital Clinic, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain
| | - Miquel Camafort
- Department of Internal Medicine, Hospital Clinic, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain
- Institut de Recerca Biomédica August Pi i Sunyer (IDIBAPS), and Institut de Recerca en Nutrició i Seguretat Alimentària del Campus d'Alimentació de Torribera (INSA-UB), University of Barcelona, Spain
- CIBER Fisiopathology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III, Gobierno de España, Madrid, Spain
| | - Ramon Estruch
- Department of Internal Medicine, Hospital Clinic, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain
- Institut de Recerca Biomédica August Pi i Sunyer (IDIBAPS), and Institut de Recerca en Nutrició i Seguretat Alimentària del Campus d'Alimentació de Torribera (INSA-UB), University of Barcelona, Spain
- CIBER Fisiopathology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III, Gobierno de España, Madrid, Spain
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Laurent S, Agabiti-Rosei C, Bruno RM, Rizzoni D. Microcirculation and Macrocirculation in Hypertension: A Dangerous Cross-Link? Hypertension 2022; 79:479-490. [PMID: 34984924 DOI: 10.1161/hypertensionaha.121.17962] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Microcirculation and macrocirculation are tightly interconnected into a dangerous cross-link in hypertension. Small artery damage includes functional (vasoconstriction, impaired vasodilatation) and structural abnormalities (mostly inward eutrophic remodeling). These abnormalities are major determinants of the increase in total peripheral resistance and mean blood pressure (BP) in primary hypertension, which in the long term induces large artery stiffening. In turn, large artery stiffening increases central systolic and pulse pressures, which are further augmented by wave reflection in response to the structural alterations in small resistance arteries. Finally, transmission of high BP and flow pulsatility to small resistance arteries further induces functional and structural abnormalities, thus leading to increased total peripheral resistance and mean BP, thus perpetuating the vicious circle. Hyperpulsatility, in addition to higher mean BP, exaggerates cardiac, brain, and kidney damages and leads to cardiovascular, cerebral, and renal complications. The dangerous cross-link between micro and macrocirculation can be reversed into a virtuous one by ACE (angiotensin-converting enzyme) inhibitors, sartans, and calcium channel blockers. These three pharmacological classes are more potent than β-blockers and diuretics for reducing arterial stiffness and small artery remodeling. The same ranking was observed for their effectiveness at reducing left ventricular hypertrophy, preserving glomerular filtration rate, and preventing dementia, suggesting that they can act beyond brachial BP reduction, by breaking the micro/macrocirculation vicious circle.
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Affiliation(s)
- Stephane Laurent
- Université de Paris, France (S.L., R.M.B.).,Department of Pharmacology, Georges Pompidou European Hospital, Assistance-Publique Hopitaux de Paris, France (S.L., R.M.B.).,INSERM U970, Cardiovascular Research Center-PARCC, Paris, France (S.L., R.M.B.)
| | - Claudia Agabiti-Rosei
- Department of Clinical and Experimental Sciences, Clinica Medica, University of Brescia, Italy (C.A.-R., D.R.)
| | - Rosa Maria Bruno
- Université de Paris, France (S.L., R.M.B.).,Department of Pharmacology, Georges Pompidou European Hospital, Assistance-Publique Hopitaux de Paris, France (S.L., R.M.B.).,INSERM U970, Cardiovascular Research Center-PARCC, Paris, France (S.L., R.M.B.)
| | - Damiano Rizzoni
- Department of Clinical and Experimental Sciences, Clinica Medica, University of Brescia, Italy (C.A.-R., D.R.).,Division of Medicine, Spedali Civili di Brescia, Montichiari, Italy (D.R.)
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Guo ZY, Chen C, Jin X, Zhao ZH, Cui L, Zhang YH. Opisthenar microvessel area as a sensitive predictive index of arterial stiffness in hypertensive patients. Sci Rep 2021; 11:23616. [PMID: 34880253 PMCID: PMC8654907 DOI: 10.1038/s41598-021-02294-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 11/10/2021] [Indexed: 11/13/2022] Open
Abstract
We aimed to analyze whether opisthenar microvessel area (OMA, measured with Optical Coherence Tomography (OCT) angiography) was associated with blood pressure (BP), arterial stiffness and whether OMA can predict arterial stiffness in hypertensive (HTN) patients. Results from 90 participants showed that BP, brachial-ankle pulse wave velocity (baPWV) and ankle brachial index (ABI) were significantly higher but OMA (in control, with cold- and warm-stimulation, NT, CST, HST and the differences, CSD, HSD) were significantly reduced in HTN group (n = 36) compared to non-HTN (n = 54). NT, CST, HST and HSD showed negative correlations with baPWV and ABI in all participants, female (n = 47) and male group (n = 43), but the correlation was absent when the participants were divided into HTN and non-HTN. Logistic Regression analysis showed that only baPWV was a significant risk factor for HSD (OR 19.7, 95%CI 4.959-78.733, p < 0.0001) but not the age, BMI, smoking, drinking or exercise status (p > 0.05). Receiver Operating Characteristics analysis for HSD was 0.781, 0.804, 0.770, respectively. HSD < 9439.5 μm2 predicted high BP and arterial stiffness (95% CI in all participants: baPWV, 0.681-0.881, SBP, 0.709-0.900, DBP, 0.672-0.867, p < 0.001). These results suggest that OMA is a sensitive index to predict arterial stiffness in HTN population.
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Affiliation(s)
- Zhen Yi Guo
- Yanbian University Hospital, Yanji City, Jilin Province, China
| | - Chen Chen
- Yanbian University Hospital, Yanji City, Jilin Province, China
| | - Xin Jin
- Yanbian University Hospital, Yanji City, Jilin Province, China
| | - Zai Hao Zhao
- Yanbian University Hospital, Yanji City, Jilin Province, China
| | - Lan Cui
- Yanbian University Hospital, Yanji City, Jilin Province, China
| | - Yin Hua Zhang
- Yanbian University Hospital, Yanji City, Jilin Province, China.
- Department of Physiology and Biomedical Sciences, Ischemic/Hypoxic Disease Institute, Seoul National University, College of Medicine, Seoul, Korea.
- Division of Cardiovascular Institute, University of Manchester, Manchester, UK.
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Takizawa Y, Song Y, Tani T, Yoshioka T, Takahashi K, Abe T, Ro-Mase T, Ishiko S, Sakai J, Minamide K, Akiba M, Tatsukawa T, Azuma N, Yoshida A. Retinal Blood Velocity Waveform Characteristics With Aging and Arterial Stiffening in Hypertensive and Normotensive Subjects. Transl Vis Sci Technol 2021; 10:25. [PMID: 34792557 PMCID: PMC8606851 DOI: 10.1167/tvst.10.13.25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose We aimed to explore the velocity waveform characteristics of the retinal artery associated with age and the cardio-ankle vascular index (CAVI) as a conventional arterial stiffness marker by applying the Doppler optical coherence tomography (DOCT) flowmeter. Methods In this cross-sectional study, DOCT flowmeter imaging was performed in 66 participants aged 21 to 83 years (17 men, 49 women) with no history of eye diseases and no systemic diseases, except for hypertension. Retinal blood velocity waveform was analyzed where several parameters in time (upstroke time, T1, T2, T3, and T4) and area under the waveform (area elevation, area declination, A1, A2, A3, and A4) were extracted. Systolic blood pressure–adjusted Pearson's coefficients were calculated to determine the correlations of each parameter with age or CAVI. Results Corrected upstroke time (UTc) was the waveform parameter most positively correlated with age (r = 0.497, P < 0.001). Area declination was the waveform parameter most negatively correlated with age (r = −0.682, P < 0.001) and CAVI (r = −0.601, P < 0.001). Conclusions We extracted the waveform parameters associated with the risks of arterial stiffening. The velocity waveform analysis of the retinal artery with DOCT flowmeter potentially could become a new method for arterial stiffness identification. Translational Relevance DOCT flowmeter could evaluate arterial stiffening in a different way from the conventional method of measuring arterial stiffening using pressure waveform. Because the DOCT flowmeter can easily, quickly, and noninvasively provide a retinal blood velocity waveform, this system could be useful as a routine medical examination for arterial stiffening.
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Affiliation(s)
- Yoshitaka Takizawa
- Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Japan
| | - Youngseok Song
- Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Japan
| | - Tomofumi Tani
- Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Japan
| | - Takafumi Yoshioka
- Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Japan
| | - Kengo Takahashi
- Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Japan
| | - Tsubasa Abe
- Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Japan
| | - Tomoko Ro-Mase
- Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Japan
| | - Satoshi Ishiko
- Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Japan
| | | | | | | | - Takamitsu Tatsukawa
- Department of Vascular Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Akitoshi Yoshida
- Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Japan
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Solanki JD, Kakadia PJ, Mehta HB, Kakadia JM, Shah CJ. Impact of diabetic retinopathy on pulse wave analysis-derived arterial stiffness and hemodynamic parameters: A cross-sectional study from Gujarat, India. Indian J Ophthalmol 2021; 69:3250-3254. [PMID: 34708782 PMCID: PMC8725125 DOI: 10.4103/ijo.ijo_3529_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/27/2021] [Accepted: 06/03/2021] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Type 2 diabetes mellitus (T2DM) is known to produce diabetic retinopathy (DR). Pulse wave analysis (PWA) provides arterial stiffness (AS) and central hemodynamic (CH) parameters. We studied the effect of DR on AS and CH parameters in type 2 diabetics (T2D). METHODS We performed a cross-sectional study on 47 T2Ds attending a private ophthalmology clinic screened for DR by optical coherence tomography angiography and divided into NDR (non-DR), NPDR (non-proliferative DR), and PDR (proliferative DR). Mobil-o-graph (IEM, Germany) based oscillometric PWA yielded AS and CH parameters. They were further compared between groups stratified by DR with P value set at 0.05. RESULTS Participants had a mean age 62, mean diabetes duration 9 years, high mean BMI, and high prevalence of physical inactivity, hypertension, and poor diseases control. Significant differences were lacking in NPDR, NDR, and PDR in rate pressure product (mean 112.71 vs 116.06 vs 119.57), central pulse pressure (mean 46.50 vs 43.09 vs 42.72), stroke work (mean 153.36 vs 132.36 vs 146.08), augmentation index (mean 29.43 vs 33.14 vs 31.64), and aortic pulse wave velocity (mean 10.06 vs 9.08 vs 9.06). There was no clear pattern of distribution of most parameters among the three subgroups. CONCLUSION We found a lack of association between DR and cardiovascular ageing studied by AS and hemodynamic parameters. It suggests a possible difference in risk factors for both of these aftermaths of T2DM and calls for further prospective studies with a large sample size.
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Affiliation(s)
- Jayesh D Solanki
- Department of Physiology, Government Medical College, Bhavnagar, Gujarat, India
| | - Param J Kakadia
- Intern Doctor, Government Medical College and Sir T Hospital, Bhavnagar, Gujarat, India
| | - Hemant B Mehta
- Department of Physiology, Government Medical College, Bhavnagar, Gujarat, India
| | - Jagdeep M Kakadia
- Private Practitioner, Ophthalmologist, Akshardeep Eye Hospital, Bhavnagar, Gujarat, India
| | - Chinmay J Shah
- Department of Physiology, Government Medical College, Bhavnagar, Gujarat, India
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Gupta K, Reddy S. Heart, Eye, and Artificial Intelligence: A Review. Cardiol Res 2021; 12:132-139. [PMID: 34046105 PMCID: PMC8139752 DOI: 10.14740/cr1179] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 11/12/2020] [Indexed: 12/30/2022] Open
Abstract
Heart disease continues to be the leading cause of death in the USA. Deep learning-based artificial intelligence (AI) methods have become increasingly common in studying the various factors involved in cardiovascular disease. The usage of retinal scanning techniques to diagnose retinal diseases, such as diabetic retinopathy, age-related macular degeneration, glaucoma and others, using fundus photographs and optical coherence tomography angiography (OCTA) has been extensively documented. Researchers are now looking to combine the power of AI with the non-invasive ease of retinal scanning to examine the workings of the heart and predict changes in the macrovasculature based on microvascular features and function. In this review, we summarize the current state of the field in using retinal imaging to diagnose cardiovascular issues and other diseases.
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Affiliation(s)
- Kush Gupta
- Kasturba Medical College, Mangalore, India
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Peregud-Pogorzelska M, Zielska M, Kawa MP, Babiak K, Safranow K, Machaliński B, Machalińska A. Association between Light-Induced Dynamic Dilation of Retinal Vessels and Echocardiographic Parameters of the Left Ventricular Function in Hypertensive Patients. ACTA ACUST UNITED AC 2020; 56:medicina56120704. [PMID: 33348594 PMCID: PMC7767260 DOI: 10.3390/medicina56120704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 11/26/2020] [Accepted: 12/10/2020] [Indexed: 12/11/2022]
Abstract
Background and Objectives: The goal was to evaluate the association of dynamic retinal vessel analysis (DVA) with echocardiographic parameters assessing systolic and diastolic function of the left ventricle in hypertension (HT) patients with preserved left ventricle ejection fraction. Materials and Methods: This observational retrospective study recruited 36 patients with HT and 28 healthy controls. Retinal vessel diameter and reactions to flicker light were examined. Each patient was examined with echocardiography to assess left ventricular systolic and diastolic function. Results: Multivariate analysis revealed that hypertension was an independent factor associated with lower flicker-induced arterial vasodilatation (β = −0.31, p = 0.029). In the HT group, there was a significant positive association between left ventricular ejection fraction and flicker-induced arterial vasodilation (Rs = +0.31, p = 0.007). Additionally, end-diastolic left ventricular diameter negatively correlated with both arterial (Rs = −0.26, p = 0.02) and venous (Rs = −0.27, p = 0.02) flicker responses. Additionally, the echocardiographic characteristics of the left atrium (LA) remodeling in the course of HT, including the area of the LA and its antero-posterior dimension, were both negatively correlated with the arterial flicker response (Rs = −0.34, p = 0.003; Rs = −0.33, p = 0.004, respectively). From tissue Doppler parameters, the left ventricular filling index E/e’ negatively correlated with AVR (arteriovenous ratio) values (Rs = −0.36, p = 0.002). Conclusions: We revealed that systolic and diastolic function of the left ventricle in hypertensive patients is associated with retinal microvascular function.
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Affiliation(s)
| | - Małgorzata Zielska
- Department of Cardiology, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland; (M.P.-P.); (M.Z.)
| | - Miłosz Piotr Kawa
- Department of General Pathology, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland; (M.P.K.); (B.M.)
| | - Katarzyna Babiak
- First Department of Ophthalmology, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland;
| | - Krzysztof Safranow
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland;
| | - Bogusław Machaliński
- Department of General Pathology, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland; (M.P.K.); (B.M.)
| | - Anna Machalińska
- First Department of Ophthalmology, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland;
- Correspondence: ; Tel.: +48-914-838-600
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Szulc U, Dąbrowska E, Pieczyński J, Białkowski P, Narkiewicz K, Schmieder RE, Harazny J. How to measure retinal microperfusion in patients with arterial hypertension. Blood Press 2020; 30:4-19. [PMID: 32969283 DOI: 10.1080/08037051.2020.1823816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Assessment and monitoring of changes in microcirculatory perfusion, perfusion dynamic, vessel structure and oxygenation is crucial in management of arterial hypertension. Constant search for non-invasive methods has led the clinical focus towards the vasculature of the retina, which offers a large opportunity to detect the early phase of the functional and structural changes in the arterial hypertension and can reflect changes in brain vasculature. We review all the available methods of retinal microcirculation measurements including angiography, oximetry, retinal vasculature assessment software, Optical Coherence Tomography Angiography, Adaptive Optics and Scanning Laser Doppler Flowmetry and their application in clinical research. MATERIALS AND METHODS To further analyse the applicability of described methods in hypertension research we performed a systematic search of the PubMed electronic database (April 2020). In our analysis, we included 111 articles in which at least one of described methods was used for assessment of microcirculation of the retina in hypertensive individuals. RESULTS Up to this point, the methods most commonly published in studies of retinal microcirculation in arterial hypertension were Scanning Laser Doppler Flowmetry followed shortly by Optical Coherence Tomography Angiography and retinal vasculature assessment software. CONCLUSIONS While none of described methods enables the simultaneous measurement of all microcirculatory parameters, certain techniques are widely used in arterial hypertension research, while others gain popularity in screening.
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Affiliation(s)
- Urszula Szulc
- Department of Human Physiology and Pathophysiology, University Warmia and Mazury, Olsztyn, Poland
| | - Edyta Dąbrowska
- Department of Hypertension and Diabetology, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland.,First Department of Cardiology, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Janusz Pieczyński
- Department of Ophthalmology, University Warmia and Mazury, Olsztyn, Poland
| | - Paweł Białkowski
- Department of Ophthalmology, Provincial Specialist Hospital, Olsztyn, Poland
| | - Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Roland E Schmieder
- Clinical Research Center, Department of Nephrology and Hypertensiology, University Erlangen-Nuremberg, Erlangen, Germany
| | - Joanna Harazny
- Department of Human Physiology and Pathophysiology, University Warmia and Mazury, Olsztyn, Poland.,Clinical Research Center, Department of Nephrology and Hypertensiology, University Erlangen-Nuremberg, Erlangen, Germany
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