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Wei X, Iao WC, Zhang Y, Lin Z, Lin H. Retinal Microvasculature Causally Affects the Brain Cortical Structure: A Mendelian Randomization Study. OPHTHALMOLOGY SCIENCE 2024; 4:100465. [PMID: 39149712 PMCID: PMC11324828 DOI: 10.1016/j.xops.2024.100465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/05/2024] [Accepted: 01/08/2024] [Indexed: 08/17/2024]
Abstract
Purpose To reveal the causality between retinal vascular density (VD), fractal dimension (FD), and brain cortex structure using Mendelian randomization (MR). Design Cross-sectional study. Participants Genome-wide association studies of VD and FD involving 54 813 participants from the United Kingdom Biobank were used. The brain cortical features, including the cortical thickness (TH) and surface area (SA), were extracted from 51 665 patients across 60 cohorts. Surface area and TH were measured globally and in 34 functional regions using magnetic resonance imaging. Methods Bidirectional univariable MR (UVMR) was used to detect the causality between FD, VD, and brain cortex structure. Multivariable MR (MVMR) was used to adjust for confounding factors, including body mass index and blood pressure. Main Outcome Measures The global and regional measurements of brain cortical SA and TH. Results At the global level, higher VD is related to decreased TH (β = -0.0140 mm, 95% confidence interval: -0.0269 mm to -0.0011 mm, P = 0.0339). At the functional level, retinal FD is related to the TH of banks of the superior temporal sulcus and transverse temporal region without global weighted, as well as the SA of the posterior cingulate after adjustment. Vascular density is correlated with the SA of subregions of the frontal lobe and temporal lobe, in addition to the TH of the inferior temporal, entorhinal, and pars opercularis regions in both UVMR and MVMR. Bidirectional MR studies showed a causation between the SA of the parahippocampal and cauda middle frontal gyrus and retinal VD. No pleiotropy was detected. Conclusions Fractal dimension and VD causally influence the cortical structure and vice versa, indicating that the retinal microvasculature may serve as a biomarker for cortex structural changes. Our study provides insights into utilizing noninvasive fundus images to predict cortical structural deteriorations and neuropsychiatric disorders. Financial Disclosures The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Xiaoyue Wei
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
- Center for Precision Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Wai Cheng Iao
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
- Center for Precision Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yi Zhang
- Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Zijie Lin
- Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Haotian Lin
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
- Center for Precision Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China
- Hainan Eye Hospital and Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Haikou, Hainan, China
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Zhai Y, Luo C, Qin N, Cao H, Dong C, Huang Z, Huang D, Wang F, Wei W, Li J, Yang J, Lu X, Huang Z, Wang W. Predictive value of combining urinary N-acetyl-β-D-glucosaminidase and serum homocysteine for contrast-induced nephropathy in patients after percutaneous coronary intervention. Front Cardiovasc Med 2024; 11:1423836. [PMID: 39228665 PMCID: PMC11368722 DOI: 10.3389/fcvm.2024.1423836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 08/01/2024] [Indexed: 09/05/2024] Open
Abstract
Background Contrast-induced nephropathy (CIN) can lead to serious complications following percutaneous coronary intervention (PCI). Urine N-Acetyl-β-D-glucosaminidase (uNAG) and serum homocysteine (sHCY) are both potential predictors for CIN detection, but their combination has not been explored. We aimed to combine uNAG and sHCY as predictors for the early detection of CIN and for prognosis prediction in patients after PCI. Methods A total of 232 consecutive patients who underwent PCI at a university hospital were recruited for this study. According to the European Society of Urology and Reproduction (ESUR) criterion, CIN is defined as an elevation of serum creatinine (sCr) by ≥25% or ≥0.5 mg/dl from baseline within 48 h. We assessed the use of individual biomarkers (uNAG and sHCY) measured around PCI and their combinations for CIN detection and prognosis prediction. Receiver operating characteristic curves (ROC) and area under the curve (AUC) were used to evaluate the predictive efficiency of potential predictors. Results In total, 54 (23.28%) patients developed CIN. Concentrations of uNAG and sHCY increased significantly in CIN subjects (p < 0.05) than non-CIN. CIN could be predicted by uNAG and sHCY but not by creatinine at an early stage. At pre-PCI, 0, 12, 24, and 48 h after PCI, the AUC-ROC value of uNAG in calculating total CIN was 0.594, 0.603, 0.685, 0.657, and 0.648, respectively. The AUC-ROC value of sHCY in calculating total CIN was 0.685, 0.726, 0.771, 0.755, and 0.821, respectively. The panel of uNAG plus sHCY detected CIN with significantly higher accuracy than either individual biomarker alone and earlier than sCr. For detecting total CIN, this panel yielded AUC-ROCs of 0.693, 0.754, 0.826, 0.796, and 0.844 at pre-PCI, 0, 12, 24, and 48 h after PCI, respectively, which were superior to those of the individual biomarkers. For predicting the incidence of major adverse cardiovascular events (MACE) within 30 days to 12 months, the AUC-ROC values for uNAG and sHCY measured before discharge were 0.637 and 0.826, respectively. The combined panel yielded an AUC-ROC of 0.832. The combined detection did not significantly enhance the predictive capability for MACE in patients with CIN. The CIN group and the non-CIN group showed no significant difference in the Coronary Heart Disease Intensive Care Unit (CCU) stay time, hospital stay time, demand for renal replacement therapy, CCU mortality rate, and in-hospital mortality rate. Conclusions The uNAG and sHCY panel demonstrated better sensitivity and specificity for predicting the diagnosis and prognosis of CIN in patients after PCI, earlier than sCr. The combination of these biomarkers revealed a significantly superior discriminative performance for CIN detection and prognosis compared to using uNAG or sHCY alone.
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Affiliation(s)
- Yiling Zhai
- Department of Emergency, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
- Department of Emergency, Affiliated Liutie Central Hospital of Guangxi Medical University, Liuzhou, Guangxi, China
- Guangxi University Key Laboratory of Emergency Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
- Key Laboratory of Molecular Diagnosis and Application, Affiliated Liutie Central Hospital of Guangxi Medical University, Liuzhou, Guangxi, China
| | - Changjun Luo
- Key Laboratory of Molecular Diagnosis and Application, Affiliated Liutie Central Hospital of Guangxi Medical University, Liuzhou, Guangxi, China
- Department of Cardiovascular Medicine, Affiliated Liutie Central Hospital of Guangxi Medical University, Liuzhou, Guangxi, China
| | - Nianying Qin
- Department of Emergency, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
- Guangxi University Key Laboratory of Emergency Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Hongying Cao
- Department of Emergency, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
- Guangxi University Key Laboratory of Emergency Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Chunyang Dong
- Department of Emergency, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
- Guangxi University Key Laboratory of Emergency Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Zhou Huang
- Department of Emergency, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
- Guangxi University Key Laboratory of Emergency Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Dongling Huang
- Department of Emergency, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
- Guangxi University Key Laboratory of Emergency Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Fan Wang
- Department of Emergency, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
- Guangxi University Key Laboratory of Emergency Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Wanxia Wei
- Department of Emergency, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
- Guangxi University Key Laboratory of Emergency Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Jincheng Li
- Department of Emergency, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
- Guangxi University Key Laboratory of Emergency Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Jie Yang
- Department of Emergency, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
- Guangxi University Key Laboratory of Emergency Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xueling Lu
- Department of Emergency, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
- Guangxi University Key Laboratory of Emergency Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Zhengzhuang Huang
- Department of Emergency, The First People’s Hospital of Nanning, Nanning, Guangxi, China
| | - Wei Wang
- Department of Emergency, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
- Guangxi University Key Laboratory of Emergency Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
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Sideri AM, Mitsopoulou D, Kandarakis SA, Katsimpris A, Kanakis M, Karamaounas A, Brouzas D, Petrou P, Papakonstantinou E, Droutsas K, Giannopoulos G, Georgalas I. Optical Coherence Tomography Angiography Changes in Patients Diagnosed With Acute Coronary Syndrome: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e54121. [PMID: 38487148 PMCID: PMC10939045 DOI: 10.7759/cureus.54121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2024] [Indexed: 03/17/2024] Open
Abstract
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.
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Affiliation(s)
- Anna Maria Sideri
- First Department of Ophthalmology, G. Gennimatas Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Dimitra Mitsopoulou
- First Department of Ophthalmology, G. Gennimatas Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Stylianos A Kandarakis
- First Department of Ophthalmology, G. Gennimatas Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | | | - Menelaos Kanakis
- Ophthalmology, University Eye Clinic, Rion University Hospital, University of Patras, Patras, GRC
| | - Aristotelis Karamaounas
- First Department of Ophthalmology, G. Gennimatas Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Dimitrios Brouzas
- Ophthalmology, National and Kapodistrian University of Athens, Athens, GRC
| | - Petros Petrou
- First Department of Ophthalmology, G. Gennimatas Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Evangelia Papakonstantinou
- First Department of Ophthalmology, G. Gennimatas Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Konstantinos Droutsas
- First Department of Ophthalmology, G. Gennimatas Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Georgios Giannopoulos
- Third Department of Cardiology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Ilias Georgalas
- First Department of Ophthalmology, G. Gennimatas Hospital, National and Kapodistrian University of Athens, Athens, GRC
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Huang Y, Yuan Y, Seth I, Bulloch G, Cheng W, Chen Y, Shang X, Kiburg K, Zhu Z, Wang W. Optic Nerve Head Capillary Network Quantified by Optical Coherence Tomography Angiography and Decline of Renal Function in Type 2 Diabetes: A Three-Year Prospective Study. Am J Ophthalmol 2023; 253:96-105. [PMID: 37059318 DOI: 10.1016/j.ajo.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/07/2022] [Accepted: 04/05/2023] [Indexed: 04/16/2023]
Abstract
PURPOSE To assess the association of optic capillary perfusion with decline in the estimated glomerular filtration rate (eGFR) and to clarify its added value. DESIGN Prospective, observational cohort study. METHODS Patients with type 2 diabetes mellitus without diabetic retinopathy (non-DR) underwent standardized examinations annually during a 3-year follow-up period. The superficial capillary plexus (SCP), deep capillary plexus (DCP), and radial peripapillary plexus (RPC) of optic nerve head (ONH) were visualized using optical coherence tomography angiography (OCTA), and the perfusion density (PD) and vascular density were quantified for the whole image and circumpapillary regions of the ONH. The lowest tercile of annual eGFR slope was defined as the rapidly progressive group, and the highest tercile was considered the stable group. RESULTS A total of 906 patients were included for 3-mm × 3-mm OCTA analysis. After adjusting for other confounders, each 1% decrease in baseline whole en face PD in SCP and RPC was associated with accelerated rates of decline in eGFR by -0.53 mL/min/1.73/m2 per year (95% confidence interval [CI] -0.17 to -0.90; P = .004) and -0.60 mL/min/1.73/m2 per year (95% CI 0.28-0.91), respectively. Adding both whole-image PD in SCP and whole-image PD in RPC to the conventional model increased the area under the curve from 0.696 (95% CI 0.654-0.737) to 0.725 (95% CI 0.685-0.765; P = .031). Another cohort of 400 eligible patients with 6-mm × 6 mm OCTA imaging validated the significant associations between ONH perfusion and rate of eGFR decline (P < .05). CONCLUSIONS Reduced capillary perfusion of ONH in patients with type 2 diabetes mellitus is associated with a greater eGFR decline, and it has additional predictive value for detecting an early stage and progression.
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Affiliation(s)
- Yining Huang
- From Nanshan School (Y.H.), Guangzhou Medical University, Guangzhou, China
| | - Yixiong Yuan
- State Key Laboratory of Ophthalmology (Y.Y., W.C., W.W.), Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Ishith Seth
- Centre for Eye Research Australia (I.S., G.B., X.S., K.K., Z.Z.), Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Gabriella Bulloch
- Centre for Eye Research Australia (I.S., G.B., X.S., K.K., Z.Z.), Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Weijing Cheng
- State Key Laboratory of Ophthalmology (Y.Y., W.C., W.W.), Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Yifan Chen
- John Radcliffe Hospital (Y.C.), Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Xianwen Shang
- Centre for Eye Research Australia (I.S., G.B., X.S., K.K., Z.Z.), Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Katerina Kiburg
- Centre for Eye Research Australia (I.S., G.B., X.S., K.K., Z.Z.), Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Zhuoting Zhu
- Centre for Eye Research Australia (I.S., G.B., X.S., K.K., Z.Z.), Royal Victorian Eye and Ear Hospital, Melbourne, Australia.
| | - Wei Wang
- State Key Laboratory of Ophthalmology (Y.Y., W.C., W.W.), Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China.
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Sideri AM, Kanakis M, Katsimpris A, Karamaounas A, Brouzas D, Petrou P, Papakonstaninou E, Droutsas K, Kandarakis S, Giannopoulos G, Georgalas I. Correlation Between Coronary and Retinal Microangiopathy in Patients With STEMI. Transl Vis Sci Technol 2023; 12:8. [PMID: 37145590 PMCID: PMC10168007 DOI: 10.1167/tvst.12.5.8] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
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.
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Affiliation(s)
- Anna-Maria Sideri
- School of Medicine, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital of Athens, Athens, Greece
| | - Menelaos Kanakis
- School of Medicine, University of Patras, University Eye Clinic, Rion University Hospital, Patras, Greece
| | - Andreas Katsimpris
- School of Medicine, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital of Athens, Athens, Greece
| | - Aristotelis Karamaounas
- School of Medicine, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital of Athens, Athens, Greece
| | - Dimitrios Brouzas
- School of Medicine, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital of Athens, Athens, Greece
| | - Petros Petrou
- School of Medicine, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital of Athens, Athens, Greece
| | - Evangelia Papakonstaninou
- School of Medicine, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital of Athens, Athens, Greece
| | - Konstantinos Droutsas
- School of Medicine, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital of Athens, Athens, Greece
| | - Stylianos Kandarakis
- School of Medicine, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital of Athens, Athens, Greece
| | - Georgios Giannopoulos
- 3rd Department of Cardiology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ilias Georgalas
- School of Medicine, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital of Athens, Athens, Greece
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Arnould L, Meriaudeau F, Guenancia C, Germanese C, Delcourt C, Kawasaki R, Cheung CY, Creuzot-Garcher C, Grzybowski A. Using Artificial Intelligence to Analyse the Retinal Vascular Network: The Future of Cardiovascular Risk Assessment Based on Oculomics? A Narrative Review. Ophthalmol Ther 2023; 12:657-674. [PMID: 36562928 PMCID: PMC10011267 DOI: 10.1007/s40123-022-00641-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
The healthcare burden of cardiovascular diseases remains a major issue worldwide. Understanding the underlying mechanisms and improving identification of people with a higher risk profile of systemic vascular disease through noninvasive examinations is crucial. In ophthalmology, retinal vascular network imaging is simple and noninvasive and can provide in vivo information of the microstructure and vascular health. For more than 10 years, different research teams have been working on developing software to enable automatic analysis of the retinal vascular network from different imaging techniques (retinal fundus photographs, OCT angiography, adaptive optics, etc.) and to provide a description of the geometric characteristics of its arterial and venous components. Thus, the structure of retinal vessels could be considered a witness of the systemic vascular status. A new approach called "oculomics" using retinal image datasets and artificial intelligence algorithms recently increased the interest in retinal microvascular biomarkers. Despite the large volume of associated research, the role of retinal biomarkers in the screening, monitoring, or prediction of systemic vascular disease remains uncertain. A PubMed search was conducted until August 2022 and yielded relevant peer-reviewed articles based on a set of inclusion criteria. This literature review is intended to summarize the state of the art in oculomics and cardiovascular disease research.
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Affiliation(s)
- Louis Arnould
- Ophthalmology Department, Dijon University Hospital, 14 Rue Paul Gaffarel, 21079, Dijon CEDEX, France. .,University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR U1219, 33000, Bordeaux, France.
| | - Fabrice Meriaudeau
- Laboratory ImViA, IFTIM, Université Bourgogne Franche-Comté, 21078, Dijon, France
| | - Charles Guenancia
- Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases, (EA 7460), Faculty of Health Sciences, Université de Bourgogne Franche-Comté, Dijon, France.,Cardiology Department, Dijon University Hospital, Dijon, France
| | - Clément Germanese
- Ophthalmology Department, Dijon University Hospital, 14 Rue Paul Gaffarel, 21079, Dijon CEDEX, France
| | - Cécile Delcourt
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR U1219, 33000, Bordeaux, France
| | - Ryo Kawasaki
- Artificial Intelligence Center for Medical Research and Application, Osaka University Hospital, Osaka, Japan
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Catherine Creuzot-Garcher
- Ophthalmology Department, Dijon University Hospital, 14 Rue Paul Gaffarel, 21079, Dijon CEDEX, France.,Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, Dijon, France
| | - Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland.,Institute for Research in Ophthalmology, Poznan, Poland
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Ren Y, Hu Y, Li C, Zhong P, Liu H, Wang H, Kuang Y, Fu B, Wang Y, Zhao H, Zeng X, Kong H, Lawali DJAM, Yu D, Yu H, Yang X. Impaired retinal microcirculation in patients with non-obstructive coronary artery disease. Microvasc Res 2023; 148:104533. [PMID: 37004959 DOI: 10.1016/j.mvr.2023.104533] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/10/2023] [Accepted: 03/30/2023] [Indexed: 04/03/2023]
Abstract
PURPOSE To quantitatively investigate alterations of retinal microcirculation in patients with non-obstructive coronary artery disease (NOCAD) using optical coherence tomography angiography (OCTA), and to identify the ability of retinal microcirculation parameters in differentiating coronary artery disease (CAD) subtypes. METHODS All participants with angina pectoris underwent coronary computed tomography angiography. Patients with lumen diameter reduction of 20-50 % in all major coronary arteries were defined as NOCAD, while patients with at least one major coronary artery lumen diameter reduction ≥ 50 % were recruited as obstructive coronary artery disease (OCAD). Participants without a history of ophthalmic or systemic vascular disease were recruited as healthy controls. Retinal neural-vasculature was measured quantitatively by OCTA, including peripapillary retinal nerve fiber layer (RNFL) thickness and vessel density (VD) of the optic disc, superficial vessel plexus (SVP), deep vessel plexus (DVP), and foveal density (FD 300). p < 0.017 is considered significant in multiple comparisons. RESULTS A total of 185 participants (65 NOCAD, 62 OCAD, and 58 controls) were enrolled. Except for the DVP fovea (p = 0.069), significantly reduced VD in all other regions of SVP and DVP was detected in both the NOCAD and OCAD groups compared to control group (all p < 0.017), while a more significant decrease was found in OCAD compared to NOCAD. Multivariate regression analysis showed that lower VD in superior hemi part of whole SVP (OR: 0.582, 95 % CI: 0.451-0.752) was an independent risk factor for NOCAD compared to controls, while lower VD in the whole SVP (OR: 0.550, 95 % CI: 0.421-0.719) was an independent risk factor for OCAD compared to NOCAD. Using the integration of retinal microvascular parameters, the area under the receiver operating characteristic curve (AUC) for NOCAD versus control and OCAD versus NOCAD were 0.840 and 0.830, respectively. CONCLUSION Significant retinal microcirculation impairment, while milder than that in OCAD was observed in NOCAD patients, indicating retinal microvasculature assessment might provide a new systemic microcirculation observation window for NOCAD. Furthermore, retinal microvasculature may serve as a new indicator to assess the severity of CAD with good performance of retinal microvascular parameters in identifying different CAD subtypes.
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Affiliation(s)
- Yun Ren
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China; Shantou University Medical College, Shantou, China
| | - Yijun Hu
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Cong Li
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China; School of Medicine, South China University of Technology, Guangzhou, China
| | - Pingting Zhong
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China; State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Hui Liu
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Huimin Wang
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yu Kuang
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Bingqi Fu
- Shantou University Medical College, Shantou, China; Division of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yan Wang
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China; School of Medicine, South China University of Technology, Guangzhou, China
| | - Hanpeng Zhao
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xiaomin Zeng
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Huiqian Kong
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Dan Jouma Amadou Maman Lawali
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Danqing Yu
- Division of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
| | - Honghua Yu
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
| | - Xiaohong Yang
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
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8
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Eid P, Arnould L, Gabrielle PH, Aho LS, Farnier M, Creuzot-Garcher C, Cottin Y. Retinal Microvascular Changes in Familial Hypercholesterolemia: Analysis with Swept-Source Optical Coherence Tomography Angiography. J Pers Med 2022; 12:jpm12060871. [PMID: 35743656 PMCID: PMC9224994 DOI: 10.3390/jpm12060871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/18/2022] [Accepted: 05/25/2022] [Indexed: 02/01/2023] Open
Abstract
Familial hypercholesterolemia (FH) is a common but underdiagnosed genetic disorder affecting cholesterol metabolism, leading to atherosclerotic disease. The relationship between retinal microvascular changes and the presence of atheroma in patients with FH (FH group), and in comparison to volunteers without FH (CT group), needs further investigation. This cross-sectional study was conducted in a university hospital between October 1, 2020 and May 31, 2021. Cardiovascular data, including the Coronary Artery Calcium (CAC) score, were recorded for FH patients. Macula angiograms were acquired using swept-source optical coherence tomography angiography (SS OCT-A) to analyze both the superficial capillary plexus (SCP) and deep capillary plexus (DCP). A total of 162 eyes of 83 patients were enrolled in the FH group and 121 eyes of 78 volunteers in the CT group. A statistically significant association was found between the CAC score and both vessel density (β = −0.002 [95% CI, −0.004; −0.0005], p = 0.010) and vessel length (β = −0.00005 [95% CI, −0.00008; −0.00001], p = 0.010) in the DCP. The FH group had a significantly lower foveal avascular zone circularity index than the CT group in multivariate analysis (0.67 ± 0.16 in the FH group vs. 0.72 ± 0.10 in the CT group, β = 0.04 [95% CI, 0.002; 0.07], p = 0.037). Retinal microvascularization is altered in FH and retinal vascular densities are modified according to the CAC score.
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Affiliation(s)
- Pétra Eid
- Ophthalmology Department, University Hospital, 21000 Dijon, France; (P.E.); (L.A.); (P.-H.G.)
| | - Louis Arnould
- Ophthalmology Department, University Hospital, 21000 Dijon, France; (P.E.); (L.A.); (P.-H.G.)
- INSERM, CIC1432, Clinical Epidemiology Unit, Dijon University Hospital, 21000 Dijon, France
| | - Pierre-Henry Gabrielle
- Ophthalmology Department, University Hospital, 21000 Dijon, France; (P.E.); (L.A.); (P.-H.G.)
- Centre des Sciences du Gout et de l’Alimentation, AgroSup Dijon, CNRS, INRAE, University of Burgundy Franche-Comté, 21000 Dijon, France
| | - Ludwig S. Aho
- Epidemiology Department, University Hospital, 21000 Dijon, France;
| | - Michel Farnier
- Lipid Clinic, Point Medical and Department of Cardiology, University Hospital, 21000 Dijon, France;
| | - Catherine Creuzot-Garcher
- Ophthalmology Department, University Hospital, 21000 Dijon, France; (P.E.); (L.A.); (P.-H.G.)
- Centre des Sciences du Gout et de l’Alimentation, AgroSup Dijon, CNRS, INRAE, University of Burgundy Franche-Comté, 21000 Dijon, France
- Correspondence: ; Tel.: +33-380293536
| | - Yves Cottin
- Cardiology Department, University Hospital, 21000 Dijon, France;
- PEC 2, University Bourgogne Franche-Comte, 21000 Dijon, France
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9
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Monteiro‐Henriques I, Rocha‐Sousa A, Barbosa‐Breda J. Optical coherence tomography angiography changes in cardiovascular systemic diseases and risk factors: A Review. Acta Ophthalmol 2022; 100:e1-e15. [PMID: 33783129 DOI: 10.1111/aos.14851] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 02/04/2021] [Accepted: 02/27/2021] [Indexed: 02/06/2023]
Abstract
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.
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Affiliation(s)
| | - Amândio Rocha‐Sousa
- Cardiovascular R&D Center Faculty of Medicine of the University of Porto Porto Portugal
- Department of Ophthalmology Centro Hospitalar e Universitário São João Porto Portugal
| | - João Barbosa‐Breda
- Cardiovascular R&D Center Faculty of Medicine of the University of Porto Porto Portugal
- Department of Ophthalmology Centro Hospitalar e Universitário São João Porto Portugal
- Research Group Ophthalmology Department of Neurosciences KULeuven Leuven Belgium
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10
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Zekavat SM, Raghu VK, Trinder M, Ye Y, Koyama S, Honigberg MC, Yu Z, Pampana A, Urbut S, Haidermota S, O’Regan DP, Zhao H, Ellinor PT, Segrè AV, Elze T, Wiggs JL, Martone J, Adelman RA, Zebardast N, Del Priore L, Wang JC, Natarajan P. Deep Learning of the Retina Enables Phenome- and Genome-Wide Analyses of the Microvasculature. Circulation 2022; 145:134-150. [PMID: 34743558 PMCID: PMC8746912 DOI: 10.1161/circulationaha.121.057709] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/03/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND The microvasculature, the smallest blood vessels in the body, has key roles in maintenance of organ health and tumorigenesis. The retinal fundus is a window for human in vivo noninvasive assessment of the microvasculature. Large-scale complementary machine learning-based assessment of the retinal vasculature with phenome-wide and genome-wide analyses may yield new insights into human health and disease. METHODS We used 97 895 retinal fundus images from 54 813 UK Biobank participants. Using convolutional neural networks to segment the retinal microvasculature, we calculated vascular density and fractal dimension as a measure of vascular branching complexity. We associated these indices with 1866 incident International Classification of Diseases-based conditions (median 10-year follow-up) and 88 quantitative traits, adjusting for age, sex, smoking status, and ethnicity. RESULTS Low retinal vascular fractal dimension and density were significantly associated with higher risks for incident mortality, hypertension, congestive heart failure, renal failure, type 2 diabetes, sleep apnea, anemia, and multiple ocular conditions, as well as corresponding quantitative traits. Genome-wide association of vascular fractal dimension and density identified 7 and 13 novel loci, respectively, that were enriched for pathways linked to angiogenesis (eg, vascular endothelial growth factor, platelet-derived growth factor receptor, angiopoietin, and WNT signaling pathways) and inflammation (eg, interleukin, cytokine signaling). CONCLUSIONS Our results indicate that the retinal vasculature may serve as a biomarker for future cardiometabolic and ocular disease and provide insights into genes and biological pathways influencing microvascular indices. Moreover, such a framework highlights how deep learning of images can quantify an interpretable phenotype for integration with electronic health record, biomarker, and genetic data to inform risk prediction and risk modification.
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Affiliation(s)
- Seyedeh Maryam Zekavat
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT (S.M.Z., J.M., R.A.A., L.D.P., J.C.W.)
- Computational Biology & Bioinformatics Program (S.M.Z., Y.Y., H.Z.), Yale University, New Haven, CT
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA (S.M.Z., V.K.R., M.T., S.K., M.C.H., Z.Y., A.P., S.U., P.T.E., P.N.)
| | - Vineet K. Raghu
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA (S.M.Z., V.K.R., M.T., S.K., M.C.H., Z.Y., A.P., S.U., P.T.E., P.N.)
- Cardiovascular Research Center (S.M.Z., V.K.R., M.C.H., S.U., S.H., P.T.E., P.N.), Massachusetts General Hospital, Harvard Medical School, Boston
- Cardiovascular Imaging Research Center (V.K.R.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Mark Trinder
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada (M.T.)
| | - Yixuan Ye
- Computational Biology & Bioinformatics Program (S.M.Z., Y.Y., H.Z.), Yale University, New Haven, CT
| | - Satoshi Koyama
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA (S.M.Z., V.K.R., M.T., S.K., M.C.H., Z.Y., A.P., S.U., P.T.E., P.N.)
| | - Michael C. Honigberg
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA (S.M.Z., V.K.R., M.T., S.K., M.C.H., Z.Y., A.P., S.U., P.T.E., P.N.)
- Cardiovascular Research Center (S.M.Z., V.K.R., M.C.H., S.U., S.H., P.T.E., P.N.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Zhi Yu
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA (S.M.Z., V.K.R., M.T., S.K., M.C.H., Z.Y., A.P., S.U., P.T.E., P.N.)
| | - Akhil Pampana
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA (S.M.Z., V.K.R., M.T., S.K., M.C.H., Z.Y., A.P., S.U., P.T.E., P.N.)
| | - Sarah Urbut
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA (S.M.Z., V.K.R., M.T., S.K., M.C.H., Z.Y., A.P., S.U., P.T.E., P.N.)
- Cardiovascular Research Center (S.M.Z., V.K.R., M.C.H., S.U., S.H., P.T.E., P.N.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Sara Haidermota
- Cardiovascular Research Center (S.M.Z., V.K.R., M.C.H., S.U., S.H., P.T.E., P.N.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Declan P. O’Regan
- MRC London Institute of Medical Sciences, Imperial College London, UK (D.P.O.)
| | - Hongyu Zhao
- Computational Biology & Bioinformatics Program (S.M.Z., Y.Y., H.Z.), Yale University, New Haven, CT
- School of Public Health (H.Z.), Yale University, New Haven, CT
| | - Patrick T. Ellinor
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA (S.M.Z., V.K.R., M.T., S.K., M.C.H., Z.Y., A.P., S.U., P.T.E., P.N.)
- Cardiovascular Research Center (S.M.Z., V.K.R., M.C.H., S.U., S.H., P.T.E., P.N.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Ayellet V. Segrè
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston (A.V.S., T.E., J.L.W., N.Z.)
| | - Tobias Elze
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston (A.V.S., T.E., J.L.W., N.Z.)
| | - Janey L. Wiggs
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston (A.V.S., T.E., J.L.W., N.Z.)
| | - James Martone
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT (S.M.Z., J.M., R.A.A., L.D.P., J.C.W.)
| | - Ron A. Adelman
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT (S.M.Z., J.M., R.A.A., L.D.P., J.C.W.)
| | - Nazlee Zebardast
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston (A.V.S., T.E., J.L.W., N.Z.)
| | - Lucian Del Priore
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT (S.M.Z., J.M., R.A.A., L.D.P., J.C.W.)
| | - Jay C. Wang
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT (S.M.Z., J.M., R.A.A., L.D.P., J.C.W.)
| | - Pradeep Natarajan
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA (S.M.Z., V.K.R., M.T., S.K., M.C.H., Z.Y., A.P., S.U., P.T.E., P.N.)
- Cardiovascular Research Center (S.M.Z., V.K.R., M.C.H., S.U., S.H., P.T.E., P.N.), Massachusetts General Hospital, Harvard Medical School, Boston
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11
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Sheludchenko VM, Kozlovskaya NL, Smirnova TV, Krasnolutskaya EI, Budzinskaya MV, Durzhinskaya MH. [Biomarkers of retinal ischemia in thrombotic microangiopathy associated with malignant arterial hypertension on optical coherence tomography]. Vestn Oftalmol 2022; 138:169-176. [PMID: 36287152 DOI: 10.17116/oftalma2022138052169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
UNLABELLED Malignant arterial hypertension is a clinical syndrome characterized by severe diastolic arterial hypertension with signs of ischemic damage to various organs. In some malignant arterial hypertension cases, thrombotic microangiopathy occurs - a rare life-threatening condition characterized by multiple systemic thrombosis of the microvasculature, including in the eyes, which can be clarified by optical scanning of the retina. PURPOSE To determine markers of retinal ischemia in the eyes with thrombotic microangiopathy associated with malignant arterial hypertension. MATERIAL AND METHODS The study included 6 patients (12 eyes) with thrombotic microangiopathy associated with malignant arterial hypertension who were examined by optical coherence tomography (OCT) and OCT angiography (OCT-A). All patients suffered from renal dysfunction, which etiology was determined by renal biopsy verifying the presence of renal thrombotic microangiopathy in all cases. RESULTS According to OCT findings, there were bilateral local foci of thinning of the inner nuclear layer with elevation of the outer plexiform and outer nuclear layers of the retina in 5 out of 6 patients (83%). OCT-A revealed that in most cases (67%), these changes had perivascular localization and corresponded to the areas of attenuation of the deep capillary plexus. A statistically significant thinning of the inner nuclear layer of the retina was found in thrombotic microangiopathy associated with malignant arterial hypertension in comparison with the control group. CONCLUSION Presence of renal thrombotic microangiopathy confirmed by renal biopsy and the anatomical similarity of the microvasculature of the kidneys and the eyes, give basis to consider the foci of «chronic» paracentral acute middle maculopathy detected with OCT in patients with malignant arterial hypertension as biomarkers of thrombotic microangiopathy of the eye.
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Affiliation(s)
| | - N L Kozlovskaya
- City Clinical Hospital No. 20 named after A.K. Yeramishantsev, Moscow, Russia
- Peoples' Friendship University of Russia, Moscow, Russia
| | - T V Smirnova
- Research Institute of Eye Diseases, Moscow, Russia
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12
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Arnould L, Guenancia C, Binquet C, Delcourt C, Chiquet C, Daien V, Cottin Y, Bron AM, Acar N, Creuzot-Garcher C. [Retinal vascular network: Changes with aging and systemic vascular disease (cardiac and cerebral)]. J Fr Ophtalmol 2021; 45:104-118. [PMID: 34836702 DOI: 10.1016/j.jfo.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/28/2021] [Accepted: 09/28/2021] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- L Arnould
- Service d'ophtalmologie, CHU de Dijon, Dijon, France; Centre d'investigation clinique 1432, Dijon, France; Laboratoire œil et nutrition, CSGA, UMR 1324 INRA, Dijon, France.
| | - C Guenancia
- Service de cardiologie, CHU de Dijon, Dijon, France; Laboratoire PEC 2, Dijon, France
| | - C Binquet
- Centre d'investigation clinique 1432, Dijon, France
| | - C Delcourt
- Inserm U1219, équipe LEHA, université de Bordeaux, Bordeaux, France
| | - C Chiquet
- Service d'ophtalmologie, CHU de Grenoble, Grenoble, France
| | - V Daien
- Service d'ophtalmologie, CHU de Montpellier, Montpellier, France
| | - Y Cottin
- Service de cardiologie, CHU de Dijon, Dijon, France
| | - A M Bron
- Service d'ophtalmologie, CHU de Dijon, Dijon, France; Laboratoire œil et nutrition, CSGA, UMR 1324 INRA, Dijon, France
| | - N Acar
- Laboratoire œil et nutrition, CSGA, UMR 1324 INRA, Dijon, France
| | - C Creuzot-Garcher
- Service d'ophtalmologie, CHU de Dijon, Dijon, France; Laboratoire œil et nutrition, CSGA, UMR 1324 INRA, Dijon, France
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13
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Arnould L, Guenancia C, Bourredjem A, Binquet C, Gabrielle PH, Eid P, Baudin F, Kawasaki R, Cottin Y, Creuzot-Garcher C, Jacquir S. Prediction of Cardiovascular Parameters With Supervised Machine Learning From Singapore "I" Vessel Assessment and OCT-Angiography: A Pilot Study. Transl Vis Sci Technol 2021; 10:20. [PMID: 34767626 PMCID: PMC8590163 DOI: 10.1167/tvst.10.13.20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose Assessment of cardiovascular risk is the keystone of prevention in cardiovascular disease. The objective of this pilot study was to estimate the cardiovascular risk score (American Hospital Association [AHA] risk score, Syntax risk, and SCORE risk score) with machine learning (ML) model based on retinal vascular quantitative parameters. Methods We proposed supervised ML algorithm to predict cardiovascular parameters in patients with cardiovascular diseases treated in Dijon University Hospital using quantitative retinal vascular characteristics measured with fundus photography and optical coherence tomography – angiography (OCT-A) scans (alone and combined). To describe retinal microvascular network, we used the Singapore “I” Vessel Assessment (SIVA), which extracts vessel parameters from fundus photography and quantitative OCT-A retinal metrics of superficial retinal capillary plexus. Results The retinal and cardiovascular data of 144 patients were included. This paper presented a high prediction rate of the cardiovascular risk score. By means of the Naïve Bayes algorithm and SIVA + OCT-A data, the AHA risk score was predicted with 81.25% accuracy, the SCORE risk with 75.64% accuracy, and the Syntax score with 96.53% of accuracy. Conclusions Performance of these algorithms demonstrated in this preliminary study that ML algorithms applied to quantitative retinal vascular parameters with SIVA software and OCT-A were able to predict cardiovascular scores with a robust rate. Quantitative retinal vascular biomarkers with the ML strategy might provide valuable data to implement predictive model for cardiovascular parameters. Translational Relevance Small data set of quantitative retinal vascular parameters with fundus and with OCT-A can be used with ML learning to predict cardiovascular parameters.
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Affiliation(s)
- Louis Arnould
- Ophthalmology Department, University Hospital, Dijon, France.,INSERM, CIC1432, Clinical Epidemiology Unit, Dijon, France; Dijon University Hospital, Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, Dijon, France.,Centre des Sciences du Gout et de l'Alimentation, AgroSup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, Dijon, France
| | - Charles Guenancia
- Cardiology Department, University Hospital, Dijon, France.,PEC 2, University Hospital, Dijon, France
| | - Abderrahmane Bourredjem
- INSERM, CIC1432, Clinical Epidemiology Unit, Dijon, France; Dijon University Hospital, Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, Dijon, France
| | - Christine Binquet
- INSERM, CIC1432, Clinical Epidemiology Unit, Dijon, France; Dijon University Hospital, Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, Dijon, France
| | - Pierre-Henry Gabrielle
- Ophthalmology Department, University Hospital, Dijon, France.,Centre des Sciences du Gout et de l'Alimentation, AgroSup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, Dijon, France
| | - Pétra Eid
- Ophthalmology Department, University Hospital, Dijon, France
| | - Florian Baudin
- Ophthalmology Department, University Hospital, Dijon, France
| | - Ryo Kawasaki
- Department of Vision Informatics, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yves Cottin
- Cardiology Department, University Hospital, Dijon, France.,PEC 2, University Hospital, Dijon, France
| | - Catherine Creuzot-Garcher
- Ophthalmology Department, University Hospital, Dijon, France.,Centre des Sciences du Gout et de l'Alimentation, AgroSup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, Dijon, France
| | - Sabir Jacquir
- Université Paris-Saclay, CNRS, Institut des Neurosciences Paris-Saclay, Gif-sur-Yvette, France
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14
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Aschauer J, Aschauer S, Pollreisz A, Datlinger F, Gatterer C, Mylonas G, Egner B, Hofer D, Steiner I, Hengstenberg C, Schmidt-Erfurth U. Identification of Subclinical Microvascular Biomarkers in Coronary Heart Disease in Retinal Imaging. Transl Vis Sci Technol 2021; 10:24. [PMID: 34787666 PMCID: PMC8606892 DOI: 10.1167/tvst.10.13.24] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
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 study we included adult patients who presented to a tertiary referral center for elective CA due to suspected CHD. All patients underwent widefield fundus photography for retinopathy grading. Optical coherence tomography angiography was used to measure vessel density (VD) of the individual capillary plexuses in 6 × 6-mm macular volume scans. Adaptive optics imaging was performed to assess the first-order arteriolar lumen diameter (LD), total diameter (TD), wall-to-lumen ratio (WLR), and wall cross-section area, as well as to qualitatively describe vessel morphology. Results Of the included 45 patients (13 females; 65 ± 10 years old), 27 were confirmed with CHD in elective CA. The most prevalent retinal vascular pathologies were arteriovenous nickings, focal arterial narrowings, and microaneurysms. VD in the superficial capillary plexus, deep capillary plexus, and choriocapillaris was lower in CHD patients, although the odds ratios were not significantly different from 1 (P = 0.06–0.92). Median arterial LD, TD, and WLR values were 98.3 µm (interquartile range [IQR] = 13.0), 122.9 µm (IQR = 17.6), and 0.26 µm (IQR = 0.07), respectively, with a trend toward a higher WLR in CHD patients. Conclusions In a cardiovascular risk population, high-resolution quantitative and qualitative microvascular phenotyping in the retina may provide valuable subclinical indicators for coronary artery impairment, although larger clinical trials are needed. Translational Relevance Subclinical retinal microvascular changes may serve as non-invasive, cost-effective biomarkers for risk stratification of patients with CHD.
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Affiliation(s)
- Julia Aschauer
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria.,Vienna Clinical Trial Center, Medical University of Vienna, Vienna, Austria
| | - Stefan Aschauer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Andreas Pollreisz
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria.,Vienna Clinical Trial Center, Medical University of Vienna, Vienna, Austria
| | - Felix Datlinger
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria.,Vienna Clinical Trial Center, Medical University of Vienna, Vienna, Austria
| | - Constantin Gatterer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Georgios Mylonas
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Berit Egner
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Dominik Hofer
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Irene Steiner
- CeMSIIS, Institute for Medical Statistics, Medical University of Vienna, Vienna, Austria
| | - Christian Hengstenberg
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Ursula Schmidt-Erfurth
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
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15
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Hannappe MA, Arnould L, Méloux A, Mouhat B, Bichat F, Zeller M, Cottin Y, Binquet C, Vergely C, Creuzot-Garcher C, Guenancia C. Vascular density with optical coherence tomography angiography and systemic biomarkers in low and high cardiovascular risk patients. Sci Rep 2020; 10:16718. [PMID: 33028913 PMCID: PMC7542456 DOI: 10.1038/s41598-020-73861-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 09/03/2020] [Indexed: 12/18/2022] Open
Abstract
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.
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Affiliation(s)
- Marc-Antoine Hannappe
- Ophthalmology Department, University Hospital, 14 rue Paul Gaffarel, 21079, Dijon Cedex, France.,Laboratoire de Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires (EA7460, PEC2), UFR Des Sciences de Santé, Bourgogne Franche-Comté University, Dijon, France
| | - Louis Arnould
- Ophthalmology Department, University Hospital, 14 rue Paul Gaffarel, 21079, Dijon Cedex, France. .,Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, 21000, Dijon, France. .,INSERM, CIC1432, Clinical Epidemiology Unit, Dijon, France. .,Dijon University Hospital, Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, Dijon, France.
| | - Alexandre Méloux
- Laboratoire de Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires (EA7460, PEC2), UFR Des Sciences de Santé, Bourgogne Franche-Comté University, Dijon, France.,Cardiology Department, University Hospital, Dijon, France
| | - Basile Mouhat
- Laboratoire de Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires (EA7460, PEC2), UFR Des Sciences de Santé, Bourgogne Franche-Comté University, Dijon, France.,Cardiology Department, University Hospital, Dijon, France
| | - Florence Bichat
- Laboratoire de Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires (EA7460, PEC2), UFR Des Sciences de Santé, Bourgogne Franche-Comté University, Dijon, France.,Cardiology Department, University Hospital, Dijon, France
| | - Marianne Zeller
- Laboratoire de Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires (EA7460, PEC2), UFR Des Sciences de Santé, Bourgogne Franche-Comté University, Dijon, France.,Cardiology Department, University Hospital, Dijon, France
| | - Yves Cottin
- Laboratoire de Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires (EA7460, PEC2), UFR Des Sciences de Santé, Bourgogne Franche-Comté University, Dijon, France.,Cardiology Department, University Hospital, Dijon, France
| | - Christine Binquet
- INSERM, CIC1432, Clinical Epidemiology Unit, Dijon, France.,Dijon University Hospital, Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, Dijon, France
| | - Catherine Vergely
- Laboratoire de Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires (EA7460, PEC2), UFR Des Sciences de Santé, Bourgogne Franche-Comté University, Dijon, France
| | - Catherine Creuzot-Garcher
- Ophthalmology Department, University Hospital, 14 rue Paul Gaffarel, 21079, Dijon Cedex, France.,INSERM, CIC1432, Clinical Epidemiology Unit, Dijon, France.,Dijon University Hospital, Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, Dijon, France
| | - Charles Guenancia
- Laboratoire de Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires (EA7460, PEC2), UFR Des Sciences de Santé, Bourgogne Franche-Comté University, Dijon, France.,Cardiology Department, University Hospital, Dijon, France
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16
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Brain Natriuretic Peptide for Predicting Contrast-Induced Acute Kidney Injury in Patients with Acute Coronary Syndrome Undergoing Coronary Angiography: A Systematic Review and Meta-Analysis. J Interv Cardiol 2020; 2020:1035089. [PMID: 33024418 PMCID: PMC7520681 DOI: 10.1155/2020/1035089] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/04/2020] [Accepted: 09/09/2020] [Indexed: 11/18/2022] Open
Abstract
Objective To assess the diagnostic value of B-type natriuretic peptide (BNP) or N-terminal pro-B-type natriuretic peptide (NT-proBNP) for contrast-induced acute kidney injury (CI-AKI) in patients with acute coronary syndrome (ACS) undergoing coronary angiography. Background ACS remains a major cause of death worldwide. Patients with ACS undergoing coronary angiography are more likely to develop CI-AKI, which correlates highly with poor clinical outcomes. Early diagnosis of CI-AKI remains a challenge. Many recent studies have suggested that BNP or NT-proBNP may be a useful biomarker for the early diagnosis of CI-AKI. Methods We searched databases (PubMed, EMBASE, and Cochrane Library) to identify eligible studies. Two authors independently screened the studies and extracted data. We used the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) criteria to assess the methodological quality of the included studies and STATA to perform all statistical analyses. Results Nine studies including 2832 patients were identified. The pooled sensitivity of 0.73 (95% CI 0.65–0.79), specificity of 0.79 (95% CI 0.70–0.85), and area under the summary receiver operating characteristic curve of 0.81 (95% CI 0.77–0.84) suggested that BNP or NT-proBNP had a good diagnostic value for CI-AKI in patients with ACS undergoing coronary angiography. Conclusions Our findings suggest that BNP or NT-proBNP may be an effective predictive marker for CI-AKI. However, additional high-quality studies are required to find the optimal cutoff value and the diagnostic value of BNP or NT-proBNP in combination with other biomarkers.
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17
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Farrah TE, Dhillon B, Keane PA, Webb DJ, Dhaun N. The eye, the kidney, and cardiovascular disease: old concepts, better tools, and new horizons. Kidney Int 2020; 98:323-342. [PMID: 32471642 PMCID: PMC7397518 DOI: 10.1016/j.kint.2020.01.039] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 01/09/2020] [Accepted: 01/13/2020] [Indexed: 12/18/2022]
Abstract
Chronic kidney disease (CKD) is common, with hypertension and diabetes mellitus acting as major risk factors for its development. Cardiovascular disease is the leading cause of death worldwide and the most frequent end point of CKD. There is an urgent need for more precise methods to identify patients at risk of CKD and cardiovascular disease. Alterations in microvascular structure and function contribute to the development of hypertension, diabetes, CKD, and their associated cardiovascular disease. Homology between the eye and the kidney suggests that noninvasive imaging of the retinal vessels can detect these microvascular alterations to improve targeting of at-risk patients. Retinal vessel-derived metrics predict incident hypertension, diabetes, CKD, and cardiovascular disease and add to the current renal and cardiovascular risk stratification tools. The advent of optical coherence tomography (OCT) has transformed retinal imaging by capturing the chorioretinal microcirculation and its dependent tissue with near-histological resolution. In hypertension, diabetes, and CKD, OCT has revealed vessel remodeling and chorioretinal thinning. Clinical and preclinical OCT has linked retinal microvascular pathology to circulating and histological markers of injury in the kidney. The advent of OCT angiography allows contrast-free visualization of intraretinal capillary networks to potentially detect early incipient microvascular disease. Combining OCT's deep imaging with the analytical power of deep learning represents the next frontier in defining what the eye can reveal about the kidney and broader cardiovascular health.
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Affiliation(s)
- Tariq E Farrah
- University/BHF Centre for Cardiovascular Science, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK; Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Baljean Dhillon
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; Princess Alexandra Eye Pavilion, Edinburgh, UK
| | - Pearse A Keane
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital, London, UK
| | - David J Webb
- University/BHF Centre for Cardiovascular Science, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Neeraj Dhaun
- University/BHF Centre for Cardiovascular Science, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK; Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK.
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18
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Hua D, Xu Y, Zhang X, He T, Chen C, Chen Z, Xing Y. Retinal Microvascular Changes in Hypertensive Patients with Different Levels of Blood Pressure Control and without Hypertensive Retinopathy. Curr Eye Res 2020; 46:107-114. [PMID: 32498561 DOI: 10.1080/02713683.2020.1775260] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To determine possible correlations between different levels of blood pressure (BP) control and retinal microvascular changes in the macula and optic nerve head, using coherence tomography angiography (OCTA) in hypertensive patients without hypertensive retinopathy. METHODS This was an observational, cross-sectional study. Seventy-three patients and 40 healthy volunteers were included in this study. The patients and volunteers were divided into four groups and from each participant one eye was selected randomly: Group A comprised 32 hypertensive patients with intensive BP control; Group B comprised 26 hypertensive patients with standard BP control; Group C comprised 15 hypertensive patients with poor BP control; Group D comprised 40 control subjects. 6 × 6 mm macula scan and 4.5 × 4.5 mm optic nerve head scan were obtained using OCTA. RESULTS In macula scans, most measured regions of retinal VD showed significant reduction in group C, compared to groups A, B, and D (all P < .05). Partial measured regions of retinal VD were significantly lower in group B than groups A and D (all P < .05). In ONH scans, RNFL thickness and inside disc capillary density were significantly thinner and lower in groups B and C than in group D (all P < .05). SBP was significantly correlated with RNFL thickness (R = 0.430, 95% CI -0.583 to -0.201, P ≤ 0.001). CONCLUSIONS We demonstrated that the frequency of OCTA follow-up may improve detection of reduced retinal VD, thus avoiding further retinal damage in hypertensive patients; however, the clinical implications of this finding deserve further study. Moreover, further exploration is needed regarding the implication that reduced SBP may be beneficial for lowering the risk of glaucoma.
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Affiliation(s)
- Dihao Hua
- Eye Center, Renmin Hospital of Wuhan University , Wuhan, Huibei, China
| | - Yishuang Xu
- Eye Center, Renmin Hospital of Wuhan University , Wuhan, Huibei, China
| | - Xiao Zhang
- Eye Center, Renmin Hospital of Wuhan University , Wuhan, Huibei, China
| | - Tao He
- Eye Center, Renmin Hospital of Wuhan University , Wuhan, Huibei, China
| | - Changzheng Chen
- Eye Center, Renmin Hospital of Wuhan University , Wuhan, Huibei, China
| | - Zhen Chen
- Eye Center, Renmin Hospital of Wuhan University , Wuhan, Huibei, China
| | - Yiqiao Xing
- Eye Center, Renmin Hospital of Wuhan University , Wuhan, Huibei, China
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19
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Wang W, He M, Gong X, Wang L, Meng J, Li Y, Xiong K, Li W, Huang W. Association of renal function with retinal vessel density in patients with type 2 diabetes by using swept-source optical coherence tomographic angiography. Br J Ophthalmol 2020; 104:1768-1773. [PMID: 32098859 DOI: 10.1136/bjophthalmol-2019-315450] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/31/2020] [Accepted: 02/10/2020] [Indexed: 12/16/2022]
Abstract
AIMS To investigate the relationship between retinal vessel density and renal function in patients with diabetes mellitus (DM) using non-invasive optical coherence tomographic angiography (OCTA). METHODS This prospective cross-sectional study recruited ocular-treatment-naïve patients with DM registered in the community of Guangzhou, China. The retinal vessel density of the superficial capillary plexus in the macula was obtained by using swept-source OCTA imaging. The Xiangya equation was used to calculate the estimated glomerular filtrate rate (eGFR). Participants were divided into the following groups by eGFR: no chronic kidney disease (non-CKD), mild CKD and moderate-to-severe CKD (MS-CKD). RESULTS A total of 874 patients with DM (874 eyes), with a mean age of 64.8±7.1 years, were included in the final analysis. The vessel density was significantly lower in patients with CKD than in non-CKD patients in a dose-response pattern, with a parafoveal vessel density of 49.1%±2.1% in non-CKD, 48.4%±1.9% in mild CKD and 47.2%±1.7% in MS-CKD (p<0.001). The sparser retinal capillaries were related to lower eGFR (β=0.037; 95% CI 0.025 to 0.049; p<0.001) and higher microalbuminuria (β = -0.023; 95% CI -0.039 to -0.008; p=0.002). The eGRF was independently associated with parafoveal vessel density (β=0.029; 95% CI 0.016 to 0.042; p<0.001), even after adjusting for other factors. CONCLUSION Retinal vessel density decreased with renal function impairment, underlining the potential value of OCTA to detect early microvascular damage in the kidney in patients with diabetes.
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Affiliation(s)
- Wei Wang
- Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Miao He
- Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Xia Gong
- Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Lanhua Wang
- Department of Preventive Ophthalmology, Zhongshan Ophthalmic Center, Guangzhou, Guangdong, China
| | - Jie Meng
- Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yuting Li
- Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Kun Xiong
- Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Wangting Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Wenyong Huang
- Department of Preventive Ophthalmology, Zhongshan Ophthalmic Center, Guangzhou, Guangdong, China
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20
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Hua D, Xu Y, Zeng X, Yang N, Jiang M, Zhang X, Yang J, He T, Xing Y. Use of optical coherence tomography angiography for assessment of microvascular changes in the macula and optic nerve head in hypertensive patients without hypertensive retinopathy. Microvasc Res 2019; 129:103969. [PMID: 31874131 DOI: 10.1016/j.mvr.2019.103969] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 11/21/2019] [Accepted: 12/17/2019] [Indexed: 01/25/2023]
Abstract
PURPOSE To compare optical coherence tomography angiography (OCTA) screening parameters of the macula and optic nerve head (ONH) between healthy volunteers and chronic hypertensive patients without hypertensive retinopathy. METHODS This was an observational, cross-sectional study. Fifty-seven chronic hypertensive patients without hypertensive retinopathy (22 men and 35 women) and 40 healthy volunteers (17 men and 23 women), ranging in age from 60 to 70 years, were included in this study. Patients and volunteers were divided into three groups and one eye was selected randomly from each participant. Group A comprised patients who had a history of hypertension for >10 years (n = 35); Group B comprised patients who had a history of hypertension for 5-10 years (n = 22); and Group C comprised 40 healthy volunteers who had no history of hypertension. A 3 × 3-mm macula scan and a 4.5 × 4.5-mm ONH scan were performed in each group by OCTA using prototype AngioVue software within the AngioVue device. Vessel density (VD), foveal avascular zone (FAZ) area, choriocapillaris flow area, ONH capillary density, retinal nerve fiber layer (RNFL) thickness, and demographic information were compared among the groups. RESULTS Macula scans showed that superficial plexus VD was significantly lower in groups A and B than in group C (P < 0.05). In addition, FAZ area was significantly larger in group A than in group C (P < 0.05). Inner retinal layer thickness was significantly thinner in groups A and B than in group C (P < 0.05). In ONH scans, RNFL thickness was significantly thinner in group A than in groups B and C (P < 0.05); it was significantly thinner in group B than in group C (P < 0.05). Inside disc capillary density and peripapillary capillary density were significantly lower (P < 0.05) and greater (P < 0.05), respectively, in groups A and B than in group C. CONCLUSIONS Superficial plexus VD, FAZ area, capillary density, and inner retinal thickness changed significantly in hypertensive patients without hypertensive retinopathy. However, only RNFL thickness was significantly thinner in patients who had >10 years of hypertension, compared to patients who had 5-10 years of hypertension. In addition, OCTA provided a method to prospectively assess changes in retinal microvasculature and thickness, thereby avoiding further long-term retinal damage in hypertensive patients.
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Affiliation(s)
- Dihao Hua
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Yishuang Xu
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | | | - Ning Yang
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Mengnan Jiang
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Xiao Zhang
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Jiayi Yang
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China.
| | - Tao He
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China.
| | - Yiqiao Xing
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China.
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