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Al Salmi I, Hannawi S. Birthweight and Lipids in Adult Life: Population-Based Cross Sectional Study. Lipids 2020; 55:365-374. [PMID: 32372421 DOI: 10.1002/lipd.12242] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/04/2020] [Accepted: 04/17/2020] [Indexed: 02/05/2023]
Abstract
The purpose of this study was to examine the association of birthweight with lipid profile in the general adult population. Participants in the second-wave of a nationally representative cross sectional AusDiab-study were asked to complete a birthweight questionnaire. Fasting total cholesterol (TC), LDL-C, HDL-C, and triacylglycerol levels were modeled against birthweight. Four thousand five hundred and two people reported their birthweights, mean (SD) of 3.4(0.7) kg. Females with low birthweight-LBW had higher levels of TC, LDL-C, and triacylglycerols, but no difference in HDL-C, than those with normal-birthweight-NBW;≥2.5 kg. People with LBW showed a trend toward increased risk for high TC (≥5.5 mmol/L) compared to NBW. Among females with LBW, the risk for high LDL-C (≥3.5 mmol/L) was increased compared to those of NBW. The risk for low HDL-C (<0.9 mmol/L) was increased among males with LBW compared to those with NBW. Examination of the relationship on the continuum showed no differences except for high triacylglycerol levels among females with the lowest birthweight quintile compared to the higher birthweight quintile. However, the risk for various abnormalities by birthweight quintiles was similar to that when we used the traditional definition of LBW vs. NBW. Females and males with low birthweight differ in their risk for lipids abnormalities. Females had higher risk for high LDL-C, whereas males had high risk for low HDL-C (<0.9 mmol/L). In addition, females with low birthweight had the highest triacylglycerol levels. High LDL-C, low HDL-C, and high triacylglycerols are well-recognized risk factors for cardiovascular disease.
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Affiliation(s)
- Issa Al Salmi
- The Medicine Department, The Royal Hospital, 23 July Street, P O Box 1331, code 111, Muscat, Oman
| | - Suad Hannawi
- The Medicine Department, MOHAP, PO Box 6552, Dubai, UAE
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2
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Geneid MI, Uusitalo JJ, Leiviskä IL, Saarela VO, Liinamaa MJ. Relation between retinal vessel diameter and posterior segment optical coherence tomography variables in middle-aged Caucasians: the Northern Finland Birth Cohort Eye Study. Br J Ophthalmol 2020; 104:1435-1442. [PMID: 31959591 DOI: 10.1136/bjophthalmol-2019-314803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 12/20/2019] [Accepted: 12/27/2019] [Indexed: 11/04/2022]
Abstract
AIMS Studying the relationship between retinal vessel diameter (RVD) with (1) macular thickness and volume, (2) retinal nerve fibre layer (RNFL), (3) ganglion cell-inner plexiform layer (GC-IPL) and (4) optic nerve head (ONH) in a population cohort of middle-aged Caucasians. METHODS We collected data from 3070 individuals. We used a semiautomated computer-assisted programme to measure central retinal arteriolar equivalent and central retinal venular equivalent. Macular and ONH parameters were assessed by optical coherence tomography. RESULTS Data from 2155 persons were analysed. A larger RVD was associated with a thicker macula and increased macular volume; each SD increase in average macular thickness and volume was associated with a 3.28 µm and a 3.19 µm increase in arteriolar diameter and a 5.10 µm and a 5.08 µm increase in venular diameter, respectively (p<0.001 for all). A larger rim area, greater GC-IPL and RNFL thicknesses were associated with larger RVD; each SD increase in rim area, GC-IPL thickness and RNFL thickness was associated with a 1.21 µm, 2.68 µm and a 3.29 µm increase in arteriolar diameter and a 2.13 µm, 4.02 µm and 5.04 µm increase in venular diameter, respectively (p<0.001 for all). CONCLUSIONS Increased macular thickness, macular volume, GC-IPL thickness, RNFL thickness and optic nerve rim area were associated with larger RVDs in all subjects. This study clarified the anatomical correlations between both macular and ONH parameters with RVD for middle-aged Caucasians; these can represent a basis for further studies investigating the vascular aetiology of eye diseases.
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Affiliation(s)
- Mohamed I Geneid
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland.,Medical Research Center, University of Oulu, Oulu, Finland.,PEDEGO Research Unit, University of Oulu, Oulu, Finland.,Department of Ophthalmology, Päijät-Häme Central Hospital, Lahti, Finland
| | - Janne J Uusitalo
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland.,Medical Research Center, University of Oulu, Oulu, Finland
| | - Ilmari L Leiviskä
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland.,Medical Research Center, University of Oulu, Oulu, Finland
| | - Ville O Saarela
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland.,Medical Research Center, University of Oulu, Oulu, Finland.,PEDEGO Research Unit, University of Oulu, Oulu, Finland
| | - M Johanna Liinamaa
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland .,Medical Research Center, University of Oulu, Oulu, Finland.,PEDEGO Research Unit, University of Oulu, Oulu, Finland
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3
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Goloba M, Raghuraman R, Botros N, Khan U, Klein M, Brown A, Duffy D, Anim-Nyame N, Wang D, Manyonda I, Antonios TF. Early Life Microcirculatory Plasticity and Blood Pressure Changes in Low Birth Weight Infants Born to Normotensive Mothers: A Cohort Study. Am J Hypertens 2019; 32:570-578. [PMID: 30821323 PMCID: PMC6508166 DOI: 10.1093/ajh/hpz034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 02/20/2019] [Accepted: 02/27/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Capillary rarefaction (CR) is an established hallmark of essential hypertension (EH). The aim of this study was to examine early changes in capillary density (CD) and blood pressure (BP) in low birth weight (LBW) infants who are at risk of developing EH in later life. METHODS We studied 77 LBW infants and 284 normal birth weight (NBW) infants, all born to mothers with normotension, in a longitudinal multicenter study. Intravital capillaroscopy was used to measure functional basal capillary density (BCD) and maximal capillary density (MCD) at birth, 3, 6, and 12 months. RESULTS We found that LBW infants, born preterm and at term, had a significantly higher CD at birth, then underwent significant CR in the 1st 3 months culminating in a CD similar to that seen in NBW infants. NBW infants showed a gradual reduction in CD between birth and 12 months. Non-Caucasian ethnicity and preterm birth were significant predictors of a higher CD at birth. Systolic BP in NBW infants increased significantly from birth to 3 months, and we identified a significant negative correlation between systolic BP and MCD. CONCLUSIONS This study has identified a process of early “accelerated capillary remodeling” in LBW infants, which corrects their higher CD at birth. This remodeling is unlikely to explain the CR seen in adult individuals with, or at risk of developing EH. Further follow-up studies are required to determine the timing and mechanisms involved in CR, which is likely to occur after the 1st year of life but before early adulthood.
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Affiliation(s)
- Muti Goloba
- Molecular and Clinical Sciences Research Institute, St George’s, University of London, London, UK
- Blood Pressure Unit, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Rajendra Raghuraman
- Molecular and Clinical Sciences Research Institute, St George’s, University of London, London, UK
| | - Nansi Botros
- Molecular and Clinical Sciences Research Institute, St George’s, University of London, London, UK
| | - Uzma Khan
- Molecular and Clinical Sciences Research Institute, St George’s, University of London, London, UK
| | - Monique Klein
- Molecular and Clinical Sciences Research Institute, St George’s, University of London, London, UK
| | - Amelia Brown
- Molecular and Clinical Sciences Research Institute, St George’s, University of London, London, UK
| | - Donovan Duffy
- Neonatal Unit, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Nick Anim-Nyame
- Obstetrics and Gynaecology Department, Kingston Hospital NHS Foundation Trust, London, UK
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Isaac Manyonda
- Obstetrics and Gynaecology Department, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Tarek F Antonios
- Molecular and Clinical Sciences Research Institute, St George’s, University of London, London, UK
- Blood Pressure Unit, St George’s University Hospitals NHS Foundation Trust, London, UK
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4
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Le D, Alam M, Miao BA, Lim JI, Yao X. Fully automated geometric feature analysis in optical coherence tomography angiography for objective classification of diabetic retinopathy. BIOMEDICAL OPTICS EXPRESS 2019; 10:2493-2503. [PMID: 31149381 PMCID: PMC6524582 DOI: 10.1364/boe.10.002493] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/14/2019] [Accepted: 04/15/2019] [Indexed: 05/10/2023]
Abstract
This study is to establish quantitative features of vascular geometry in optical coherence tomography angiography (OCTA) and validate them for the objective classification of diabetic retinopathy (DR). Six geometric features, including total vessel branching angle (VBA: θ), child branching angles (CBAs: α1 and α2), vessel branching coefficient (VBC), and children-to-parent vessel width ratios (VWR1 and VWR2), were automatically derived from each vessel branch in OCTA. Comparative analysis of heathy control, diabetes with no DR (NoDR), and non-proliferative DR (NPDR) was conducted. Our study reveals four quantitative OCTA features to produce robust DR detection and staging classification: (ANOVA, P<0.05), VBA, CBA1, VBC, and VWR1.
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Affiliation(s)
- David Le
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60607, USA
- These authors contributed equally to this work
| | - Minhaj Alam
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60607, USA
- These authors contributed equally to this work
| | | | - Jennifer I. Lim
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Xincheng Yao
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60607, USA
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA
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5
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Souza LV, De Meneck F, Oliveira V, Higa EM, Akamine EH, Franco MDC. Detrimental Impact of Low Birth Weight on Circulating Number and Functional Capacity of Endothelial Progenitor Cells in Healthy Children: Role of Angiogenic Factors. J Pediatr 2019; 206:72-77.e1. [PMID: 30798839 DOI: 10.1016/j.jpeds.2018.10.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 09/27/2018] [Accepted: 10/23/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To provide a comprehensive assessment of the relationship of birth weight with both endothelial progenitor cell function and angiogenic factors in children. STUDY DESIGN Anthropometric measures, biochemical profile, endothelial progenitor cell number, endothelial progenitor cell colony-forming units, vascular endothelial growth factor-A, and nitric oxide plasma levels of 58 children aged 7-11 years were determined. RESULTS A positive correlation was observed between birth weight and circulating endothelial progenitor cell number (r= 0.461; P= .001), endothelial progenitor cell colony-forming units (r= 0.512; P < .001), vascular endothelial growth factor-A (r= 0.407; P= .002), and nitric oxide (r= 0.547; P < .001) levels, whereas the adjustment for prematurity, family history of cardiovascular disease, and systolic blood pressure levels did not modify these associations. CONCLUSION Low birth weight was associated with a decrease in the circulating/functional capacity of endothelial progenitor cells among healthy children, independent of traditional cardiovascular risk factors. This detrimental impact was accompanied by lower circulating levels of angiogenic factors.
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Affiliation(s)
- Livia Victorino Souza
- Division of Nephrology, School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Franciele De Meneck
- Division of Nephrology, School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Vanessa Oliveira
- Division of Nephrology, School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Elisa Mieko Higa
- Division of Nephrology, School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Eliana Hiromi Akamine
- Pharmacology Department, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Maria do Carmo Franco
- Division of Nephrology, School of Medicine, Federal University of São Paulo, São Paulo, Brazil.
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6
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Huang F, Dashtbozorg B, Tan T, Ter Haar Romeny BM. Retinal artery/vein classification using genetic-search feature selection. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2018; 161:197-207. [PMID: 29852962 DOI: 10.1016/j.cmpb.2018.04.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 03/09/2018] [Accepted: 04/17/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND OBJECTIVES The automatic classification of retinal blood vessels into artery and vein (A/V) is still a challenging task in retinal image analysis. Recent works on A/V classification mainly focus on the graph analysis of the retinal vasculature, which exploits the connectivity of vessels to improve the classification performance. While they have overlooked the importance of pixel-wise classification to the final classification results. This paper shows that a complicated feature set is efficient for vessel centerline pixels classification. METHODS We extract enormous amount of features for vessel centerline pixels, and apply a genetic-search based feature selection technique to obtain the optimal feature subset for A/V classification. RESULTS The proposed method achieves an accuracy of 90.2%, the sensitivity of 89.6%, the specificity of 91.3% on the INSPIRE dataset. It shows that our method, using only the information of centerline pixels, gives a comparable performance as the techniques which use complicated graph analysis. In addition, the results on the images acquired by different fundus cameras show that our framework is capable for discriminating vessels independent of the imaging device characteristics, image resolution and image quality. CONCLUSION The complicated feature set is essential for A/V classification, especially on the individual vessels where graph-based methods receive limitations. And it could provide a higher entry to the graph-analysis to achieve a better A/V labeling.
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Affiliation(s)
- Fan Huang
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Behdad Dashtbozorg
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Tao Tan
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Mammography, ScreenPoint Medical, Nijmegen, The Netherlands
| | - Bart M Ter Haar Romeny
- Department of Biomedical and Information Engineering, Northeastern University, Shenyang, China; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
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7
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Tapp RJ, Hughes AD, Kähönen M, Wong TY, Witt N, Lehtimäki T, Hutri-Kähönen N, Sahota P, Juonala M, Raitakari OT. Cardiometabolic Health Among Adult Offspring of Hypertensive Pregnancies: The Cardiovascular Risk in Young Finns Study. J Am Heart Assoc 2018; 7:JAHA.117.006284. [PMID: 29306901 PMCID: PMC5778953 DOI: 10.1161/jaha.117.006284] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background Cardiometabolic health among adult offspring of hypertensive disorders of pregnancy (HDP) is relatively unknown. We hypothesized that offspring of HDP would have abnormalities in the retinal microvasculature and cardiac structure by midadulthood. Methods and Results The Cardiovascular Risk in Young Finns Study included randomly selected children from 5 Finnish university cities. The mean age of participants was 40 years (range 34–49 years) at the time of retinal photography and cardiac assessment. Offspring born ≥37 weeks of gestation and appropriate for gestational age (n=1006) were included. Offspring of HDP had higher systolic blood pressure (β=4.68, P<0.001), body mass index (β=1.25, P=0.009), and waist circumference (β=0.25, P=0.042), compared with offspring of normotensive pregnancies. However, no differences in fasting glucose, insulin, lipid profile, carotid intima media thickness, or brachial artery flow‐mediated dilatation were shown. Retinal arteriolar diameters were narrower (β=−0.43, P=0.009) and longer (β=32.5, P=0.023) and the arteriolar length‐to‐diameter ratio was higher (β=2.32, P=0.006) among offspring of HDP, after adjustment for age and sex. Left atrial volume indexed to body surface area (β=1.34, P=0.040) was increased. Adjustment for the confounding effects of birth weight, body mass index, smoking and socioeconomic status, and the mediating effect of hypertension had little impact on the associations. Conclusions Abnormalities of the retinal microvasculature and cardiac structure are seen in offspring of HDP in midadulthood. These findings may need to be considered in future primary prevention strategies of cardiovascular disease among offspring of HDP.
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Affiliation(s)
- Robyn J Tapp
- Melbourne School of Population and Global Health University of Melbourne, Australia .,School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, United Kingdom.,Department of Optometry and Vision Sciences, The University of Melbourne, Australia
| | - Alun D Hughes
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Mika Kähönen
- Department of Clinical Physiology, Tampere University Hospital and the University of Tampere, Finland
| | - Tien Yin Wong
- Singapore National Eye Center, Singapore & Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Nicholas Witt
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories and School of Medicine, University of Tampere, Finland
| | - Nina Hutri-Kähönen
- Department of Pediatrics, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Pinki Sahota
- School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, United Kingdom
| | - Markus Juonala
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland.,Turku University Hospital, Turku, Finland
| | - Olli T Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland.,Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
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Li LJ, Ikram MK, Wong TY. Retinal vascular imaging in early life: insights into processes and risk of cardiovascular disease. J Physiol 2015; 594:2175-203. [PMID: 26435039 DOI: 10.1113/jp270947] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 09/28/2015] [Indexed: 12/18/2022] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality globally. In recent years, studies have shown that the origins of CVD may be traced to vascular and metabolic processes in early life. Retinal vascular imaging is a new technology that allows detailed non-invasive in vivo assessment and monitoring of the microvasculature. In this systematic review, we described the application of retinal vascular imaging in children and adolescents, and we examined the use of retinal vascular imaging in understanding CVD risk in early life. We reviewed all publications with quantitative retinal vascular assessment in two databases: PubMed and Scopus. Early life CVD risk factors were classified into four groups: birth risk factors, environmental risk factors, systemic risk factors and conditions linked to future CVD development. Retinal vascular changes were associated with lower birth weight, shorter gestational age, low-fibre and high-sugar diet, lesser physical activity, parental hypertension history, childhood hypertension, childhood overweight/obesity, childhood depression/anxiety and childhood type 1 diabetes mellitus. In summary, there is increasing evidence supporting the view that structural changes in the retinal microvasculature are associated with CVD risk factors in early life. Thus, the retina is a useful site for pre-clinical assessment of microvascular processes that may underlie the future development of CVD in adulthood.
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Affiliation(s)
- Ling-Jun Li
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Duke-NUS Graduate Medical School, National University of Singapore, Singapore
| | - Mohammad Kamran Ikram
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Duke-NUS Graduate Medical School, National University of Singapore, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Duke-NUS Graduate Medical School, National University of Singapore, Singapore
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Tapp RJ, Hussain SM, Battista J, Hutri-Kähönen N, Lehtimäki T, Hughes AD, Thom SAM, Metha A, Raitakari OT, Kähönen M. Impact of blood pressure on retinal microvasculature architecture across the lifespan: the Young Finns Study. Microcirculation 2015; 22:146-55. [PMID: 25559612 DOI: 10.1111/micc.12187] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 01/02/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The present study examined the impact of BP from childhood to mid-adulthood on retinal microvascular architecture. METHODS The Cardiovascular Risk in Young Finns Study included children aged 3-18 years, from five Finnish University cities, with participants chosen randomly from the national population registrar from those areas. The age of participants included in the current analyses in childhood (1980) ranged from three to nine years and in mid-adulthood (2011) ranged from 34 to 40 years (complete data n = 657). Measures of retinal microvasculature architecture measured in adulthood included diameters, tortuosity, lengths, and LDR. RESULTS Regression analysis showed a strong negative association between childhood systolic BP and adult arteriolar diameter (standardized regression coefficient [β] -0.300; p < 0.001) and with change in systolic BP from childhood to adulthood (β = -0.249; p < 0.001). For arteriolar tortuosity, there was a strong positive association between childhood systolic BP and adult arteriolar tortuosity (β = 0.154; p < 0.001) and no association with change in systolic BP from childhood to adulthood (β = 0.072; p = 0.110). CONCLUSIONS High BP in childhood and increased BP from childhood to adulthood impacts on retinal microvascular architecture in mid-adulthood.
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Affiliation(s)
- Robyn J Tapp
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, Victoria, Australia
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10
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Hussain SM, Kähönen M, Raitakari OT, Skilton MR, Witt N, Chaturvedi N, Hutri-Kähönen N, Lehtimäki T, Vaahtoranta-Lehtonen H, Juonala M, Wijetunge S, Hughes AD, McG Thom SA, Metha A, Tapp RJ. Impact of Fetal Growth and Preterm Birth on the Retinal Microvasculature in Mid-Adulthood. Microcirculation 2015; 22:285-93. [DOI: 10.1111/micc.12197] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 02/26/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Sultana Monira Hussain
- Department of Optometry and Vision Sciences; The University of Melbourne; Parkville Victoria Australia
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Victoria Australia
| | - Mika Kähönen
- Department of Clinical Physiology; Tampere University Hospital and the University of Tampere; Tampere Finland
| | - Olli T. Raitakari
- The Research Centre of Applied and Preventive Cardiovascular Medicine; University of Turku; Turku Finland
- Department of Clinical Physiology and Nuclear Medicine; Turku University Hospital; Turku Finland
| | - Michael R. Skilton
- Boden Institute of Obesity Nutrition Exercise and Eating Disorders; University of Sydney; Sydney New South Wales Australia
| | - Nicholas Witt
- International Centre for Circulatory Health; NHLI; Imperial College; London and Imperial College Healthcare NHS Trust; London UK
| | - Nish Chaturvedi
- International Centre for Circulatory Health; NHLI; Imperial College; London and Imperial College Healthcare NHS Trust; London UK
| | - Nina Hutri-Kähönen
- Department of Pediatrics; University of Tampere and Tampere University Hospital; Tampere Finland
| | - Terho Lehtimäki
- Department of Clinical Chemistry; Fimlab Laboratories; University of Tampere School of Medicine; Tampere Finland
| | | | - Markus Juonala
- Division of Medicine; Turku University Hospital; Turku Finland
| | - Sumangali Wijetunge
- International Centre for Circulatory Health; NHLI; Imperial College; London and Imperial College Healthcare NHS Trust; London UK
| | - Alun D. Hughes
- International Centre for Circulatory Health; NHLI; Imperial College; London and Imperial College Healthcare NHS Trust; London UK
- Institute of Cardiovascular Science; University College London; London UK
| | - Simon A. McG Thom
- International Centre for Circulatory Health; NHLI; Imperial College; London and Imperial College Healthcare NHS Trust; London UK
| | - Andrew Metha
- Department of Optometry and Vision Sciences; The University of Melbourne; Parkville Victoria Australia
| | - Robyn J. Tapp
- Department of Optometry and Vision Sciences; The University of Melbourne; Parkville Victoria Australia
- The Melbourne School of Population and Global Health; The University of Melbourne; Parkville Victoria Australia
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12
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Raghuraman RP, D'Souza R, Nathan P, Wang D, Manyonda IT, Antonios TFT. Skin capillary density in infants born to normotensive mothers: a comparison between singleton and twin infants. Microcirculation 2014; 21:67-73. [PMID: 23844560 DOI: 10.1111/micc.12076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 07/09/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Twin infants tend to have LBW and microvascular alterations but do not appear to have an increase in cardiovascular mortality later in life as singleton infants. We hypothesized that twin infants born to normotensive mothers would not have capillary rarefaction at birth. METHODS We studied 26 dizygotic twin infants and compared them with 115 consecutive singleton infants to normotensive mothers. We used orthogonal polarized spectroscopy to measure basal (i.e., functional) and maximal (i.e., structural) skin capillary density according to a well-standardized protocol. RESULTS Twin infants have significantly higher BCD (mean difference 4.3 capillaries/mm(2) , 95% CI: 0.4, 8.1, p = 0.03) and have marginally significantly higher MCD (mean difference 3.9 capillaries/mm(2) , 95% CI: -0.6, 8.3, p = 0.086) compared to singleton infants. Birth weight was significantly associated with BCD and MCD (p = 0.003 and 0.006). CONCLUSIONS Twin infants with low and NBWs tend to have higher functional and structural capillary densities compared to singleton infants. Further longitudinal studies of skin capillary density and of retinal vascular parameters commencing from birth to various stages in early childhood are essential to identify the dynamics and the exact timing, if any, of the remodeling of microcirculation in these individuals.
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Affiliation(s)
- Rajendra P Raghuraman
- Blood Pressure Unit & Division of Clinical Sciences, St. George's, University of London, London, UK
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13
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Aortic growth arrest after preterm birth: a lasting structural change of the vascular tree. J Dev Orig Health Dis 2014; 2:218-25. [PMID: 25141166 DOI: 10.1017/s2040174411000274] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Young people who are born very preterm exhibit a narrower arterial tree as compared with people born at term. We hypothesized that such arterial narrowing occurs as a direct result of premature birth. The aim of this study was to compare aortic and carotid artery growth in infants born preterm and at term. Observational and longitudinal cohort study of 50 infants (21 born very preterm, all appropriate for gestational age, 29 controls born at term) was conducted. Diameters of the upper abdominal aorta and common carotid artery were measured with ultrasonography at three months before term, at term and three months after term-equivalent age. At the first assessment, the aortic end-diastolic diameter (aEDD) was slightly larger in very preterm infants as compared with fetal dimensions. Fetal aortic EDD increased by 2.6 mm during the third trimester, whereas very preterm infants exhibited 0.9 mm increase in aEDD during the same developmental period (P < 0.001 for group difference). During the following 3-month period, aortic growth continued unchanged (+0.9 mm) in very preterm infants, whereas postnatal growth in term controls slowed down to +1.3 mm (P < 0.001 v. fetal aortic growth). At the final examination, aEDD was 22% and carotid artery EDD was 14% narrower in infants born preterm compared with controls, also after adjusting for current weight (P < 0.01). Aortic and carotid artery growth is impaired after very preterm birth, resulting in arterial narrowing. Arterial growth failure may be a generalized vascular phenomenon after preterm birth, with implications for cardiovascular morbidity in later life.
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Habib MS, Al-Diri B, Hunter A, Steel DHW. The association between retinal vascular geometry changes and diabetic retinopathy and their role in prediction of progression--an exploratory study. BMC Ophthalmol 2014; 14:89. [PMID: 25001248 PMCID: PMC4094636 DOI: 10.1186/1471-2415-14-89] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 06/30/2014] [Indexed: 11/12/2022] Open
Abstract
Background The study describes the relationship of retinal vascular geometry (RVG) to severity of diabetic retinopathy (DR), and its predictive role for subsequent development of proliferative diabetic retinopathy (PDR). Methods The research project comprises of two stages. Firstly, a comparative study of diabetic patients with different grades of DR. (No DR: Minimal non-proliferative DR: Severe non-proliferative DR: PDR) (10:10: 12: 19). Analysed RVG features including vascular widths and branching angles were compared between patient cohorts. A preliminary statistical model for determination of the retinopathy grade of patients, using these features, is presented. Secondly, in a longitudinal predictive study, RVG features were analysed for diabetic patients with progressive DR over 7 years. RVG at baseline was examined to determine risk for subsequent PDR development. Results In the comparative study, increased DR severity was associated with gradual vascular dilatation (p = 0.000), and widening of the bifurcating angle (p = 0.000) with increase in smaller-child-vessel branching angle (p = 0.027). Type 2 diabetes and increased diabetes duration were associated with increased vascular width (p = <0.05 In the predictive study, at baseline, reduced small-child vascular width (OR = 0.73 (95% CI 0.58-0.92)), was predictive of future progression to PDR. Conclusions The study findings suggest that RVG alterations can act as novel markers indicative of progression of DR severity and establishment of PDR. RVG may also have a potential predictive role in determining the risk of future retinopathy progression.
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Affiliation(s)
- Maged S Habib
- Sunderland Eye Infirmary - Queen Alexandra Road, Sunderland SR2 9HP, UK.
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15
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Huyard F, Yzydorczyk C, Castro MM, Cloutier A, Bertagnolli M, Sartelet H, Germain N, Comte B, Schulz R, DeBlois D, Nuyt AM. Remodeling of aorta extracellular matrix as a result of transient high oxygen exposure in newborn rats: implication for arterial rigidity and hypertension risk. PLoS One 2014; 9:e92287. [PMID: 24743169 PMCID: PMC3990546 DOI: 10.1371/journal.pone.0092287] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 02/20/2014] [Indexed: 12/22/2022] Open
Abstract
Neonatal high-oxygen exposure leads to elevated blood pressure, microvascular rarefaction, vascular dysfunction and arterial (aorta) rigidity in adult rats. Whether structural changes are present in the matrix of aorta wall is unknown. Considering that elastin synthesis peaks in late fetal life in humans, and early postnatal life in rodents, we postulated that transient neonatal high-oxygen exposure can trigger premature vascular remodelling. Sprague Dawley rat pups were exposed from days 3 to 10 after birth to 80% oxygen (vs. room air control) and were studied at 4 weeks. Blood pressure and vasomotor response of the aorta to angiotensin II and to the acetylcholine analogue carbachol were not different between groups. Vascular superoxide anion production was similar between groups. There was no difference between groups in aortic cross sectional area, smooth muscle cell number or media/lumen ratio. In oxygen-exposed rats, aorta elastin/collagen content ratio was significantly decreased, the expression of elastinolytic cathepsin S was increased whereas collagenolytic cathepsin K was decreased. By immunofluorescence we observed an increase in MMP-2 and TIMP-1 staining in aortas of oxygen-exposed rats whereas TIMP-2 staining was reduced, indicating a shift in the balance towards degradation of the extra-cellular matrix and increased deposition of collagen. There was no significant difference in MMP-2 activity between groups as determined by gelatin zymography. Overall, these findings indicate that transient neonatal high oxygen exposure leads to vascular wall alterations (decreased elastin/collagen ratio and a shift in the balance towards increased deposition of collagen) which are associated with increased rigidity. Importantly, these changes are present prior to the elevation of blood pressure and vascular dysfunction in this model, and may therefore be contributory.
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Affiliation(s)
- Fanny Huyard
- Sainte-Justine University Hospital Research Center, Department of Paediatrics, Université de Montréal, Montreal, Québec, Canada
| | - Catherine Yzydorczyk
- Sainte-Justine University Hospital Research Center, Department of Paediatrics, Université de Montréal, Montreal, Québec, Canada
| | - Michele M. Castro
- Departments of Pediatrics & Pharmacology, Cardiovascular Research Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Anik Cloutier
- Sainte-Justine University Hospital Research Center, Department of Paediatrics, Université de Montréal, Montreal, Québec, Canada
| | - Mariane Bertagnolli
- Sainte-Justine University Hospital Research Center, Department of Paediatrics, Université de Montréal, Montreal, Québec, Canada
| | - Hervé Sartelet
- Sainte-Justine University Hospital Research Center, Department of Pathology, Université de Montréal, Montreal, Québec, Canada
| | - Nathalie Germain
- Sainte-Justine University Hospital Research Center, Department of Paediatrics, Université de Montréal, Montreal, Québec, Canada
| | - Blandine Comte
- Unit of Human Nutrition UMR 1019, INRA, Research Centre of Clermont-Ferrand/Theix, Saint-Genès-Champanelle, France
| | - Richard Schulz
- Departments of Pediatrics & Pharmacology, Cardiovascular Research Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Denis DeBlois
- Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada
| | - Anne Monique Nuyt
- Sainte-Justine University Hospital Research Center, Department of Paediatrics, Université de Montréal, Montreal, Québec, Canada
- * E-mail:
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Sasongko MB, Wong TY, Wang JJ. Retinal microvascular structure: determinants and potential utility of novel imaging measurements. EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/eop.10.27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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17
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Tapp RJ, Ness A, Williams C, Howe LD, Tilling K, Witt N, Chaturvedi N, McG Thom SA, Hughes AD. Differential Effects of Adiposity and Childhood Growth Trajectories on Retinal Microvascular Architecture. Microcirculation 2013; 20:609-16. [DOI: 10.1111/micc.12060] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 03/17/2013] [Indexed: 11/28/2022]
Affiliation(s)
| | - Andrew Ness
- School of Oral and Dental Sciences; University of Bristol; Bristol; UK
| | - Cathy Williams
- Centre for Child and Adolescent Health; University of Bristol; Bristol; UK
| | | | - Kate Tilling
- School of Social and Community Medicine; University of Bristol; Bristol; UK
| | - Nicholas Witt
- International Centre for Circulatory Health; NHLI; St Mary's Hospital & Imperial College London; London; UK
| | - Nish Chaturvedi
- International Centre for Circulatory Health; NHLI; St Mary's Hospital & Imperial College London; London; UK
| | - Simon A. McG Thom
- International Centre for Circulatory Health; NHLI; St Mary's Hospital & Imperial College London; London; UK
| | - Alun D. Hughes
- International Centre for Circulatory Health; NHLI; St Mary's Hospital & Imperial College London; London; UK
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Li R, Yang X, Wang Y, Chu Z, Liu T, Zhu T, Gao X, Ma Z. Effect(s) of preterm birth on normal retinal vascular development and oxygen-induced retinopathy in the neonatal rat. Curr Eye Res 2013; 38:1266-73. [PMID: 23885967 DOI: 10.3109/02713683.2013.813556] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Maturity is a critical factor in the pathogenesis of retinopathy of prematurity (ROP). One widely used method for studying this condition is that of oxygen-induced retinopathy (OIR). The general conditions of an OIR term animal, both at the time of birth and following birth, differ from those of the preterm infant. This, to simulate preterm conditions and to provide a basis for further studies on ROP, we investigated the effect(s) of preterm birth on retinal vascularization using the neonatal rat. MATERIALS AND METHODS Sprague-Dawley (SD) rats were delivered preterm by caesarean section on the day 19 of gestation. Term pups were used as controls. On the day of birth, preterm and term pups were housed under conditions of room air or cyclic oxygen. Retinas of pups housed in room air on days 4, 7, 10, 14, 18 and 22, as well as pups housed in oxygen on days 14, 18, and 22 were whole-mounted and stained with isolectin-B4. On day 18, cross-sections of the retina were cut and stained with hematoxylin and eosin for the identification of preretinal neovascular tufts. Images of avascular and neovascular areas were compared using light and fluorescence microscopy. RESULTS Preterm pups had significantly larger avascular retinal areas than term rats on the various postnatal days. After exposure to cyclic oxygen, preterm pups demonstrated significantly larger avascular (days 14 and 18) and neovascular areas (day 18) compared with term rats. On day 22, residual retinopathy of preterm pups was greater than that of term pups. CONCLUSIONS Preterm birth of rats, which are comparable in their physiology to humans, had negative effects on retinal vascularization. The impaired retinal vascular development and subsequent vasoproliferation resulting from hyperoxia in preterm pups is more severe and enduring.
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Affiliation(s)
- Rong Li
- Department of Ophthalmology, Xijing Hospital, Fourth Military Medical University , Xi'an, Shaanxi , China
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Grinton ME, Laude A, MacGillivray T, Henderson R, Starr JM, Deary IJ, Aspinall P, Dhillon B. The Association Between Retinal Vessel Morphology and Retinal Nerve Fiber Layer Thickness in an Elderly Population. Ophthalmic Surg Lasers Imaging Retina 2012; 43:S61-6. [DOI: 10.3928/15428877-20120802-03] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 05/02/2012] [Indexed: 11/20/2022]
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20
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Affiliation(s)
- Harry A J Struijker-Boudier
- Departments of Pharmacology, Maastricht University, room 4.254, Universiteitssingel 50, 6229 ER, Maastricht, The Netherlands.
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Kandasamy Y, Smith R, Wright IMR, Hartley L. Relationship between birth weight and retinal microvasculature in newborn infants. J Perinatol 2012; 32:443-7. [PMID: 21941229 PMCID: PMC3365284 DOI: 10.1038/jp.2011.118] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The purposes of this study were to determine the normal retinal microvasculature measurements in human infants who are born at term and to determine whether birth weight influences measurements of retinal microvasculature. STUDY DESIGN Retinal arteriole and venule measurements were obtained in a cohort of 24 infants who were born at term. Digital images of both the retinas were obtained using a digital retinal camera after pupillary dilation. RESULT In all, 24 newborn infants born at term (12 females and 12 males) were analyzed in this study. The measured retinal arteriole diameters were from 66.8 to 147.8 μm (mean, 94.2±19.6 μm), and the venule diameters were from 102.0 to 167.8 μm (mean, 135.2±19.1 μm). Seven babies in the sample had low birth weight (LBW), while 17 babies were born with normal weight. Babies with lower birth weights had larger arteriole (113.1±17.9 μm vs 86.4±14.4 μm; P=0.0009) and venule diameters (151.7±14.9 μm vs 128.4±16.9 μm; P=0.0040). CONCLUSION Retinal venules and arterioles in LBW babies are larger compared with those of normal-birth-weight babies. We postulate that the difference observed in our study was due to in utero pathophysiological changes that occurred in the cerebral circulation of growth-restricted fetuses.
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Affiliation(s)
- Y Kandasamy
- Department of Neonatology, The Townsville Hospital, Douglas, QLD, Australia.
| | - R Smith
- Mother and Babies' Research Unit/University of Newcastle John Hunter Hospital, Hunter Region Mail Centre, Newcastle, NSW, Australia
| | - I M R Wright
- Mother and Babies' Research Unit/University of Newcastle John Hunter Hospital, Hunter Region Mail Centre, Newcastle, NSW, Australia
| | - L Hartley
- Department of Neonatology, The Townsville Hospital, Douglas, QLD, Australia
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Bonamy AKE, Källén K, Norman M. High blood pressure in 2.5-year-old children born extremely preterm. Pediatrics 2012; 129:e1199-204. [PMID: 22473369 DOI: 10.1542/peds.2011-3177] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Adolescents and young adults born preterm have elevated blood pressure (BP). The objective of this study was to investigate if BP is elevated at 2.5 years of age after an extremely preterm birth (EXPT). METHODS In a regional subset of the national population-based cohort Extremely Preterm Infants in Sweden Study, BP at 2.5 years of age was studied in 68 survivors of EXPT (gestational age: 23.6-26.9 weeks; mean ± SD birth weight: 810 ± 164 g), and 65 matched controls born at term. RESULTS At follow-up at 2.5 years of corrected age, EXPT children had significantly higher systolic blood pressure (SBP) and diastolic blood pressure (DBP) z scores than controls born at term, according to pediatric BP nomograms by age, gender, and height. The proportion of SBP ≥90th percentile was 44% (30 of 68) in EXPT children and 23% (15 of 65) in controls (P = .01). In logistic regression analyses stratified according to gender, EXPT was associated with an odds ratio for a SBP ≥90th percentile of 3.32 (95% confidence interval: 1.25-8.81) among boys. The corresponding odds ratio among EXPT girls was 2.18 (95% confidence interval: 0.62-7.61). In EXPT children, SBP and DBP z scores were inversely correlated to catch-up growth from 36 weeks' postmenstrual age to follow-up at 2.5 years of age. CONCLUSIONS Children born extremely preterm have elevated office SBP and DBP at a corrected age of 2.5 years. This finding might have implications for their cardiovascular health later in life.
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Kandasamy Y, Smith R, Wright IMR. Retinal microvascular changes in low-birth-weight babies have a link to future health. J Perinat Med 2012; 40:209-14. [PMID: 22150014 DOI: 10.1515/jpm.2011.116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In utero insults that result in low-birth-weight (LBW) infants are now recognized risk factors for the development of vascular-related diseases in adulthood. Microcirculatory pathologies are believed to form a mechanistic link between fetal insult and the manifestation of illness in adulthood. OBJECTIVES The challenge has been to investigate microcirculatory changes in vivo. The objective of this review is to determine whether LBW infants and individuals undergo abnormal microvascular changes and, if so, whether these changes can be objectively identified and measured by investigating retinal vessels. METHODS An online publication search was carried out using the following keywords to identify and review relevant articles: retinal microvasculature, retinal vessels, small for gestation age, growth restriction, and intrauterine growth restriction. Articles published from 1980 to 2011 were considered. CONCLUSIONS The ability of retinal imaging technology to assess and measure retinal microvasculature makes it a valuable assessment tool. The current tool is, however, unsuitable for non-invasive assessment in infants and young children. Once this hurdle has been overcome, a longitudinal study of LBW individuals from infancy to adulthood, with regular retinal microvascular assessments, would help prove the mechanistic link between LBW and cardiovascular disease in adulthood.
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Hughes AD. Genetic and Early Life Influences on the Human Retinal Microcirculation. Basic Clin Pharmacol Toxicol 2011; 110:19-25. [DOI: 10.1111/j.1742-7843.2011.00817.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kandasamy Y, Smith R, Wright IM. Retinal microvasculature measurements in full-term newborn infants. Microvasc Res 2011; 82:381-4. [DOI: 10.1016/j.mvr.2011.07.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Revised: 07/27/2011] [Accepted: 07/28/2011] [Indexed: 10/17/2022]
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D'Souza R, Raghuraman RP, Nathan P, Manyonda IT, Antonios TF. Low Birth Weight Infants Do Not Have Capillary Rarefaction at Birth. Hypertension 2011; 58:847-51. [DOI: 10.1161/hypertensionaha.111.179226] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Low birth weight predicts adult essential hypertension and is linked to increased cardiovascular mortality in adult life. A reduction in capillary density (ie, rarefaction) is a hallmark of essential hypertension, and evidence suggests that rarefaction precedes the onset of the rise in blood pressure, because it is found in normotensive individuals at high risk of developing hypertension, suggesting that rarefaction is likely to be a primary structural abnormality. We hypothesized that low birth weight infants would have significant capillary rarefaction at birth. We studied 44 low birth weight infants born to normotensive mothers (33 were born preterm, birth weight: 1823±446 g; and 11 were born at term, birth weight: 2339±177 g) and compared them with 71 infants born at term with normal weight (birth weight: 3333±519 g). We used orthogonal polarized spectroscopy to measure basal (ie, functional) and maximal (ie, structural) skin capillary densities. Low birth weight infants, whether born preterm or at term, had significantly higher functional capillary density (mean difference of 10.5 capillaries per millimeter squared; 95% CI: 6.6–14.4 capillaries per millimeter squared;
P
<0.0001) and higher structural capillary density (mean difference of 11.1 capillaries per millimeter squared; 95% CI: 7.6–14.5 capillaries per millimeter squared;
P
<0.0001) when compared with normal weight term infants. We conclude that low birth weight infants born to normotensive mothers do not have capillary rarefaction at birth. These results contradict what might have been predicted from the concept of the intrauterine origins of adult disease and suggest that microcirculatory abnormalities observed in individuals of low birth weight occur in postnatal life rather than during their intrauterine existence.
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Affiliation(s)
- Rohan D'Souza
- From the Blood Pressure Unit and Department of Clinical Sciences (R.D., R.P.R., P.N., T.F.T.A.), St George's, University of London, London, United Kingdom; Department of Obstetrics and Gynaecology (R.D., I.T.M.), St George's Hospital National Health Service Trust, London, United Kingdom
| | - Rajendra P. Raghuraman
- From the Blood Pressure Unit and Department of Clinical Sciences (R.D., R.P.R., P.N., T.F.T.A.), St George's, University of London, London, United Kingdom; Department of Obstetrics and Gynaecology (R.D., I.T.M.), St George's Hospital National Health Service Trust, London, United Kingdom
| | - Preetha Nathan
- From the Blood Pressure Unit and Department of Clinical Sciences (R.D., R.P.R., P.N., T.F.T.A.), St George's, University of London, London, United Kingdom; Department of Obstetrics and Gynaecology (R.D., I.T.M.), St George's Hospital National Health Service Trust, London, United Kingdom
| | - Isaac T. Manyonda
- From the Blood Pressure Unit and Department of Clinical Sciences (R.D., R.P.R., P.N., T.F.T.A.), St George's, University of London, London, United Kingdom; Department of Obstetrics and Gynaecology (R.D., I.T.M.), St George's Hospital National Health Service Trust, London, United Kingdom
| | - Tarek F.T. Antonios
- From the Blood Pressure Unit and Department of Clinical Sciences (R.D., R.P.R., P.N., T.F.T.A.), St George's, University of London, London, United Kingdom; Department of Obstetrics and Gynaecology (R.D., I.T.M.), St George's Hospital National Health Service Trust, London, United Kingdom
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Nistala R, Hayden MR, DeMarco VG, Henriksen EJ, Lackland DT, Sowers JR. Prenatal Programming and Epigenetics in the Genesis of the Cardiorenal Syndrome. Cardiorenal Med 2011; 1:243-254. [PMID: 22096456 PMCID: PMC3214897 DOI: 10.1159/000332756] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The presence of a group of interacting maladaptive factors, including hypertension, insulin resistance, metabolic dyslipidemia, obesity, and microalbuminuria and/or reduced renal function, collectively constitutes the cardiorenal metabolic syndrome (CRS). Nutritional and other environmental cues during fetal development can permanently affect the composition, homeostatic systems, and functions of multiple organs and systems; this process has been referred to as 'programming'. Since the original formulation of the notion that low birth weight is a proxy for 'prenatal programming' of adult hypertension and cardiovascular disease, evidence has also emerged for programming of kidney disease, insulin resistance, obesity, metabolic dyslipidemia, and other chronic diseases. The programming concept was initially predicated on the notion that in utero growth restriction due to famine was responsible for increased hypertension, and cardiovascular and renal diseases. On the other hand, we are now more commonly exposed to increasing rates of maternal obesity. The current review will discuss the overarching role of maternal overnutrition, as well as fetal undernutrition, in epigenetic programming in relation to the pathogenesis of the CRS in children and adults.
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Affiliation(s)
- Ravi Nistala
- University of Missouri Diabetes Cardiovascular Center, Columbia, Mo., USA
| | - Melvin R. Hayden
- University of Missouri Diabetes Cardiovascular Center, Columbia, Mo., USA
| | - Vincent G. DeMarco
- University of Missouri Diabetes Cardiovascular Center, Columbia, Mo., USA
- Department of Physiology and Pharmacology, Columbia, Mo., USA
| | - Erik J. Henriksen
- Department of Physiology, University of Arizona College of Medicine, Tucson, Ariz., USA
| | - Daniel T. Lackland
- Department of Neurosciences, Medical University of South Carolina, Charleston, S.C., USA
| | - James R. Sowers
- University of Missouri Diabetes Cardiovascular Center, Columbia, Mo., USA
- Department of Physiology and Pharmacology, Columbia, Mo., USA
- Harry S. Truman VA Medical Center, Columbia, Mo., USA
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CLOUGH GERALDINEF, NORMAN MIKAEL. The Microcirculation: A Target for Developmental Priming. Microcirculation 2011; 18:286-97. [DOI: 10.1111/j.1549-8719.2011.00087.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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30
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Doubal FN, de Haan R, MacGillivray TJ, Cohn-Hokke PE, Dhillon B, Dennis MS, Wardlaw JM. Retinal arteriolar geometry is associated with cerebral white matter hyperintensities on magnetic resonance imaging. Int J Stroke 2011; 5:434-9. [PMID: 21050397 PMCID: PMC3489044 DOI: 10.1111/j.1747-4949.2010.00483.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Cerebral small vessel disease (lacunar stroke and cerebral white matter hyperintensities) is caused by vessel abnormalities of unknown aetiology. Retinal vessels show developmental and pathophysiological similarities to cerebral small vessels and microvessel geometry may influence vascular efficiency. Hypothesis Retinal arteriolar branching angles or coefficients (the ratio of the sum of the cross-sectional areas of the two daughter vessels to the cross-sectional area of the parent vessel at an arteriolar bifurcation) may be associated with cerebral small vessel disease. Methods We performed a cross-sectional observational study in a UK tertiary referral hospital. An experienced stroke physician recruited consecutive patients presenting with lacunar ischaemic stroke with a control group consisting of patients with minor cortical ischaemic stroke. We performed brain magnetic resonance imaging to assess the recent infarct and periventricular and deep white matter hyperintensities. We subtyped stroke with clinical and radiological findings. We took digital retinal photographs to assess retinal arteriolar branching coefficients and branching angles using a semi-automated technique. Results Two hundred and five patients were recruited (104 lacunar stroke, 101 cortical stroke), mean age 68-years (standard deviation 12). With multivariate analysis, increased branching coefficient was associated with periventricular white matter hyperintensities (P=0·006) and ischaemic heart disease (P<0·001), and decreased branching coefficient with deep white matter hyperintensities (P=0·003), but not with lacunar stroke subtype (P=0·96). We found no associations with retinal branching angles. Conclusions Retinal arteriolar geometry differs between cerebral small vessel phenotypes. Further research is needed to ascertain the clinical significance of these findings.
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Affiliation(s)
- Fergus N Doubal
- Division of Clinical Neurosciences, University of Edinburgh, Edinburgh, UK.
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Ritz E, Amann K, Koleganova N, Benz K. Prenatal programming-effects on blood pressure and renal function. Nat Rev Nephrol 2011; 7:137-44. [PMID: 21283139 DOI: 10.1038/nrneph.2011.1] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Impaired intrauterine nephrogenesis-most clearly illustrated by low nephron number-is frequently associated with low birthweight and has been recognized as a powerful risk factor for renal disease; it increases the risks of low glomerular filtration rate, of more rapid progression of primary kidney disease, and of increased incidence of chronic kidney disease or end-stage renal disease. Another important consequence of impaired nephrogenesis is hypertension, which further amplifies the risk of onset and progression of kidney disease. Hypertension is associated with low nephron numbers in white individuals, but the association is not universal and is not seen in individuals of African origin. The derangement of intrauterine kidney development is an example of a more general principle that illustrates the paradigm of plasticity during development-that is, that transcription of the genetic code is modified by epigenetic factors (as has increasingly been documented). This Review outlines the concept of prenatal programming and, in particular, describes its role in kidney disease and hypertension.
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Affiliation(s)
- Eberhard Ritz
- Division of Nephrology, Department of Internal Medicine, University of Heidelberg, Heidelberg 69100, Germany.
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Blanco MV, Vega HR, Giuliano R, Grana DR, Azzato F, Lerman J, Milei J. Histomorphometry of Umbilical Cord Blood Vessels in Preeclampsia. J Clin Hypertens (Greenwich) 2010; 13:30-4. [DOI: 10.1111/j.1751-7176.2010.00384.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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SASONGKO MUHAMMADBAYU, WONG TIENYIN, WANG JIEJIN. Retinal Arteriolar Changes: Intermediate Pathways Linking Early Life Exposures to Cardiovascular Disease? Microcirculation 2010; 17:21-31. [DOI: 10.1111/j.1549-8719.2009.00007.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Liew G, Wang JJ, Klein R, Duncan BB, Yeh HC, Brancati FL, Mitchell P, Wong TY. Birth Weight is Not Related to Risk of Diabetic Retinopathy in Type 2 Diabetes: The Atherosclerosis Risk in Communities Study. Curr Eye Res 2009; 33:193-8. [DOI: 10.1080/02713680701855044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Aslam T, Fleck B, Patton N, Trucco M, Azegrouz H. Digital image analysis of plus disease in retinopathy of prematurity. Acta Ophthalmol 2009; 87:368-77. [PMID: 19210329 DOI: 10.1111/j.1755-3768.2008.01448.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
An accurate assessment of retinopathy of prematurity (ROP) is essential in ensuring correct and timely treatment of this potentially blinding condition. Current modes of assessment are based upon clinical grading by expert examination of retinal changes. However, this may be subjective, unreliable and difficult and there has been significant interest in alternative means of measurement. These have been made possible through technological advancements in image capture and analysis as well as progress in clinical research, highlighting the specific importance of plus disease in ROP. Progress in these two fields has highlighted the potential for digital image analysis of plus disease to be used as an objective, reliable and valid measurement of ROP. The potential for clinical and scientific advancement through this method is argued and demonstrated in this article. Along with the potential benefits, there are significant challenges such as in image capture, segmentation, measurement of vessel width and tortuosity; these are also addressed. After discussing and explaining the challenges involved, the research articles addressing digital image analysis of ROP are critically reviewed. Benefits and limitations of the currently published techniques for digital ROP assessment are discussed with particular reference to the validity and reliability of outcome measures. Finally, the general limitations of current methods of analysis are discussed and more diverse potential areas of development are discussed.
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Affiliation(s)
- Tariq Aslam
- Princess Alexandra Eye Pavilion, Chalmers Street, Edinburgh, UK.
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Sun C, Ponsonby AL, Wong TY, Brown SA, Kearns LS, Cochrane J, MacKinnon JR, Ruddle JB, Hewitt AW, Liew G, Dwyer T, Scurrah K, Mackey DA. Effect of birth parameters on retinal vascular caliber: the Twins Eye Study in Tasmania. Hypertension 2009; 53:487-93. [PMID: 19139377 DOI: 10.1161/hypertensionaha.108.125914] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Recent studies reported an association between smaller birth size and narrower retinal vascular caliber, but it remains unclear whether this association is attributed to confounding by shared environment or genetic factors. At a mean age of 9.3 years, 266 twins (49 monozygotic and 84 dizygotic pairs) in the Twins Eye Study in Tasmania underwent an ophthalmic examination including retinal photography. Retinal vascular caliber was measured using a validated protocol. The majority of these twins were also in the Tasmanian Infant Health Study, which prospectively collected data on birth parameters and antenatal maternal factors. We conducted the main analysis using linear mixed models, accounting for birth set clustering. Both the within-pair (-9.73; 95% CI: -14.68 to -4.77 microm per 5-cm decrease in birth length) and between-pair associations (-7.15; 95% CI: -11.54 to -3.01) with retinal arteriolar caliber were significant and of similar magnitude (difference in effect, P=0.61), after adjusting for age, sex, maternal smoking, mean arterial blood pressure, and other confounders. These associations remained within dizygotic and monozygotic pairs. Analyses of head circumference and retinal arteriolar caliber were similar to those of birth length (within-pair regression coefficient: -2.41; 95% CI: -5.09 to 0.28; between-pair regression coefficient: -2.60; 95% CI: -5.00 to -0.19). For birth weight, only a between-pair association was evident (-7.28; 95% CI: -13.07 to -1.48). This study demonstrates a consistent association between smaller birth size and narrower retinal arterioles in twins. The independent effect of shorter birth length on retinal arteriolar caliber supports a role for twin-specific supply line factors affecting fetal growth on vascular structure.
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Affiliation(s)
- Cong Sun
- Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia
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Syddall HE, Simmonds SJ, Martin HJ, Watson C, Dennison EM, Cooper C, Sayer AA. Cohort profile: The Hertfordshire Ageing Study (HAS). Int J Epidemiol 2009; 39:36-43. [PMID: 19131391 DOI: 10.1093/ije/dyn275] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- H E Syddall
- MRC Epidemiology Resource Centre, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK.
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38
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Early retinal vascular abnormalities in African-American cocaine users. Am J Ophthalmol 2008; 146:612-619. [PMID: 18662808 DOI: 10.1016/j.ajo.2008.05.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2007] [Revised: 05/23/2008] [Accepted: 05/28/2008] [Indexed: 11/22/2022]
Abstract
PURPOSE To investigate whether cocaine use is associated with early retinal vascular abnormalities. DESIGN Population-based cross-sectional study. METHODS SETTINGS Inner-city neighborhoods in Baltimore, Maryland. STUDY POPULATION Sixty-eight participants were recruited from an ongoing observational study, investigating cardiovascular complications of human immunodeficiency virus (HIV) infection and cocaine use in African Americans aged between 25 and 54 years. Those with hypertension and known cardiovascular/cerebrovascular diseases were excluded. OBSERVATION PROCEDURES Ophthalmoscopic examinations and fundus photography of the retinas of these subjects were performed after pupillary dilation. The largest angle of arterial bifurcation (LAAB), central retinal artery equivalent (CRAE), and central retinal vein equivalent (CRVE) were measured by single-masked fundus image examiners. MAIN OUTCOME MEASURES LAAB, CRAE, and CRVE. RESULTS Among the 68 study subjects, 52 (76.5%) were chronic cocaine users and 16 (23.5%) were non-cocaine users. Univariate and multivariate analyses indicated that the LAAB was associated with age and duration of cocaine use of more than 10 years. The LAAB was also inversely associated with very low-density lipoproteins levels. Multivariate analysis indicated a positive association between CRVE and cocaine use. CRAE was also associated with intravenous injection. We confirmed that CRAE was inversely associated with age. HIV infection was not found to be associated with any retinal vascular parameters. CONCLUSIONS Cocaine use is associated with increased retinal arterial branching angle and venular caliber. The retinal vascular changes provided the first evidence that cocaine use has an effect on the retinal vascular system.
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Abstract
UNLABELLED Low birth weight (LBW) is a risk factor for hypertension, stroke and coronary heart disease in adults. Mechanisms underlying cardiovascular disease may therefore be initiated in early life. Studies to investigate the initiating events and emergence of vascular risk markers in infancy and childhood have been an area of particular interest in recent years. The aim of this review is to focus on the early development of the human vascular tree in relation to LBW. Specific characteristics, including endothelial function, intima-media thickness, microvascular density, arterial dimensions and elasticity, will be discussed. LBW due to different causes--poor foetal growth or preterm birth--results in different patterns of altered development of the vascular system, which can already be seen in infancy. Follow-up studies in children and young adults indicate that vascular compromise in many ways persists in those born either small for gestational age or prematurely. CONCLUSION LBW is associated with structural and functional changes in the vascular tree, which have implications for cardiovascular health in adult life.
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Affiliation(s)
- Mikael Norman
- Department for Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden.
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Mitchell P, Liew G, Rochtchina E, Wang JJ, Robaei D, Cheung N, Wong TY. Evidence of Arteriolar Narrowing in Low-Birth-Weight Children. Circulation 2008; 118:518-24. [DOI: 10.1161/circulationaha.107.747329] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Cardiovascular disease may have its origins in utero, but the influence of in utero growth on microvascular structure in children is unknown. We hypothesized that poor in utero growth is associated with narrower arteriolar caliber, which may help explain the established association of low birth weight with hypertension and cardiovascular disease in adulthood.
Methods and Results—
We examined the relation of birth weight and other markers of in utero growth to microvascular caliber in the retina in a population-based study of 1369 6-year-old children in Sydney, Australia (Sydney Childhood Eye Study). Birth weight, birth length, and head circumference were obtained from parental records. Retinal arteriolar and venular calibers were measured from digitized retinal photographs by a validated computer-assisted method. Lower birth weight, shorter birth length, and smaller head circumference were associated with narrower retinal arteriolar caliber. Each kilogram decrease in birth weight was associated with a 2.3-μm (95% CI 0.6 to 3.9,
P
=0.01) narrower retinal arteriolar caliber after controlling for age, gender, ethnicity, height, body mass index, axial length, mean arterial blood pressure, and prematurity. Similar associations were observed between shorter birth length and smaller head circumference with narrower retinal arteriolar caliber.
Conclusions—
Children who had lower birth weight, shorter birth length, and smaller head circumference had narrower retinal arteriolar calibers. These data support the concept that poor in utero growth may have an adverse influence on microvascular structure.
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Affiliation(s)
- Paul Mitchell
- From the Centre for Vision Research (P.M., G.L., E.R., J.J.W., D.R.), Department of Ophthalmology, Westmead Millennium Institute, University of Sydney, Australia; Centre for Eye Research Australia (J.J.W., N.C., T.Y.W.), University of Melbourne, Melbourne, Australia; and Singapore Eye Research Institute (T.Y.W.), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Gerald Liew
- From the Centre for Vision Research (P.M., G.L., E.R., J.J.W., D.R.), Department of Ophthalmology, Westmead Millennium Institute, University of Sydney, Australia; Centre for Eye Research Australia (J.J.W., N.C., T.Y.W.), University of Melbourne, Melbourne, Australia; and Singapore Eye Research Institute (T.Y.W.), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Elena Rochtchina
- From the Centre for Vision Research (P.M., G.L., E.R., J.J.W., D.R.), Department of Ophthalmology, Westmead Millennium Institute, University of Sydney, Australia; Centre for Eye Research Australia (J.J.W., N.C., T.Y.W.), University of Melbourne, Melbourne, Australia; and Singapore Eye Research Institute (T.Y.W.), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jie Jin Wang
- From the Centre for Vision Research (P.M., G.L., E.R., J.J.W., D.R.), Department of Ophthalmology, Westmead Millennium Institute, University of Sydney, Australia; Centre for Eye Research Australia (J.J.W., N.C., T.Y.W.), University of Melbourne, Melbourne, Australia; and Singapore Eye Research Institute (T.Y.W.), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Dana Robaei
- From the Centre for Vision Research (P.M., G.L., E.R., J.J.W., D.R.), Department of Ophthalmology, Westmead Millennium Institute, University of Sydney, Australia; Centre for Eye Research Australia (J.J.W., N.C., T.Y.W.), University of Melbourne, Melbourne, Australia; and Singapore Eye Research Institute (T.Y.W.), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ning Cheung
- From the Centre for Vision Research (P.M., G.L., E.R., J.J.W., D.R.), Department of Ophthalmology, Westmead Millennium Institute, University of Sydney, Australia; Centre for Eye Research Australia (J.J.W., N.C., T.Y.W.), University of Melbourne, Melbourne, Australia; and Singapore Eye Research Institute (T.Y.W.), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tien Y. Wong
- From the Centre for Vision Research (P.M., G.L., E.R., J.J.W., D.R.), Department of Ophthalmology, Westmead Millennium Institute, University of Sydney, Australia; Centre for Eye Research Australia (J.J.W., N.C., T.Y.W.), University of Melbourne, Melbourne, Australia; and Singapore Eye Research Institute (T.Y.W.), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Liew G, Wang JJ, Duncan BB, Klein R, Sharrett AR, Brancati F, Yeh HC, Mitchell P, Wong TY. Low Birthweight Is Associated With Narrower Arterioles in Adults. Hypertension 2008; 51:933-8. [DOI: 10.1161/hypertensionaha.107.101584] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Gerald Liew
- From the Centre for Vision Research (G.L., J.J.W., P.M.), University of Sydney, Department of Ophthalmology, Westmead Hospital, the Westmead Millennium Institute, Australia; the Centre for Eye Research Australia (J.J.W., T.Y.W.), University of Melbourne, Victoria, Australia; the Graduate Studies Program in Epidemiology (B.B.D.), School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS Brazil; the Department of Ophthalmology and Visual Science (R.K.), University of Wisconsin,
| | - Jie Jin Wang
- From the Centre for Vision Research (G.L., J.J.W., P.M.), University of Sydney, Department of Ophthalmology, Westmead Hospital, the Westmead Millennium Institute, Australia; the Centre for Eye Research Australia (J.J.W., T.Y.W.), University of Melbourne, Victoria, Australia; the Graduate Studies Program in Epidemiology (B.B.D.), School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS Brazil; the Department of Ophthalmology and Visual Science (R.K.), University of Wisconsin,
| | - Bruce B. Duncan
- From the Centre for Vision Research (G.L., J.J.W., P.M.), University of Sydney, Department of Ophthalmology, Westmead Hospital, the Westmead Millennium Institute, Australia; the Centre for Eye Research Australia (J.J.W., T.Y.W.), University of Melbourne, Victoria, Australia; the Graduate Studies Program in Epidemiology (B.B.D.), School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS Brazil; the Department of Ophthalmology and Visual Science (R.K.), University of Wisconsin,
| | - Ronald Klein
- From the Centre for Vision Research (G.L., J.J.W., P.M.), University of Sydney, Department of Ophthalmology, Westmead Hospital, the Westmead Millennium Institute, Australia; the Centre for Eye Research Australia (J.J.W., T.Y.W.), University of Melbourne, Victoria, Australia; the Graduate Studies Program in Epidemiology (B.B.D.), School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS Brazil; the Department of Ophthalmology and Visual Science (R.K.), University of Wisconsin,
| | - A. Richey Sharrett
- From the Centre for Vision Research (G.L., J.J.W., P.M.), University of Sydney, Department of Ophthalmology, Westmead Hospital, the Westmead Millennium Institute, Australia; the Centre for Eye Research Australia (J.J.W., T.Y.W.), University of Melbourne, Victoria, Australia; the Graduate Studies Program in Epidemiology (B.B.D.), School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS Brazil; the Department of Ophthalmology and Visual Science (R.K.), University of Wisconsin,
| | - Frederick Brancati
- From the Centre for Vision Research (G.L., J.J.W., P.M.), University of Sydney, Department of Ophthalmology, Westmead Hospital, the Westmead Millennium Institute, Australia; the Centre for Eye Research Australia (J.J.W., T.Y.W.), University of Melbourne, Victoria, Australia; the Graduate Studies Program in Epidemiology (B.B.D.), School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS Brazil; the Department of Ophthalmology and Visual Science (R.K.), University of Wisconsin,
| | - Hsin-Chieh Yeh
- From the Centre for Vision Research (G.L., J.J.W., P.M.), University of Sydney, Department of Ophthalmology, Westmead Hospital, the Westmead Millennium Institute, Australia; the Centre for Eye Research Australia (J.J.W., T.Y.W.), University of Melbourne, Victoria, Australia; the Graduate Studies Program in Epidemiology (B.B.D.), School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS Brazil; the Department of Ophthalmology and Visual Science (R.K.), University of Wisconsin,
| | - Paul Mitchell
- From the Centre for Vision Research (G.L., J.J.W., P.M.), University of Sydney, Department of Ophthalmology, Westmead Hospital, the Westmead Millennium Institute, Australia; the Centre for Eye Research Australia (J.J.W., T.Y.W.), University of Melbourne, Victoria, Australia; the Graduate Studies Program in Epidemiology (B.B.D.), School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS Brazil; the Department of Ophthalmology and Visual Science (R.K.), University of Wisconsin,
| | - Tien Y. Wong
- From the Centre for Vision Research (G.L., J.J.W., P.M.), University of Sydney, Department of Ophthalmology, Westmead Hospital, the Westmead Millennium Institute, Australia; the Centre for Eye Research Australia (J.J.W., T.Y.W.), University of Melbourne, Victoria, Australia; the Graduate Studies Program in Epidemiology (B.B.D.), School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS Brazil; the Department of Ophthalmology and Visual Science (R.K.), University of Wisconsin,
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Tapp RJ, Williams C, Witt N, Chaturvedi N, Evans R, Thom SAM, Hughes AD, Ness A. Impact of size at birth on the microvasculature: the Avon Longitudinal Study of Parents and Children. Pediatrics 2007; 120:e1225-8. [PMID: 17974715 PMCID: PMC2780696 DOI: 10.1542/peds.2006-2951] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The impact of early life factors on the microvasculature is relatively unknown. OBJECTIVES We hypothesized that small birth size may be associated with structural variations in the retinal vasculature in children. METHODS The Avon Longitudinal Study of Parents and Children followed a cohort of children born in 1991-1992 from birth. The current study included the first 263 children who were systematically screened in the year-12 follow-up. Complete data were available for 166 children with a gestation of > or = 37 weeks. Retinal circulatory measures were evaluated, including retinal microvascular tortuosity and bifurcation optimality deviance, an indicator of abnormal endothelial function. RESULTS Optimality deviance and retinal tortuosity were higher among those with lower birth weight. Linear regression modeling was used to assess the association of retinal microvascular measures with birth weight. The standardized beta coefficient between optimality deviance and birth weight was -.182 adjusted for gender and age in weeks; additional adjustment for systolic blood pressure and heart rate had little impact on the beta coefficient. A similar association was observed for retinal tortuosity. CONCLUSION The findings of this study suggest that early life factors may have an important impact on retinal vascular structure, possibly through an adverse effect on endothelial function.
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Affiliation(s)
- Robyn J. Tapp
- International Centre for Circulatory Health, National Heart and Lung Institute, St Mary’s Hospital and Imperial College London, United Kingdom
,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Cathy Williams
- Department of Social Medicine, University of Bristol, United Kingdom
| | - Nicholas Witt
- International Centre for Circulatory Health, National Heart and Lung Institute, St Mary’s Hospital and Imperial College London, United Kingdom
| | - Nish Chaturvedi
- International Centre for Circulatory Health, National Heart and Lung Institute, St Mary’s Hospital and Imperial College London, United Kingdom
| | - Richard Evans
- International Centre for Circulatory Health, National Heart and Lung Institute, St Mary’s Hospital and Imperial College London, United Kingdom
| | - Simon A. McG Thom
- International Centre for Circulatory Health, National Heart and Lung Institute, St Mary’s Hospital and Imperial College London, United Kingdom
| | - Alun D. Hughes
- International Centre for Circulatory Health, National Heart and Lung Institute, St Mary’s Hospital and Imperial College London, United Kingdom
| | - Andrew Ness
- Department of Social Medicine, University of Bristol, United Kingdom
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Hughes AD. The clinical assessment of retinal microvascular structure and therapeutic implications. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2007; 9:236-41. [PMID: 17601388 DOI: 10.1007/s11936-007-0018-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Examination of the retinal microvasculature is widely used to assess diabetic eye disease and as an indicator of target organ damage in hypertension. The diagnostic value of grading of hypertensive retinopathy is dubious; however, many recent studies have demonstrated that hypertensive retinopathy is associated with a range of risk factors for cardiovascular disease and may predict cardiovascular events independently of blood pressure. Developments in digital imaging and computer-assisted analysis have facilitated the quantitative assessment of microvascular changes in cardiovascular disease. These approaches may be useful for assessing cardiovascular risk and targeting therapeutic intervention.
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Affiliation(s)
- Alun D Hughes
- Clinical Pharmacology, International Centre for Circulatory Health, NHLI Division, Faculty of Medicine, Imperial College London, St. Mary's Campus, London W2 1NY, UK.
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Serné EH, de Jongh RT, Eringa EC, IJzerman RG, Stehouwer CDA. Microvascular dysfunction: a potential pathophysiological role in the metabolic syndrome. Hypertension 2007; 50:204-11. [PMID: 17470716 DOI: 10.1161/hypertensionaha.107.089680] [Citation(s) in RCA: 180] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Erik H Serné
- Department of Internal Medicine, VU Medical Center, Amsterdam, The Netherlands.
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45
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Barker DJP, Bagby SP, Hanson MA. Mechanisms of Disease: in utero programming in the pathogenesis of hypertension. ACTA ACUST UNITED AC 2006; 2:700-7. [PMID: 17124527 DOI: 10.1038/ncpneph0344] [Citation(s) in RCA: 188] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2006] [Accepted: 08/25/2006] [Indexed: 01/08/2023]
Abstract
Nutritional and other environmental cues during development can permanently alter the structure, homeostatic systems, and functions of the body. This phenomenon has been referred to as 'programming'. Epidemiological and animal studies show that programmed effects operate within the normal range of growth and development, and influence the risk of chronic disease in adult life. We review the evidence that these effects include reduced nephron number and compensatory adaptations, which might lead to hypertension, and perhaps accelerate the decline in renal function that accompanies aging. These processes might be exacerbated by programmed changes in vascular structure and function, and alterations in endocrine and metabolic homeostasis. Programmed effects might be initiated as early as the periconceptual phase of development, and could involve epigenetic changes in gene expression or altered stem cell allocation. Better understanding of these processes could lead to the development of novel diagnostic and preventive measures, and to early detection of at-risk individuals. By monitoring blood pressure, weight, and renal function in children, it might be possible to reduce the risk of cardiovascular and renal disease in later life.
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Affiliation(s)
- David J P Barker
- Developmental Origins of Health and Disease Division (MP 887), University of Southampton, Princess Anne Hospital, Southampton SO16 5YA, UK.
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46
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Witt N, Wong TY, Hughes AD, Chaturvedi N, Klein BE, Evans R, McNamara M, Thom SAM, Klein R. Abnormalities of retinal microvascular structure and risk of mortality from ischemic heart disease and stroke. Hypertension 2006; 47:975-81. [PMID: 16585415 DOI: 10.1161/01.hyp.0000216717.72048.6c] [Citation(s) in RCA: 226] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abnormalities of the retinal microcirculation are found in hypertension and diabetes and predict cardiovascular mortality. This study examined the relationship between abnormalities of the retinal microvasculature and death from ischemic heart disease (IHD) and stroke. A population-based, nested case-control study was undertaken within the Beaver Dam Eye Study. Subjects (43 to 74 years) who died of IHD (n=126) or stroke (n=28) over a 10-year period were age and gender matched with controls subjects (n=528; case:control matching, approximately 1:4). Retinal photographs of cases and controls were digitized and analyzed using a computer-based technique. Increased risk of IHD death was associated with a suboptimal relationship of arteriolar diameters at bifurcation (P=0.02 unadjusted) and decreased retinal arteriolar tortuosity (P=0.011 unadjusted). These associations remained significant after adjustment for age, sex, past history of cardiovascular disease, and other known cardiovascular risk factors. Increased arteriolar length:diameter ratio, a measure of generalized arteriolar narrowing, was associated with increased stroke mortality (P=0.02 unadjusted). This association was independent of age and gender but was attenuated by adjustment for systolic blood pressure (P=0.15). Other quantitative measures of the retinal microvascular network (eg, venular tortuosity and arteriolar and venular bifurcation angle) were not associated with death from IHD or stroke. Retinal microvascular abnormalities are predictive of death from IHD and stroke. A detailed assessment of the retinal microvascular network from digitized photographs may be useful in the noninvasive assessment of target organ damage and cardiovascular risk.
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Affiliation(s)
- Nicholas Witt
- National Heart and Lung Institute Division, Department of Clinical Pharmacology, International Centre for Circulatory Health, Faculty of Medicine, Imperial College London, United Kingdom
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Wilson C, Theodorou M, Cocker KD, Fielder AR. The temporal retinal vessel angle and infants born preterm. Br J Ophthalmol 2006; 90:702-4. [PMID: 16464971 PMCID: PMC1860202 DOI: 10.1136/bjo.2005.085019] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM To determine the temporal retinal vessel angle in babies and its relation to preterm birth. METHODS Digital images were obtained during routine screening for retinopathy of prematurity (ROP). The temporal retinal vessel angle was measured in 164 eyes of 82 babies born "very preterm" (24-27 weeks gestational age (GA)), "preterm" (28-31 weeks GA), and "near term" (>/=32 weeks GA). RESULTS Mean temporal vessel angle (TVA) for all three GA groups together is 80.0 degrees (SD 17.0 degrees ) for the right eye and 80.5 degrees (16.7 degrees ) for the left eye. The range is right eye 59-106 degrees , left eye 69-97 degrees , with 95% data above 67 degrees for the right and 63 degrees for the left eye. For babies born near term, TVA is 82 degrees in each eye. There is a high degree of interocular symmetry between right and left eyes and a statistically insignificant trend for increasing TVA with increasing GA. The presence and stage of ROP affected one parameter of the left eye alone. CONCLUSIONS These data provide normative data on the TVA in babies and will facilitate, especially if there is interocular asymmetry, determining whether there is macular displacement.
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Affiliation(s)
- C Wilson
- Department of Optometry and Visual Science, City University, Northampton Square, London EC1V 0HB, UK
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Patton N, Maini R, MacGillivary T, Aslam TM, Deary IJ, Dhillon B. Effect of axial length on retinal vascular network geometry. Am J Ophthalmol 2005; 140:648-53. [PMID: 16140248 DOI: 10.1016/j.ajo.2005.04.040] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2004] [Revised: 04/17/2005] [Accepted: 04/19/2005] [Indexed: 11/24/2022]
Abstract
PURPOSE To explore the association between axial length and retinal vascular network geometry (arteriovenous diameter ratio [AVR], arteriolar branching angles, and junctional exponents). DESIGN Prospective, cross-sectional study. METHODS Patients were recruited from a pseudophakic population that had preexisting axial length measurements. Mean arterial blood pressure and previous medical history were recorded. Fundal photographs were taken. Digital image analysis was used to determine the AVR, mean arteriolar bifurcation angle, and junctional exponent for each subject. RESULTS In total, 52 subjects were analyzed. Axial length had no association with AVR (R = -0.01, P = .941), mean angles at arteriolar bifurcations (R = -.134, P = .342), or junctional exponents (R = .003, P = .982). However, increased axial length was associated with a trend for lower measured retinal venular and arteriolar diameters (R = -.28, P = .04 and R = -.23, P = .10, respectively). Junctional exponents correlated with both the AVR (R = .32, P = .019) and vascular bifurcation angles (omega) (R = .317, P = .022). CONCLUSIONS Increased axial length is associated with narrowing of both arteriolar and venular diameters, but not on the AVR, or vessel junctions. Future studies exploring the influence of systemic disease on retinal vascular topography do not need to consider axial length as a potential confounding variable when utilizing measures such as AVR or vessel junctions. Vascular arteriolar junctional exponents may serve as a good measure of overall altered retinal vascular geometry in cardiovascular disease.
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Affiliation(s)
- Niall Patton
- Sir Charles Gairdner Hospital, Perth, Western Australia.
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Patton N, Aslam TM, MacGillivray T, Deary IJ, Dhillon B, Eikelboom RH, Yogesan K, Constable IJ. Retinal image analysis: concepts, applications and potential. Prog Retin Eye Res 2005; 25:99-127. [PMID: 16154379 DOI: 10.1016/j.preteyeres.2005.07.001] [Citation(s) in RCA: 257] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
As digital imaging and computing power increasingly develop, so too does the potential to use these technologies in ophthalmology. Image processing, analysis and computer vision techniques are increasing in prominence in all fields of medical science, and are especially pertinent to modern ophthalmology, as it is heavily dependent on visually oriented signs. The retinal microvasculature is unique in that it is the only part of the human circulation that can be directly visualised non-invasively in vivo, readily photographed and subject to digital image analysis. Exciting developments in image processing relevant to ophthalmology over the past 15 years includes the progress being made towards developing automated diagnostic systems for conditions, such as diabetic retinopathy, age-related macular degeneration and retinopathy of prematurity. These diagnostic systems offer the potential to be used in large-scale screening programs, with the potential for significant resource savings, as well as being free from observer bias and fatigue. In addition, quantitative measurements of retinal vascular topography using digital image analysis from retinal photography have been used as research tools to better understand the relationship between the retinal microvasculature and cardiovascular disease. Furthermore, advances in electronic media transmission increase the relevance of using image processing in 'teleophthalmology' as an aid in clinical decision-making, with particular relevance to large rural-based communities. In this review, we outline the principles upon which retinal digital image analysis is based. We discuss current techniques used to automatically detect landmark features of the fundus, such as the optic disc, fovea and blood vessels. We review the use of image analysis in the automated diagnosis of pathology (with particular reference to diabetic retinopathy). We also review its role in defining and performing quantitative measurements of vascular topography, how these entities are based on 'optimisation' principles and how they have helped to describe the relationship between systemic cardiovascular disease and retinal vascular changes. We also review the potential future use of fundal image analysis in telemedicine.
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Affiliation(s)
- Niall Patton
- Lions Eye Institute, 2, Verdun Street, Nedlands, WA 6009, Australia.
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Patton N, Aslam T, Macgillivray T, Pattie A, Deary IJ, Dhillon B. Retinal vascular image analysis as a potential screening tool for cerebrovascular disease: a rationale based on homology between cerebral and retinal microvasculatures. J Anat 2005; 206:319-48. [PMID: 15817102 PMCID: PMC1571489 DOI: 10.1111/j.1469-7580.2005.00395.x] [Citation(s) in RCA: 507] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
The retinal and cerebral microvasculatures share many morphological and physiological properties. Assessment of the cerebral microvasculature requires highly specialized and expensive techniques. The potential for using non-invasive clinical assessment of the retinal microvasculature as a marker of the state of the cerebrovasculature offers clear advantages, owing to the ease with which the retinal vasculature can be directly visualized in vivo and photographed due to its essential two-dimensional nature. The use of retinal digital image analysis is becoming increasingly common, and offers new techniques to analyse different aspects of retinal vascular topography, including retinal vascular widths, geometrical attributes at vessel bifurcations and vessel tracking. Being predominantly automated and objective, these techniques offer an exciting opportunity to study the potential to identify retinal microvascular abnormalities as markers of cerebrovascular pathology. In this review, we describe the anatomical and physiological homology between the retinal and cerebral microvasculatures. We review the evidence that retinal microvascular changes occur in cerebrovascular disease and review current retinal image analysis tools that may allow us to use different aspects of the retinal microvasculature as potential markers for the state of the cerebral microvasculature.
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Affiliation(s)
- Niall Patton
- Princess Alexandra Eye Pavilion, Chalmers Street, Edinburgh, UK.
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