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Saloň A, De Boever P, Goswami N. Microvascular Changes during Viral Infections: A Systematic Review of Studies Using Retinal Vessel Diameter Assessments. Biomedicines 2024; 12:1488. [PMID: 39062061 PMCID: PMC11274461 DOI: 10.3390/biomedicines12071488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/18/2024] [Accepted: 07/01/2024] [Indexed: 07/28/2024] Open
Abstract
Viral infection frequently affects the cardiovascular system, and vascular disturbances in patients can lead to health complications. One essential component of the cardiovascular system that is vulnerable to the inflammatory effects of viral infections is the microcirculatory system. As a suitable and practical non-invasive method to assess the structure and function of the retinal microcirculation, a proxy for the microcirculatory system, retinal fundus imaging can be used. We examined the impact of viral infections on retinal vessel diameters and performed a systematic analysis of the literature. Our search was carried out on PubMed using predefined search queries. After a methodological filtering process, we were able to reduce the corpus of 363 publications to 16 studies that met the search parameters. We used a narrative review style to summarise the observations. Six studies covered COVID-19, seven described HIV, and three were included in the subgroup called others, covering viruses, such as Dengue Fever and Crimean-Congo Haemorrhagic Fever. Analysis of the literature showed that viral infections are associated with alterations in the retinal vessels' vasoactivity. COVID-19 and other infections cause inflammation-associated the vasodilatation of microvasculature as a short-term effect of the infection. Long COVID-19 as well as HIV are the cause of chronic inflammation impacting microvascular morphology via retinal vessel diameter narrowing. The review emphasises the importance of the understudied area of viral infections' effects on retinal microcirculation. Continuous research in this area is needed to further verify retinal fundus imaging as an innovative tool for the optimal diagnosis of microvascular changes. As changes in the microvasculature precede changes in bigger arteries, the early detection of microvascular changes can go a long way in reducing the morbidity and mortality associated with cardiovascular diseases.
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Affiliation(s)
- Adam Saloň
- Division of Physiology & Pathophysiology, Otto Loewi Research Centre for Vascular Biology, Immunology, and Inflammation, Medical University of Graz, 8010 Graz, Austria
- Vascular Biology Center, Augusta University, Augusta, GA 30912, USA
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, 2624 Lillehammer, Norway
| | - Patrick De Boever
- Centre for Environmental Sciences, Hasselt University, 3500 Hasselt, Belgium;
- Antwerp University Hospital (UZA), 2650 Edegem, Belgium
| | - Nandu Goswami
- Division of Physiology & Pathophysiology, Otto Loewi Research Centre for Vascular Biology, Immunology, and Inflammation, Medical University of Graz, 8010 Graz, Austria
- Center for Space and Aviation Health, College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai P.O. Box 505055, United Arab Emirates
- Integrative Health Department, Alma Mater Europaea, 2000 Maribor, Slovenia
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Freiberg J, Welikala R, Rovelt J, Barman SA, Owen CG, Rudnicka AR, Kolko M. Longitudinal associations of retinal vessel morphology with intraocular pressure and blood pressure at follow-up visit-Findings from a Danish eye and vision cohort, Project FOREVER. Acta Ophthalmol 2024. [PMID: 38953839 DOI: 10.1111/aos.16737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 06/22/2024] [Indexed: 07/04/2024]
Abstract
PURPOSE To characterise the retinal vasculometry of a Danish eye and vision cohort and examine associations with systolic blood pressure (BP), diastolic BP, mean arterial BP, and intraocular pressure (IOP). DESIGN Longitudinal study. METHODS The retinal vasculature of fundus images from the FOREVER (Finding Ophthalmic Risks and Evaluating the Value of Eye exams and their predictive Reliability) cohort was analysed using a fully automated image analysis program. Longitudinal associations of retinal vessel morphology at follow-up visit with IOP (baseline and follow-up) and BP (follow-up) were examined using multilevel linear regression models adjusting for age, sex and retinal vasculometry at baseline as fixed effects and person as random effect. Width measurements were additionally adjusted for the spherical equivalent. RESULTS A total of 2089 subjects (62% female) with a mean age of 61 (standard deviation 8) years and a mean follow-up period of 4.1 years (SD 0.6 years) were included. The mean arteriolar diameter was approximately 20% thinner than the mean venular diameter, and venules were about 21%-23% less tortuous than arterioles. BP at follow-up was associated with decreased arteriolar diameter from baseline to follow-up. After adjusting for baseline IOP, IOP at follow-up was associated with increased arteriolar tortuosity above baseline (0.59%, 95% CI 0.08-1.10, p-value 0.024). CONCLUSION In a Danish eye and vision cohort, variations in BP and alterations in IOP over time were associated with changes in the width and tortuosity of retinal vessels. Our findings contribute novel insights into retinal vascular alterations over time.
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Affiliation(s)
- Josefine Freiberg
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Roshan Welikala
- School of Computer Science and Mathematics, Kingston University, Surrey, UK
| | - Jens Rovelt
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Sarah A Barman
- School of Computer Science and Mathematics, Kingston University, Surrey, UK
| | - Christopher G Owen
- Population Health Research Institute, St. George's, University of London, London, UK
| | - Alicja R Rudnicka
- Population Health Research Institute, St. George's, University of London, London, UK
| | - Miriam Kolko
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
- Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet, Glostrup, Copenhagen, Denmark
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Pai V, Bileck A, Hommer N, Janku P, Lindner T, Kauer V, Rumpf B, Haslacher H, Hagn G, Meier-Menches SM, Schmetterer L, Schmidl D, Gerner C, Garhöfer G. Impaired retinal oxygen metabolism and perfusion are accompanied by plasma protein and lipid alterations in recovered COVID-19 patients. Sci Rep 2024; 14:8395. [PMID: 38600099 PMCID: PMC11006918 DOI: 10.1038/s41598-024-56834-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 03/12/2024] [Indexed: 04/12/2024] Open
Abstract
The aim of the present study was to investigate retinal microcirculatory and functional metabolic changes in patients after they had recovered from a moderate to severe acute COVID-19 infection. Retinal perfusion was quantified using laser speckle flowgraphy. Oxygen saturation and retinal calibers were assessed with a dynamic vessel analyzer. Arterio-venous ratio (AVR) was calculated based on retinal vessel diameter data. Blood plasma samples underwent mass spectrometry-based multi-omics profiling, including proteomics, metabolomics and eicosadomics. A total of 40 subjects were included in the present study, of which 29 had recovered from moderate to severe COVID-19 within 2 to 23 weeks before inclusion and 11 had never had COVID-19, as confirmed by antibody testing. Perfusion in retinal vessels was significantly lower in patients (60.6 ± 16.0 a.u.) than in control subjects (76.2 ± 12.1 a.u., p = 0.006). Arterio-venous (AV) difference in oxygen saturation and AVR was significantly lower in patients compared to healthy controls (p = 0.021 for AVR and p = 0.023 for AV difference in oxygen saturation). Molecular profiles demonstrated down-regulation of cell adhesion molecules, NOTCH3 and fatty acids, and suggested a bisphasic dysregulation of nitric oxide synthesis after COVID-19 infection. The results of this study imply that retinal perfusion and oxygen metabolism is still significantly altered in patients well beyond the acute phase of COVID-19. This is also reflected in the molecular profiling analysis of blood plasma, indicating a down-regulation of nitric oxide-related endothelial and immunological cell functions.Trial Registration: ClinicalTrials.gov ( https://clinicaltrials.gov ) NCT05650905.
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Affiliation(s)
- Viktoria Pai
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Andrea Bileck
- Department of Analytical Chemistry, Faculty of Chemistry, University of Vienna, Währinger Straße 38, 1090, Vienna, Austria
- Joint Metabolome Facility, University of Vienna and Medical University Vienna, Vienna, Austria
| | - Nikolaus Hommer
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Patrick Janku
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Theresa Lindner
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Victoria Kauer
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Department of Medicine IV for Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria
| | - Benedikt Rumpf
- Department of Medicine IV for Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria
| | - Helmuth Haslacher
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Gerhard Hagn
- Department of Analytical Chemistry, Faculty of Chemistry, University of Vienna, Währinger Straße 38, 1090, Vienna, Austria
| | - Samuel M Meier-Menches
- Department of Analytical Chemistry, Faculty of Chemistry, University of Vienna, Währinger Straße 38, 1090, Vienna, Austria
- Joint Metabolome Facility, University of Vienna and Medical University Vienna, Vienna, Austria
- Institute of Inorganic Chemistry, Faculty of Chemistry, University of Vienna, Vienna, Austria
| | - Leopold Schmetterer
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore, Singapore
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Doreen Schmidl
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Christopher Gerner
- Department of Analytical Chemistry, Faculty of Chemistry, University of Vienna, Währinger Straße 38, 1090, Vienna, Austria.
- Joint Metabolome Facility, University of Vienna and Medical University Vienna, Vienna, Austria.
| | - Gerhard Garhöfer
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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Wong YL, Yu M, Chong C, Yang D, Xu D, Lee ML, Hsu W, Wong TY, Cheng C, Cheung CY. Association between deep learning measured retinal vessel calibre and incident myocardial infarction in a retrospective cohort from the UK Biobank. BMJ Open 2024; 14:e079311. [PMID: 38514140 PMCID: PMC10961540 DOI: 10.1136/bmjopen-2023-079311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 02/19/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Cardiovascular disease is a leading cause of global death. Prospective population-based studies have found that changes in retinal microvasculature are associated with the development of coronary artery disease. Recently, artificial intelligence deep learning (DL) algorithms have been developed for the fully automated assessment of retinal vessel calibres. METHODS In this study, we validate the association between retinal vessel calibres measured by a DL system (Singapore I Vessel Assessment) and incident myocardial infarction (MI) and assess its incremental performance in discriminating patients with and without MI when added to risk prediction models, using a large UK Biobank cohort. RESULTS Retinal arteriolar narrowing was significantly associated with incident MI in both the age, gender and fellow calibre-adjusted (HR=1.67 (95% CI: 1.19 to 2.36)) and multivariable models (HR=1.64 (95% CI: 1.16 to 2.32)) adjusted for age, gender and other cardiovascular risk factors such as blood pressure, diabetes mellitus (DM) and cholesterol status. The area under the receiver operating characteristic curve increased from 0.738 to 0.745 (p=0.018) in the age-gender-adjusted model and from 0.782 to 0.787 (p=0.010) in the multivariable model. The continuous net reclassification improvements (NRIs) were significant in the age and gender-adjusted (NRI=21.56 (95% CI: 3.33 to 33.42)) and the multivariable models (NRI=18.35 (95% CI: 6.27 to 32.61)). In the subgroup analysis, similar associations between retinal arteriolar narrowing and incident MI were observed, particularly for men (HR=1.62 (95% CI: 1.07 to 2.46)), non-smokers (HR=1.65 (95% CI: 1.13 to 2.42)), patients without DM (HR=1.73 (95% CI: 1.19 to 2.51)) and hypertensive patients (HR=1.95 (95% CI: 1.30 to 2.93)) in the multivariable models. CONCLUSION Our results support DL-based retinal vessel measurements as markers of incident MI in a predominantly Caucasian population.
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Affiliation(s)
- Yiu Lun Wong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Marco Yu
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Crystal Chong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Dawei Yang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Dejiang Xu
- School of Computing, National University of Singapore, Singapore
| | - Mong Li Lee
- School of Computing, National University of Singapore, Singapore
| | - Wynne Hsu
- School of Computing, National University of Singapore, Singapore
| | - Tien Y Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Tsinghua Medicine, Tsinghua University, Beijing, China
| | - Chingyu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
- Centre for Innovation and Precision Eye Health; and Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
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Triantafyllou A, Anyfanti P, Koletsos N, Malliora A, Lamprou S, Dipla K, Gkaliagkousi E. Clinical Significance of Altered Vascular Morphology and Function in Normotension. Curr Hypertens Rep 2023; 25:287-297. [PMID: 37392357 PMCID: PMC10505095 DOI: 10.1007/s11906-023-01251-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 07/03/2023]
Abstract
PURPOSE OF REVIEW To review current literature examining the presence of subclinical micro- and macrovascular alterations in normotensive individuals and their clinical significance in terms of hypertension prediction. Emphasis is placed on alterations that can be detected in peripheral vascular beds using non-invasive, easily applicable methodology, as these are in general easier to capture and evaluate in clinical practice compared to more complex invasive or functional tests. RECENT FINDINGS Arterial stiffness, increased carotid intima-media thickness, and altered retinal microvascular diameters predict the progression from the normotensive to the hypertensive state. By contrast, there is substantial lack of relevant prospective studies for skin microvascular alterations. Although conclusions regarding causality cannot be safely deduced from available studies, detection of morphological and functional vascular alterations in normotensive individuals emerges as a sensitive indicator of progression to hypertension and hence increased CVD risk. An increasing amount of evidence suggests that early detection of subclinical micro- and macrovascular alterations would be clinically useful for the early identification of individuals at high risk for future hypertension onset. Methodological issues and gaps in knowledge need to be addressed before detection of such changes could guide the development of strategies to prevent new-onset hypertension in normotensive individuals.
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Affiliation(s)
- A Triantafyllou
- Third Department of Internal Medicine, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 56429, Thessaloniki, Greece.
| | - P Anyfanti
- Second Medical Department, Hippokration Hospital, Aristotle University of Thessaloniki, 54642, Thessaloniki, Greece
| | - N Koletsos
- Third Department of Internal Medicine, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 56429, Thessaloniki, Greece
| | - A Malliora
- Third Department of Internal Medicine, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 56429, Thessaloniki, Greece
| | - S Lamprou
- Third Department of Internal Medicine, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 56429, Thessaloniki, Greece
| | - K Dipla
- Physiology & Biochemistry Laboratory, Department of Sport Sciences at Serres, Aristotle University of Thessaloniki, 62100, Serres, Greece
| | - E Gkaliagkousi
- Third Department of Internal Medicine, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 56429, Thessaloniki, Greece
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Afsharan H, Silva D, Joo C, Cense B. Non-Invasive Retinal Blood Vessel Wall Measurements with Polarization-Sensitive Optical Coherence Tomography for Diabetes Assessment: A Quantitative Study. Biomolecules 2023; 13:1230. [PMID: 37627295 PMCID: PMC10452597 DOI: 10.3390/biom13081230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/31/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
Diabetes affects the structure of the blood vessel walls. Since the blood vessel walls are made of birefringent organized tissue, any change or damage to this organization can be evaluated using polarization-sensitive optical coherence tomography (PS-OCT). In this paper, we used PS-OCT along with the blood vessel wall birefringence index (BBI = thickness/birefringence2) to non-invasively assess the structural integrity of the human retinal blood vessel walls in patients with diabetes and compared the results to those of healthy subjects. PS-OCT measurements revealed that blood vessel walls of diabetic patients exhibit a much higher birefringence while having the same wall thickness and therefore lower BBI values. Applying BBI to diagnose diabetes demonstrated high accuracy (93%), sensitivity (93%) and specificity (93%). PS-OCT measurements can quantify small changes in the polarization properties of retinal vessel walls associated with diabetes, which provides researchers with a new imaging tool to determine the effects of exercise, medication, and alternative diets on the development of diabetes.
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Affiliation(s)
- Hadi Afsharan
- Optical+Biomedical Engineering Laboratory, Department of Electrical, Electronic and Computer Engineering, The University of Western Australia, Perth, WA 6009, Australia;
| | - Dilusha Silva
- Microelectronics Research Group, Department of Electrical, Electronic and Computer Engineering, The University of Western Australia, Perth, WA 6009, Australia;
| | - Chulmin Joo
- Department of Mechanical Engineering, Yonsei University, Seodaemun-gu, Seoul 03722, Republic of Korea;
| | - Barry Cense
- Optical+Biomedical Engineering Laboratory, Department of Electrical, Electronic and Computer Engineering, The University of Western Australia, Perth, WA 6009, Australia;
- Department of Mechanical Engineering, Yonsei University, Seodaemun-gu, Seoul 03722, Republic of Korea;
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7
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Muchuchuti S, Viriri S. Retinal Disease Detection Using Deep Learning Techniques: A Comprehensive Review. J Imaging 2023; 9:84. [PMID: 37103235 PMCID: PMC10145952 DOI: 10.3390/jimaging9040084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/02/2023] [Accepted: 04/07/2023] [Indexed: 04/28/2023] Open
Abstract
Millions of people are affected by retinal abnormalities worldwide. Early detection and treatment of these abnormalities could arrest further progression, saving multitudes from avoidable blindness. Manual disease detection is time-consuming, tedious and lacks repeatability. There have been efforts to automate ocular disease detection, riding on the successes of the application of Deep Convolutional Neural Networks (DCNNs) and vision transformers (ViTs) for Computer-Aided Diagnosis (CAD). These models have performed well, however, there remain challenges owing to the complex nature of retinal lesions. This work reviews the most common retinal pathologies, provides an overview of prevalent imaging modalities and presents a critical evaluation of current deep-learning research for the detection and grading of glaucoma, diabetic retinopathy, Age-Related Macular Degeneration and multiple retinal diseases. The work concluded that CAD, through deep learning, will increasingly be vital as an assistive technology. As future work, there is a need to explore the potential impact of using ensemble CNN architectures in multiclass, multilabel tasks. Efforts should also be expended on the improvement of model explainability to win the trust of clinicians and patients.
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Affiliation(s)
| | - Serestina Viriri
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Durban 4001, South Africa
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Streese L, Pichler FA, Hauser C, Hanssen H. Microvascular wall-to-lumen ratio in patients with arterial hypertension: A randomized controlled exercise trial. Microvasc Res 2023; 148:104526. [PMID: 36914089 DOI: 10.1016/j.mvr.2023.104526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/07/2023] [Accepted: 03/07/2023] [Indexed: 03/15/2023]
Abstract
BACKGROUND AND AIMS High blood pressure is one of the main cardiovascular disease risk factors that contribute to vascular remodeling and dysfunction. We aimed to investigate I) group differences of the retinal microstructure between patients with hypertension and healthy individuals and II) the effects of a high-intensity interval training (HIIT) on hypertension-induced microvascular remodeling in patients with hypertension in a randomized controlled trial. METHODS Arteriolar and venular retinal vessel microstructure including retinal vessel wall (RVW), lumen diameter and wall-to-lumen ratio (WLR) of 41 hypertensive patients, treated with anti-hypertensive medication, and 19 normotensive healthy controls were screened based on high-resolution fundoscopies. Patients with hypertension were randomized to a control group receiving standard physical activity recommendations and an intervention group receiving a supervised and walking-based HIIT for eight weeks. Measurements were repeated after the intervention period. RESULTS Hypertensive patients showed thicker arteriolar RVW (28.0 ± 7.7mu vs. 21.4 ± 4.4mu, p = 0.003) and higher arteriolar WLR (58.5 ± 14.8 % vs. 42.5 ± 8.2 %, p < 0.001) compared to normotensive controls. The intervention group showed reductions in arteriolar RVW (β -3.1 (95 % CI, -4.38, -1.78) p < 0.001) and arteriolar WLR (-5.3 (-10.14, -0.39) p = 0.035) compared to the control group. The intervention effects were independent of age, sex, change in blood pressure and change in cardiorespiratory fitness. CONCLUSIONS HIIT in patients with hypertension improves retinal vessel microvascular remodeling after eight weeks of training. In patients with hypertension, screening retinal vessel microstructure by fundoscopy and monitoring efficacy of short-term exercise treatment are sensitive diagnostic approaches to quantify microvascular health in these patients.
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Affiliation(s)
- Lukas Streese
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland; Faculty of Health Care, Niederrhein University of Applied Sciences, Krefeld, Germany.
| | - Franziska Anna Pichler
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
| | - Christoph Hauser
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
| | - Henner Hanssen
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
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Tomasoni M, Beyeler MJ, Vela SO, Mounier N, Porcu E, Corre T, Krefl D, Button AL, Abouzeid H, Lazaros K, Bochud M, Schlingemann R, Bergin C, Bergmann S. Genome-Wide Association Studies of Retinal Vessel Tortuosity Identify Numerous Novel Loci Revealing Genes and Pathways Associated with Ocular and Cardiometabolic Diseases. OPHTHALMOLOGY SCIENCE 2023; 3:100288. [PMID: 37131961 PMCID: PMC10149284 DOI: 10.1016/j.xops.2023.100288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 02/03/2023] [Accepted: 02/09/2023] [Indexed: 02/18/2023]
Abstract
Purpose To identify novel susceptibility loci for retinal vascular tortuosity, to better understand the molecular mechanisms modulating this trait, and reveal causal relationships with diseases and their risk factors. Design Genome-wide Association Studies (GWAS) of vascular tortuosity of retinal arteries and veins followed by replication meta-analysis and Mendelian randomization (MR). Participants We analyzed 116 639 fundus images of suitable quality from 63 662 participants from 3 cohorts, namely the UK Biobank (n = 62 751), the Swiss Kidney Project on Genes in Hypertension (n = 397), and OphtalmoLaus (n = 512). Methods Using a fully automated retina image processing pipeline to annotate vessels and a deep learning algorithm to determine the vessel type, we computed the median arterial, venous and combined vessel tortuosity measured by the distance factor (the length of a vessel segment over its chord length), as well as by 6 alternative measures that integrate over vessel curvature. We then performed the largest GWAS of these traits to date and assessed gene set enrichment using the novel high-precision statistical method PascalX. Main Outcome Measure We evaluated the genetic association of retinal tortuosity, measured by the distance factor. Results Higher retinal tortuosity was significantly associated with higher incidence of angina, myocardial infarction, stroke, deep vein thrombosis, and hypertension. We identified 175 significantly associated genetic loci in the UK Biobank; 173 of these were novel and 4 replicated in our second, much smaller, metacohort. We estimated heritability at ∼25% using linkage disequilibrium score regression. Vessel type specific GWAS revealed 116 loci for arteries and 63 for veins. Genes with significant association signals included COL4A2, ACTN4, LGALS4, LGALS7, LGALS7B, TNS1, MAP4K1, EIF3K, CAPN12, ECH1, and SYNPO2. These tortuosity genes were overexpressed in arteries and heart muscle and linked to pathways related to the structural properties of the vasculature. We demonstrated that retinal tortuosity loci served pleiotropic functions as cardiometabolic disease variants and risk factors. Concordantly, MR revealed causal effects between tortuosity, body mass index, and low-density lipoprotein. Conclusions Several alleles associated with retinal vessel tortuosity suggest a common genetic architecture of this trait with ocular diseases (glaucoma, myopia), cardiovascular diseases, and metabolic syndrome. Our results shed new light on the genetics of vascular diseases and their pathomechanisms and highlight how GWASs and heritability can be used to improve phenotype extraction from high-dimensional data, such as images. Financial Disclosures The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Mattia Tomasoni
- Department of Computational Biology, University of Lausanne, Lausanne, Switzerland
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
- Jules-Gonin Eye Hospital, Lausanne, Switzerland
| | - Michael Johannes Beyeler
- Department of Computational Biology, University of Lausanne, Lausanne, Switzerland
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Sofia Ortin Vela
- Department of Computational Biology, University of Lausanne, Lausanne, Switzerland
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Ninon Mounier
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Eleonora Porcu
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
- Center for Integrative Genomics, University of Lausanne, Lausanne, Switzerland
| | - Tanguy Corre
- Department of Computational Biology, University of Lausanne, Lausanne, Switzerland
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Daniel Krefl
- Department of Computational Biology, University of Lausanne, Lausanne, Switzerland
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Alexander Luke Button
- Department of Computational Biology, University of Lausanne, Lausanne, Switzerland
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Hana Abouzeid
- Division of Ophthalmology, Geneva University Hospitals, Geneva, Switzerland
- Clinical Eye Research Center Memorial Adolphe de Rothschild, Geneva, Switzerland
| | | | - Murielle Bochud
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Reinier Schlingemann
- Jules-Gonin Eye Hospital, Lausanne, Switzerland
- Department of Ophthalmology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | | | - Sven Bergmann
- Department of Computational Biology, University of Lausanne, Lausanne, Switzerland
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
- Department of Integrative Biomedical Sciences, University of Cape Town, Cape Town, South Africa
- Correspondence: Sven Bergmann, PhD, University of Lausanne, Genopode, Lausanne 1016, Switzerland.
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10
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Güven YZ, Akay F, Akmaz B, Akmaz EN, Özen Ç. Evaluation of subclinical changes in recently diagnosed pediatric hypertension patients without hypertensive retinopathy: an OCT study. Int Ophthalmol 2023:10.1007/s10792-022-02622-w. [PMID: 36626040 DOI: 10.1007/s10792-022-02622-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE To investigate subclinical choroidal and retinal changes in recently diagnosed pediatric hypertension (HT) patients. METHODS This prospective case-control study consisted of 62 treatment naive HT patients (34 essential HT and 28 renal-induced HT) and 62 control subjects aged 10-16 years. All demographic data and ocular parameters were noted. Macula and choroid measurements were acquired by spectral domain optical coherence tomography (SD-OCT). Choroidal measurements were obtained by taking the mean of the measurements taken from 3 nasal and 3 temporal locations at 500µ intervals (mean nasal, mean temporal) in addition to the subfoveal area. RESULTS All choroidal thickness (ChT) values in HT subjects were significantly lower than in the healthy group (p < 0.001 for all). Also, there was no statistically significant difference between central macular thickness (CMT) and mean macular thickness (MMT) between the two groups. Subfoveal ChT, mean ChT, and CMT values were statistically lower in patients with renal-induced HT compared to essential HT subjects (p < 0.001, p = 0.04, p = 0.014, respectively). No significant correlation was observed between choroidal thicknesses and blood pressure values in essential and renal HT groups except weak correlation between mean temporal ChT and systolic blood pressure (SBP) in renal HT group (r = - 0.464, p = 0.013). CONCLUSION This study demonstrated that choroidal thickness decreased even during the subclinical period in treatment naive pediatric HT subjects. In addition, it has been shown that the choroid is more affected in renal-induced HT compared to essential HT group.
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Affiliation(s)
- Yusuf Ziya Güven
- Department of Ophthalmology, İzmir Katip Çelebi University Atatürk Educating and Research Hospital, 35200, İzmir, Turkey.
| | - Fahrettin Akay
- Department of Ophthalmology, Gülhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Berkay Akmaz
- Department of Ophthalmology, Manisa State Hospital, Manisa, Turkey
| | | | - Çınar Özen
- Department of Pediatric Nephrology, Manisa State Hospital, Manisa, Turkey
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11
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Huang Y, Zhou H, Zhang S, Zhong X, Lin Y, Xiong Z, Liu M, Yimamu A, Christopher O, Zhou Z, Zhuang X, Liao X. Mid- to Late-Life Time-Averaged Cumulative Blood Pressure and Late-Life Retinal Microvasculature: The ARIC Study. J Am Heart Assoc 2022; 11:e25226. [PMID: 35876422 PMCID: PMC9375499 DOI: 10.1161/jaha.122.025226] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The associations of time-averaged cumulative blood pressure (BP) from midlife to late life with microvasculature expressed as retinal vessel diameters is not well studied. The aim of this study was to evaluate the association of cumulative systolic BP and diastolic BP (DBP) with retinal vessel calibers, focusing on race differences. Methods and Results The analysis included 1818 adults from the ARIC (Atherosclerosis Risk in Communities) study attending the fifth visit (2011-2013; age 77±5 years, 17.1% Black participants). Time-averaged cumulative BPs were calculated as the sum of averaged BPs from adjacent consecutive visits (visits 1-5) indexed to total observation time (24±1 years). Summarized estimates for central retinal arteriolar equivalent and central retinal venular equivalent at the fifth visit represent average retinal vessel diameters. The arteriole:venule ratio was calculated. We tested for effect modification by race. Results from multiple linear regression models suggested that higher time-averaged cumulative DBP (β [95% CI] per 1-SD increase: -1.78 [-2.53, -1.02], P<0.001 and -0.005 [-0.009, -0.002], P=0.004, respectively) but not systolic BP (-0.52 [-1.30, 0.26], P=0.189 and 0.001 [-0.002, 0.005], P=0.485, respectively) was associated with smaller central retinal arteriolar equivalent and arteriole:venule ratio. The association between time-averaged cumulative DBP and arteriole:venule ratio was strongest in White participants (interaction P=0.007). The association of cumulative systolic BP and DBP with central retinal venular equivalent was strongest in Black participants (interaction P=0.015 and 0.011, respectively). Conclusions Exposure to higher BP levels, particularly DBP, from midlife to late life is associated with narrower retinal vessel diameters in late life. Furthermore, race moderated the association of cumulative BP exposure with retinal microvasculature.
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Affiliation(s)
- Yiquan Huang
- Cardiology Department First Affiliated Hospital of Sun Yat-Sen University Guangzhou China.,National Health Commission (NHC) Key Laboratory of Assisted Circulation (Sun Yat-Sen University) Guangzhou China
| | - Huimin Zhou
- Cardiology Department First Affiliated Hospital of Sun Yat-Sen University Guangzhou China.,National Health Commission (NHC) Key Laboratory of Assisted Circulation (Sun Yat-Sen University) Guangzhou China
| | - Shaozhao Zhang
- Cardiology Department First Affiliated Hospital of Sun Yat-Sen University Guangzhou China.,National Health Commission (NHC) Key Laboratory of Assisted Circulation (Sun Yat-Sen University) Guangzhou China
| | - Xiangbin Zhong
- Cardiology Department First Affiliated Hospital of Sun Yat-Sen University Guangzhou China.,National Health Commission (NHC) Key Laboratory of Assisted Circulation (Sun Yat-Sen University) Guangzhou China
| | - Yifen Lin
- Cardiology Department First Affiliated Hospital of Sun Yat-Sen University Guangzhou China.,National Health Commission (NHC) Key Laboratory of Assisted Circulation (Sun Yat-Sen University) Guangzhou China
| | - Zhenyu Xiong
- Cardiology Department First Affiliated Hospital of Sun Yat-Sen University Guangzhou China.,National Health Commission (NHC) Key Laboratory of Assisted Circulation (Sun Yat-Sen University) Guangzhou China
| | - Menghui Liu
- Cardiology Department First Affiliated Hospital of Sun Yat-Sen University Guangzhou China.,National Health Commission (NHC) Key Laboratory of Assisted Circulation (Sun Yat-Sen University) Guangzhou China
| | - Aili Yimamu
- Cardiology Department First Affiliated Hospital of Sun Yat-Sen University Guangzhou China.,National Health Commission (NHC) Key Laboratory of Assisted Circulation (Sun Yat-Sen University) Guangzhou China
| | - Odong Christopher
- Cardiology Department First Affiliated Hospital of Sun Yat-Sen University Guangzhou China.,National Health Commission (NHC) Key Laboratory of Assisted Circulation (Sun Yat-Sen University) Guangzhou China
| | - Ziwei Zhou
- Cardiology Department First Affiliated Hospital of Sun Yat-Sen University Guangzhou China.,National Health Commission (NHC) Key Laboratory of Assisted Circulation (Sun Yat-Sen University) Guangzhou China
| | - Xiaodong Zhuang
- Cardiology Department First Affiliated Hospital of Sun Yat-Sen University Guangzhou China.,National Health Commission (NHC) Key Laboratory of Assisted Circulation (Sun Yat-Sen University) Guangzhou China
| | - Xinxue Liao
- Cardiology Department First Affiliated Hospital of Sun Yat-Sen University Guangzhou China.,National Health Commission (NHC) Key Laboratory of Assisted Circulation (Sun Yat-Sen University) Guangzhou China
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12
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Zhou Y, Wagner SK, Chia MA, Zhao A, Woodward-Court P, Xu M, Struyven R, Alexander DC, Keane PA. AutoMorph: Automated Retinal Vascular Morphology Quantification Via a Deep Learning Pipeline. Transl Vis Sci Technol 2022; 11:12. [PMID: 35833885 PMCID: PMC9290317 DOI: 10.1167/tvst.11.7.12] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To externally validate a deep learning pipeline (AutoMorph) for automated analysis of retinal vascular morphology on fundus photographs. AutoMorph has been made publicly available, facilitating widespread research in ophthalmic and systemic diseases. Methods AutoMorph consists of four functional modules: image preprocessing, image quality grading, anatomical segmentation (including binary vessel, artery/vein, and optic disc/cup segmentation), and vascular morphology feature measurement. Image quality grading and anatomical segmentation use the most recent deep learning techniques. We employ a model ensemble strategy to achieve robust results and analyze the prediction confidence to rectify false gradable cases in image quality grading. We externally validate the performance of each module on several independent publicly available datasets. Results The EfficientNet-b4 architecture used in the image grading module achieves performance comparable to that of the state of the art for EyePACS-Q, with an F1-score of 0.86. The confidence analysis reduces the number of images incorrectly assessed as gradable by 76%. Binary vessel segmentation achieves an F1-score of 0.73 on AV-WIDE and 0.78 on DR HAGIS. Artery/vein scores are 0.66 on IOSTAR-AV, and disc segmentation achieves 0.94 in IDRID. Vascular morphology features measured from the AutoMorph segmentation map and expert annotation show good to excellent agreement. Conclusions AutoMorph modules perform well even when external validation data show domain differences from training data (e.g., with different imaging devices). This fully automated pipeline can thus allow detailed, efficient, and comprehensive analysis of retinal vascular morphology on color fundus photographs. Translational Relevance By making AutoMorph publicly available and open source, we hope to facilitate ophthalmic and systemic disease research, particularly in the emerging field of oculomics.
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Affiliation(s)
- Yukun Zhou
- Centre for Medical Image Computing, University College London, London, UK.,NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.,Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Siegfried K Wagner
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Mark A Chia
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - An Zhao
- Centre for Medical Image Computing, University College London, London, UK.,Department of Computer Science, University College London, London, UK
| | - Peter Woodward-Court
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.,Institute of Health Informatics, University College London, London, UK
| | - Moucheng Xu
- Centre for Medical Image Computing, University College London, London, UK.,Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Robbert Struyven
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.,Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Daniel C Alexander
- Centre for Medical Image Computing, University College London, London, UK.,Department of Computer Science, University College London, London, UK
| | - Pearse A Keane
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
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13
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Hanssen H, Streese L, Vilser W. Retinal vessel diameters and function in cardiovascular risk and disease. Prog Retin Eye Res 2022; 91:101095. [PMID: 35760749 DOI: 10.1016/j.preteyeres.2022.101095] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/03/2022] [Accepted: 06/13/2022] [Indexed: 12/13/2022]
Abstract
In the last two decades evidence has gradually accumulated suggesting that the eye may be a unique window for cardiovascular risk stratification based on the assessment of subclinical damage of retinal microvascular structure and function. This can be facilitated by non-invasive analysis of static retinal vessel diameters and dynamic recording of flicker light-induced and endothelial function-related dilation of both retinal arterioles and venules. Recent new findings have made retinal microvascular biomarkers strong candidates for clinical implementation as reliable risk predictors. Beyond a review of the current evidence and state of research, the article aims to discuss the methodological benefits and pitfalls and to identify research gaps and future directions. Above all, the potential use for screening and treatment monitoring of cardiovascular disease risk are highlighted. The article provides fundamental comprehension of retinal vessel imaging by explaining anatomical and physiological essentials of the retinal microcirculation leading to a detailed description of the methodological approach. This allows for better understanding of the underlying retinal microvascular pathology associated with the prevalence and development of cardiovascular disease. A body of new evidence is presented on the clinical validity and predictive value of retinal vessel diameters and function for incidence cardiovascular disease and outcome. Findings in children indicate the potential for utility in childhood cardiovascular disease prevention, and the efficacy of exercise interventions highlight the treatment sensitivity of retinal microvascular biomarkers. Finally, coming from the availability of normative data, solutions for diagnostic challenges are discussed and conceptual steps towards clinical implementation are put into perspective.
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Affiliation(s)
- Henner Hanssen
- Department of Sport, Exercise and Health, Preventive Sports Medicine and Systems Physiology, Medical Faculty, University of Basel, Switzerland.
| | - Lukas Streese
- Department of Sport, Exercise and Health, Preventive Sports Medicine and Systems Physiology, Medical Faculty, University of Basel, Switzerland
| | - Walthard Vilser
- Institute of Biomedical Engineering and Informatics, Ilmenau University of Technology, Ilmenau, Germany; Neonatology and Pediatric Intensive Care Unit, Department of Pediatrics, Jena University Hospital, Jena, Germany
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14
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Retinal microvascular abnormalities and risks of incident stroke and its subtypes: The Circulatory Risk in Communities Study. J Hypertens 2022; 40:732-740. [PMID: 35081584 DOI: 10.1097/hjh.0000000000003071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study aimed to investigate the association between retinal microvascular abnormalities and the risk of incident stroke and its subtypes in the general Japanese population. METHODS A total of 12 965 residents aged 40-74 years without a history of stroke and/or coronary heart disease underwent retinal photography during the annual health checkups of four Japanese communities between 1990 and 1999. Retinal microvascular abnormalities, such as the presence or absence of generalized arteriolar narrowing, focal arteriolar narrowing, arteriovenous nicking, enhanced arteriolar light reflex, and retinal hemorrhages were graded using standard protocols. RESULTS During a median follow-up of 20 years, 817 patients were diagnosed with incident stroke. Retinal microvascular abnormalities were positively associated with the risk of total stroke; after adjustment for age, sex, community, SBP, antihypertensive medication use, and other cardiovascular risk factors, the multivariable hazard ratio [95% confidence interval (CI)] was 1.68 (1.42-1.98), 1.67 (1.34-2.07), 1.41 (1.17-1.72), 1.54 (1.26-1.87), and 1.57 (1.19-2.07) for generalized arteriolar narrowing, focal arteriolar narrowing, arteriovenous nicking, enhanced arteriolar light reflex, and retinal hemorrhages, respectively. Similar positive associations were observed for the risk of stroke subtypes, except for subarachnoid hemorrhage, for which no association was observed. Furthermore, the positive associations were similar in participants with and without hypertension. CONCLUSION Retinal microvascular abnormalities were positively associated with the risk of incident stroke in the general Japanese population. Routine retinal photography could provide positive clinical insights into stroke risk stratification independent of blood pressure, antihypertensive medication use, and other risk factors.
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15
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Laigaard PP, Wibaek R, Vaag AA, Hansen MH, Munch IC, Olsen EM, Skovgaard AM, Larsen M. Smoking in pregnancy is associated with increased adiposity and retinal arteriolar wall-to-lumen ratio in adolescence: The Copenhagen Child Cohort Study 2000. Microvasc Res 2022; 142:104364. [PMID: 35346719 DOI: 10.1016/j.mvr.2022.104364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/05/2022] [Accepted: 03/21/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate the association between prenatal exposures and anthropometric data and cardiovascular risk factors including retinal arteriolar wall-to-lumen ratio in adolescence. METHODS This longitudinal observational study included all 1445 adolescents from the Copenhagen Child Cohort 2000 who attended the 2016-2017 examination. Outcome measures included retinal arteriolar wall-to-lumen ratio, height, body mass index, waist-to-hip ratio, body composition measured by bioimpedance, and blood pressure. Information on prenatal exposures (birth weight, gestational age, maternal smoking during pregnancy) as well as sex, parental age, household income and parental educational levels were obtained from national registries. Associations between exposures and outcome measures were analyzed using general linear models. RESULTS Maternal smoking during pregnancy was associated with a higher retinal arteriolar wall-to-lumen ratio (0.004 or 1.9%, P = 0.009) at age 16/17 years, an association driven exclusively by the female participants (0.008 or 3.7%, P < 0.0001). Maternal smoking during pregnancy was also associated to higher body-mass index (1.43 kg/m2, P < 0.0001), waist-to-hip ratio (0.02, P < 0.0001) and fat mass index (0.93 kg/m2, P < 0.0001). Birth weight, gestational age, and parental age had no detectable impact on retinal arteriolar wall-to-lumen ratios. CONCLUSION Prenatal exposure to tobacco smoking is associated with a higher risk of obesity and, predominantly in girls, to a greater retinal arteriolar wall thickness, which suggests that maternal smoking may induce an unfavorable cardiovascular and metabolic risk profile in the child.
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Affiliation(s)
- Poul P Laigaard
- Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark; Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
| | - Rasmus Wibaek
- Clinical Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Allan A Vaag
- Clinical Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Mathias H Hansen
- Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark
| | - Inger C Munch
- Center for Clinical Research and Prevention, the Capital Region of Denmark, Copenhagen, Denmark
| | - Else Marie Olsen
- Center for Clinical Research and Prevention, the Capital Region of Denmark, Copenhagen, Denmark; Outpatient Clinic for Eating Disorders in Adults, Psychiatric Centre Ballerup, the Capital Region of Denmark, Denmark
| | - Anne Mette Skovgaard
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Michael Larsen
- Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark; Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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16
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Cheung CY, Biousse V, Keane PA, Schiffrin EL, Wong TY. Hypertensive eye disease. Nat Rev Dis Primers 2022; 8:14. [PMID: 35273180 DOI: 10.1038/s41572-022-00342-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/18/2022] [Indexed: 02/07/2023]
Abstract
Hypertensive eye disease includes a spectrum of pathological changes, the most well known being hypertensive retinopathy. Other commonly involved parts of the eye in hypertension include the choroid and optic nerve, sometimes referred to as hypertensive choroidopathy and hypertensive optic neuropathy. Together, hypertensive eye disease develops in response to acute and/or chronic elevation of blood pressure. Major advances in research over the past three decades have greatly enhanced our understanding of the epidemiology, systemic associations and clinical implications of hypertensive eye disease, particularly hypertensive retinopathy. Traditionally diagnosed via a clinical funduscopic examination, but increasingly documented on digital retinal fundus photographs, hypertensive retinopathy has long been considered a marker of systemic target organ damage (for example, kidney disease) elsewhere in the body. Epidemiological studies indicate that hypertensive retinopathy signs are commonly seen in the general adult population, are associated with subclinical measures of vascular disease and predict risk of incident clinical cardiovascular events. New technologies, including development of non-invasive optical coherence tomography angiography, artificial intelligence and mobile ocular imaging instruments, have allowed further assessment and understanding of the ocular manifestations of hypertension and increase the potential that ocular imaging could be used for hypertension management and cardiovascular risk stratification.
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Affiliation(s)
- Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Valérie Biousse
- Departments of Ophthalmology and Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Pearse A Keane
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Institute of Ophthalmology, University College London, London, UK
| | - Ernesto L Schiffrin
- Hypertension and Vascular Research Unit, Lady Davis Institute for Medical Research, and Department of Medicine, Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Tien Y Wong
- Singapore Eye Research Institute, Singapore National Eye Center, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore. .,Tsinghua Medicine, Tsinghua University, Beijing, China.
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17
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French C, Cubbidge RP, Heitmar R. The application of arterio-venous ratio (AVR) cut-off values in clinic to stratify cardiovascular risk in patients. Ophthalmic Physiol Opt 2022; 42:666-674. [PMID: 35257402 PMCID: PMC9310762 DOI: 10.1111/opo.12967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/30/2022] [Accepted: 02/04/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Cardiovascular risk calculators are a useful tool for identifying at-risk individuals. There are standardised methods for assessing the retinal microcirculation which alters as a consequence of cardiovascular disease (CVD). This study aimed to explore if a standardised retinal vessel assessment conducted in primary optometric care reflects current cardiovascular risk, as measured using two validated CVD risk calculators (QRISK 2; Mayo Clinic). METHODS A total of 120 subjects were included in the analyses. Following a routine eye examination, participants had disc-centred retinal photographs and systemic blood pressure taken. Retinal vessel parameters (central retinal artery and vein equivalent and arterio-venous ratio (AVR)) were calculated using semi-automated software. Participants were then grouped into AVR quintiles as defined by the Atherosclerosis Risk in Communities Study (ARIC). Cardiovascular risk was calculated with the validated QRISK and Mayo Clinic health calculators. RESULTS Systolic blood pressure was significantly greater in those with an AVR value falling in the lowest quintile compared to the highest quintile (150.65 mmHg vs. 132.21 mmHg [p = 0.001]). Similarly, CVD risk was significantly higher in those with the lowest AVR compared to the highest (QRISK: 14.28% vs. 9.87% [p = 0.05]; MAYO risk: 36.35% vs. 19.21% [p = 0.01]). Chi squared analyses showed a significant difference in the number of hypertensives in the lowest AVR quintile compared to those in the highest [p = 0.02]. CONCLUSION Whilst the ARIC population is not directly comparable to the population used to develop the QRISK calculator, it has been shown that its application could help to identify at risk individuals using retinal vessel analyses.
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Affiliation(s)
- Christian French
- Department of Clinical, Biological & Pharmaceutical Science, University of Hertfordshire, Hatfield, UK.,Kettering General Hospital, Kettering, UK
| | | | - Rebekka Heitmar
- Centre for Vision across the LifeSpan (CVLS), School of Applied Sciences, University of Huddersfield, Huddersfield, UK
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18
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Mordi IR, Trucco E, Syed MG, MacGillivray T, Nar A, Huang Y, George G, Hogg S, Radha V, Prathiba V, Anjana RM, Mohan V, Palmer CNA, Pearson ER, Lang CC, Doney ASF. Prediction of Major Adverse Cardiovascular Events From Retinal, Clinical, and Genomic Data in Individuals With Type 2 Diabetes: A Population Cohort Study. Diabetes Care 2022; 45:710-716. [PMID: 35043139 DOI: 10.2337/dc21-1124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 11/20/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Improved identification of individuals with type 2 diabetes at high cardiovascular (CV) risk could help in selection of newer CV risk-reducing therapies. The aim of this study was to determine whether retinal vascular parameters, derived from retinal screening photographs, alone and in combination with a genome-wide polygenic risk score for coronary heart disease (CHD PRS) would have independent prognostic value over traditional CV risk assessment in patients without prior CV disease. RESEARCH DESIGN AND METHODS Patients in the Genetics of Diabetes Audit and Research Tayside Scotland (GoDARTS) study were linked to retinal photographs, prescriptions, and outcomes. Retinal photographs were analyzed using VAMPIRE (Vascular Assessment and Measurement Platform for Images of the Retina) software, a semiautomated artificial intelligence platform, to compute arterial and venous fractal dimension, tortuosity, and diameter. CHD PRS was derived from previously published data. Multivariable Cox regression was used to evaluate the association between retinal vascular parameters and major adverse CV events (MACE) at 10 years compared with the pooled cohort equations (PCE) risk score. RESULTS Among 5,152 individuals included in the study, a MACE occurred in 1,017 individuals. Reduced arterial fractal dimension and diameter and increased venous tortuosity each independently predicted MACE. A risk score combining these parameters significantly predicted MACE after adjustment for age, sex, PCE, and the CHD PRS (hazard ratio 1.11 per SD increase, 95% CI 1.04-1.18, P = 0.002) with similar accuracy to PCE (area under the curve [AUC] 0.663 vs. 0.658, P = 0.33). A model incorporating retinal parameters and PRS improved MACE prediction compared with PCE (AUC 0.686 vs. 0.658, P < 0.001). CONCLUSIONS Retinal parameters alone and in combination with genome-wide CHD PRS have independent and incremental prognostic value compared with traditional CV risk assessment in type 2 diabetes.
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Affiliation(s)
- Ify R Mordi
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, U.K
| | - Emanuele Trucco
- VAMPIRE Project, Computing, School of Science and Engineering, University of Dundee, Dundee, U.K
| | - Mohammad Ghouse Syed
- VAMPIRE Project, Computing, School of Science and Engineering, University of Dundee, Dundee, U.K
| | - Tom MacGillivray
- VAMPIRE Project, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, U.K
| | - Adi Nar
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, U.K
| | - Yu Huang
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, U.K
| | - Gittu George
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, U.K
| | - Stephen Hogg
- VAMPIRE Project, Computing, School of Science and Engineering, University of Dundee, Dundee, U.K
| | - Venkatesan Radha
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Vijayaraghavan Prathiba
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Colin N A Palmer
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, U.K
| | - Ewan R Pearson
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, U.K
| | - Chim C Lang
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, U.K
| | - Alex S F Doney
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, U.K
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19
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Li J, Kokubo Y, Arafa A, Sheerah HA, Watanabe M, Nakao YM, Honda-Kohmo K, Kashima R, Sakai Y, Watanabe E, Teramoto M, Dohi T, Koga M. Mild Hypertensive Retinopathy and Risk of Cardiovascular Disease: The Suita Study. J Atheroscler Thromb 2022; 29:1663-1671. [PMID: 35034920 DOI: 10.5551/jat.63317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIMS This study aimed to investigate the association of mild hypertensive retinopathy with cardiovascular disease (CVD) risk. METHODS A total of 7,027 residents aged 30-79 years without a history of CVD participated in the annual health checkups and retinal photography assessments. Retinal microvascular abnormalities were graded using the standard protocols and classified according to the Keith-Wagener-Barker classification. Mild hypertensive retinopathy was defined as grades 1 and 2. Cox proportional hazard model was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for total CVD and its subtypes according to the presence and absence of mild hypertensive retinopathy. RESULTS During a median follow-up of 17 years, 351 incident stroke and 247 coronary heart disease (CHD) cases were diagnosed. After adjustment for traditional cardiovascular risk factors, mild hypertensive retinopathy was positively associated with risk of CVD (multivariable HR=1.24; 95% CI, 1.04-1.49) and stroke (1.28; 1.01-1.62) but not with risk of CHD (1.19; 0.89-1.58). Generalized arteriolar narrowing and enhanced arteriolar wall reflex were positively associated with CVD risk, the multivariable HR (95% CI) was 1.24 (1.00- 1.54)and 1.33 (1.02-1.74), respectively. Moreover, mild hypertensive retinopathy was positively associated with stroke risk in normotensive participants. CONCLUSION Mild hypertensive retinopathy was positively associated with CVD and stroke risk in the urban Japanese population. Especially, generalized arteriolar narrowing and enhanced arteriolar wall reflex were positively associated with CVD risk. These findings suggested that retinal photography could be helpful for cardiovascular risk stratification in the primary cardiovascular prevention.
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Affiliation(s)
- Jiaqi Li
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center.,Public health, Department of Social Medicine, Osaka University Graduate School of Medicine
| | - Yoshihiro Kokubo
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
| | - Ahmed Arafa
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center.,Public health, Department of Social Medicine, Osaka University Graduate School of Medicine.,Department of Public Health, Faculty of Medicine, Beni-Suef University
| | - Haytham A Sheerah
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center.,Public health, Department of Social Medicine, Osaka University Graduate School of Medicine.,Health Promotion and Health Education Research Chair, King Saud University
| | - Makoto Watanabe
- Division of Preventive Healthcare, National Cerebral and Cardiovascular Center
| | - Yoko M Nakao
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center.,Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
| | - Kyoko Honda-Kohmo
- Division of Preventive Healthcare, National Cerebral and Cardiovascular Center
| | - Rena Kashima
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center.,Public Health Division, Ibaraki Public Health Center, Osaka Prefectural Government
| | - Yukie Sakai
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
| | - Emi Watanabe
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
| | - Masayuki Teramoto
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center.,Public health, Department of Social Medicine, Osaka University Graduate School of Medicine
| | - Tomoharu Dohi
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center.,Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
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20
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Askarizadeh F, Heirani M, Khorrami-Nejad M, Narooie-Noori F, Khabazkhoob M, Ostadrahimi A. Is there any connection between choroidal thickness and obesity? Ther Adv Ophthalmol 2022; 14:25158414221100649. [PMID: 35795720 PMCID: PMC9251961 DOI: 10.1177/25158414221100649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 04/27/2022] [Indexed: 11/16/2022] Open
Abstract
Obesity is a health-threatening and epidemic medical condition that can affect individuals of different ages and is potentially associated with an increased risk of systemic and ocular disorders. Despite the well-documented adverse effects of obesity on different parts of the body vasculature, less published data are available concerning obesity-related consequences on the ocular vasculature. As the human choroid is a highly vascularized tissue, its morphology and function might be altered in obese individuals. The micro-structural changes within the choroid could also trigger development of subsequent functional abnormalities of the eye. Previous population-based studies have asserted an association between obesity and choroidal thickness; however, they reported conflicting patterns of association between obesity and changes in choroidal thickness. Therefore, to enhance our understanding of the changes in choroidal morphology secondary to obesity, we reviewed studies describing the micro-structural consequences of obesity on the choroidal thickness profile and its underlying physiological and anatomical basis. This review includes all original publications related to the association between choroidal thickness and obesity published until mid-2021 that were indexed in PubMed, Google Scholar, ScienceDirect, or Scopus.
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Affiliation(s)
- Farshad Askarizadeh
- Department of Optometry, Faculty of Rehabilitation Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Masoud Khorrami-Nejad
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Foroozan Narooie-Noori
- Department of Optometry, Faculty of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Khabazkhoob
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, IranNoor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Alireza Ostadrahimi
- Nutrition Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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21
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Liu X, Wang G, Wang X, Wang Y, Min Y, Zhang J, Chang RT, Zhao X, He W, Moshfeghi DM, Lu Y, Hsing AW, Yao K, Zhu S. Daytime napping is associated with retinal microcirculation: a large population-based study in China. Sleep 2021; 45:6432408. [PMID: 34875091 DOI: 10.1093/sleep/zsab277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/04/2021] [Indexed: 11/15/2022] Open
Abstract
STUDY OBJECTIVES To investigate the association between daytime napping and retinal microcirculation. METHODS This is a cross-sectional study from a prospective population-based cohort. 2,662 participants were recruited after quota sampling. Information on napping was collected through face-to-face interviews. Retinal vascular calibers (RVCs), including central retinal arteriolar equivalent (CRAE), central retinal venular equivalent (CRVE), and arterio-to-venous ratio (AVR), were obtained from fundus photography. Multivariate regression and restricted cubic spline curve were performed to determine the association between RVCs and daytime napping duration. RESULTS 56.4% participants reported daytime napping regularly. Compared to no nap, daytime nap was related to higher CRAE, with nap duration of 0.5-1 h showing the most significant association. 0.5-1 h daytime nappers displayed an average of 4.18 µm (95% confidence interval [CI] 2.45-5.91, p < 0.001) wider CRAE than non-nappers after adjustment. No significant association was found between CRVE and daytime napping. Moreover, individuals with 0.5-1 h daytime napping had a lower risk for AVR reduction (odds ratio [OR] 0.70, 95% confidence interval [CI] 0.56-0.86, p = 0.001) than non-nappers. Similar association persisted in non-hypertensive population. Restricted cubic spline indicated a J-shaped relationship between AVR reduction and nap duration. CONCLUSION Retinal microcirculation was positively associated with self-reported 0.5-1 h daytime napping. Better indicators of retinal microcirculation were probably related to nap duration in a J-shaped manner. Also, the possibly beneficial role of 0.5-1 h daytime napping on retinal microcirculation might be independent of clinically diagnosed vascular diseases.
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Affiliation(s)
- Xin Liu
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Chronic Disease Research Institute, The Children's Hospital, and National Clinical Research Center for Child Health, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Guowei Wang
- Chronic Disease Research Institute, The Children's Hospital, and National Clinical Research Center for Child Health, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Department of Nutrition and Food Hygiene, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiaoyan Wang
- Chronic Disease Research Institute, The Children's Hospital, and National Clinical Research Center for Child Health, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Department of Nutrition and Food Hygiene, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yueye Wang
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Chronic Disease Research Institute, The Children's Hospital, and National Clinical Research Center for Child Health, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yan Min
- Stanford Prevention Research Center, Department of Medicine, Stanford School of Medicine, Stanford University, Stanford, CA, USA
- Department of Epidemiology and Population Health, Stanford School of Medicine, Stanford University, Stanford, CA, USA
| | - Janice Zhang
- Stanford Prevention Research Center, Department of Medicine, Stanford School of Medicine, Stanford University, Stanford, CA, USA
| | - Robert T Chang
- Department of Ophthalmology, Stanford School of Medicine, Stanford University, Stanford, CA, USA
| | - Xueyin Zhao
- Chronic Disease Research Institute, The Children's Hospital, and National Clinical Research Center for Child Health, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Department of Nutrition and Food Hygiene, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Wei He
- Chronic Disease Research Institute, The Children's Hospital, and National Clinical Research Center for Child Health, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Department of Nutrition and Food Hygiene, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Darius M Moshfeghi
- Department of Ophthalmology, Stanford School of Medicine, Stanford University, Stanford, CA, USA
| | - Ying Lu
- Department of Biomedical Data Science, Stanford School of Medicine, Stanford University, Stanford, CA, USA
- Stanford Cancer Institute, Stanford School of Medicine, Stanford University, Stanford, CA, USA
| | - Ann W Hsing
- Stanford Prevention Research Center, Department of Medicine, Stanford School of Medicine, Stanford University, Stanford, CA, USA
- Department of Epidemiology and Population Health, Stanford School of Medicine, Stanford University, Stanford, CA, USA
- Stanford Cancer Institute, Stanford School of Medicine, Stanford University, Stanford, CA, USA
| | - Ke Yao
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Shankuan Zhu
- Chronic Disease Research Institute, The Children's Hospital, and National Clinical Research Center for Child Health, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Department of Nutrition and Food Hygiene, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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22
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Kortuem C, Dietter J, Bozkurt Y, Kortuem FC, Abaza A, Wahl S, Ivanov IV, Ueffing M, Voykov B. Vessel Evaluation in Patients with Primary Open-Angle Glaucoma, Normal Tension Glaucoma and Healthy Controls. Clin Ophthalmol 2021; 15:4269-4280. [PMID: 34707346 PMCID: PMC8544789 DOI: 10.2147/opth.s320505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 08/31/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare changes in central retinal arterial equivalent (CRAE), central retinal vein equivalent (CRVE), arteriovenous ratio (AVR), tortuosity and fractal dimension in primary open-angle glaucoma (POAG), normal-tension glaucoma (NTG) and in a control group (CG) on fundus photographs. Further, to provide further evidence of vascular change in glaucoma patients using a novel method of tortuosity. Patients and Methods The primary endpoint was the change in CRAE, CRVE, AVR, fractal dimension and tortuosity of the retinal vasculature from baseline, retrospectively analyzed from 2011 to 2017 at the University Eye Hospital Tuebingen. Fundus photos of POAG (N = 49), NTG (N = 38) and CG (N = 18) were computer evaluated and analyzed in the quantities mentioned above. Results CRAE in NTG and POAG and CRVE in NTG significantly decreased (P = 0.02, P = 0.01; P = 0.03) whereas CRVE in POAG increased insignificantly (P = 0.72). In NTG, AVR decreased significantly (P = 0.05), but to a lesser extent than in POAG (P < 0.001). In CG, CRAE decreased insignificantly (P = 0.10), CRVE decreased significantly (P = 0.03) and AVR increased insignificantly (P = 0.77). In POAG tortuosity calculated using standard methods as well as our novel method, increased significantly (P = 0.015-0.04), whereas it did not occur in NTG (P = 0.18-0.57) and CG (P = 0.11-0.21). Fractal dimensions in POAG decreased significantly (P = 0.001-0.002), whereas in NTG and CG changes were insignificant (P = 0.33-0.92). Conclusion Based on a retrospective analysis of fundus photographs, specific retinal vasculature features of the retinal vasculature display significant alterations associated with NTG and POAG. The assessment of tortuosity using our novel method was consistent with previously established methods for analyzing tortuosity.
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Affiliation(s)
- Constanze Kortuem
- Department of Ophthalmology, University Eye Hospital, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Johannes Dietter
- Department of Ophthalmology, Institute for Ophthalmic Research University of Tuebingen, Tuebingen, Germany
| | - Yagmur Bozkurt
- Department of Ophthalmology, Institute for Ophthalmic Research University of Tuebingen, Tuebingen, Germany
| | | | - Annegret Abaza
- Department of Ophthalmology, University Eye Hospital, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Siegfried Wahl
- Department of Ophthalmology, Institute for Ophthalmic Research University of Tuebingen, Tuebingen, Germany.,Carl Zeiss Vision International GmbH, Aalen, Germany
| | - Iliya V Ivanov
- Department of Ophthalmology, Institute for Ophthalmic Research University of Tuebingen, Tuebingen, Germany.,Carl Zeiss Vision International GmbH, Aalen, Germany
| | - Marius Ueffing
- Department of Ophthalmology, Institute for Ophthalmic Research University of Tuebingen, Tuebingen, Germany
| | - Bogomil Voykov
- Department of Ophthalmology, University Eye Hospital, Eberhard Karls University Tuebingen, Tuebingen, Germany
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23
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French C, Heitmar R. Comparison of Static Retinal Vessel Caliber Measurements by Different Commercially Available Platforms. Optom Vis Sci 2021; 98:1104-1112. [PMID: 34570034 DOI: 10.1097/opx.0000000000001774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE Commercially available platforms show good agreement in clinical outcomes for retinal vessel caliber measurements, despite differing absolute values. Tighter agreement is observed when right and left eye data are averaged, suggesting an approach suitable for clinical practice. PURPOSE The purpose of this study was to compare the retinal vessel caliber measurements generated by different commercially available platforms and their associations with systemic blood pressure and age. METHODS A total of 209 participants were recruited from a UK optometric practice. After a routine eye examination, participants had disc-centered retinal photographs and systemic blood pressure taken. Retinal vessel calibers (central retinal artery equivalent, central retinal vein equivalent, and arteriovenous ratio) were calculated using both MONA REVA and VesselMap. RESULTS An inverse Pearson correlation was observed between central retinal artery equivalent and mean arterial blood pressure on both platforms (r = -0.275 [P ≤ .001] and r = -0.388 [P ≤ .001] for MONA REVA and VesselMap, respectively); this correlation was also observed with arteriovenous ratio and blood pressure. An inverse correlation was observed between central retinal artery equivalent and age (r = -0.362 [P ≤ .001] and r = -0.404 [P ≤ .001] for MONA REVA and VesselMap, respectively); this was also seen between central retinal vein equivalent and age (r = -0.322 [P ≤ .001] and r = -0.369 [P ≤ .001]). Arteriovenous ratio remained independent from age for both platforms. Bland-Altman plots demonstrated good agreement between the platforms for all three variables. CONCLUSIONS Although absolute caliber measurements differed between the platforms, the correlations observed were of similar magnitudes, with good agreement between the two platforms. Tighter spaced limits of agreement were observed when right and left eye data were averaged for each subject. In the absence of localized ocular pathology, this approach should be used.
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24
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Gour N, Khanna P. Multi-class multi-label ophthalmological disease detection using transfer learning based convolutional neural network. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2020.102329] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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25
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Choriocapillaris microvasculature dysfunction in systemic hypertension. Sci Rep 2021; 11:4603. [PMID: 33633311 PMCID: PMC7907127 DOI: 10.1038/s41598-021-84136-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/11/2021] [Indexed: 12/13/2022] Open
Abstract
We examined the choriocapillaris microvasculature using a non-invasive swept-source optical coherence tomography angiography (SS-OCTA) in 41 healthy controls and 71 hypertensive patients and determined possible correlations with BP and renal parameters. BP levels, serum creatinine and urine microalbumin/creatinine ratio (MCR) specimens were collected. The estimated glomerular filtration rate (eGFR) was calculated based on CKD-EPI Creatinine Equation. The main outcome was choriocapillaris flow deficits (CFD) metrics (density, size and numbers). The CFD occupied a larger area and were fewer in number in the hypertensive patients with poor BP control (407 ± 10 µm2; 3260 ± 61) compared to the hypertensives with good BP control (369 ± 5 µm2; 3551 ± 41) and healthy controls (365 ± 11 µm2; 3581 ± 84). Higher systolic BP (β = 9.90, 95% CI, 2.86–16.93), lower eGFR (β = − 0.85; 95% CI, − 1.58 to − 0.13) and higher urine MCR (β = 1.53, 95% CI, 0.32–2.78) were associated with larger areas of CFD. Similar significant associations with systolic BP, eGFR and urine MCR were found with number of CFD. These findings highlight the potential role of choriocapillaris imaging using SS-OCTA as an indicator of systemic microvascular abnormalities secondary to hypertensive disease.
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26
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Aşıkgarip N, Temel E, Hızmalı L, Örnek K, Sezgin FM. Retinal Vessel Diameter Changes in COVID-19 Infected Patients. Ocul Immunol Inflamm 2021; 29:645-651. [PMID: 33497297 DOI: 10.1080/09273948.2020.1853783] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Purpose: To evaluate the longitudinal changes in retinal vessel diameters in patients with coronavirus disease 2019 (COVID-19).Methods: This study included 25 patients with COVID-19 (Group 1) and 25 healthy subjects (Group 2). The diameters of peripapillary temporal and nasal retinal arteries and veins were measured at baseline and at 4 months after remission.Results: The baseline diameters of the inferior temporal vein and the artery were increased in group 1 compared to controls (p = .007 and p = .041, respectively). There was also an increase in the diameters of the inferior and superior nasal veins and arteries in group 1 at baseline (p = .001, p = .019, p = .037, and p = .008, respectively). Retinal vessel diameters decreased after remission in all quadrants in comparison to baseline measurements (all p < .05).Conclusion: Increased retinal vessel diameters were measured in COVID-19 patients during the disease. Measurement of retinal vessel diameters may be a noninvasive method of estimating the vascular risk.
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Affiliation(s)
- Nazife Aşıkgarip
- Department of Opthalmology, Kırşehir Ahi Evran Training and Research Hospital, Kırşehir, Turkey
| | - Emine Temel
- Department of Opthalmology, Kırşehir Ahi Evran Training and Research Hospital, Kırşehir, Turkey
| | - Lokman Hızmalı
- Department of Infectious Disease and Clinical Microbiology, Kırşehir Ahi Evran University School of Medicine, Kırşehir, Turkey
| | - Kemal Örnek
- Department of Opthalmology, Kırşehir Ahi Evran University School of Medicine, Kırşehir, Turkey
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27
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High-salt intake affects retinal vascular tortuosity in healthy males: an exploratory randomized cross-over trial. Sci Rep 2021; 11:801. [PMID: 33436709 PMCID: PMC7803999 DOI: 10.1038/s41598-020-79753-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 12/07/2020] [Indexed: 01/10/2023] Open
Abstract
The retinal microcirculation is increasingly receiving credit as a relatively easily accessible microcirculatory bed that correlates closely with clinical cardiovascular outcomes. The effect of high salt (NaCl) intake on the retinal microcirculation is currently unknown. Therefore, we performed an exploratory randomized cross-over dietary intervention study in 18 healthy males. All subjects adhered to a two-week high-salt diet and low-salt diet, in randomized order, after which fundus photographs were taken and assessed using a semi-automated computer-assisted program (SIVA, version 4.0). Outcome parameters involved retinal venular and arteriolar tortuosity, vessel diameter, branching angle and fractal dimension. At baseline, participants had a mean (SD) age of 29.8 (4.4) years and blood pressure of 117 (9)/73 (5) mmHg. Overall, high-salt diet significantly increased venular tortuosity (12.2%, p = 0.001). Other retinal parameters were not significantly different between diets. Changes in arteriolar tortuosity correlated with changes in ambulatory systolic blood pressure (r = - 0.513; p = 0.04). In conclusion, high-salt diet increases retinal venular tortuosity, and salt-induced increases in ambulatory systolic blood pressure associate with decreases in retinal arteriolar tortuosity. Besides potential eye-specific consequences, both phenomena have previously been associated with hypertension and other cardiovascular risk factors, underlining the deleterious microcirculatory effects of high salt intake.
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Jennings JR, Muldoon MF, Allen B, Ginty AT, Gianaros PJ. Cerebrovascular function in hypertension: Does high blood pressure make you old? Psychophysiology 2020; 58:e13654. [PMID: 32830869 DOI: 10.1111/psyp.13654] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 05/22/2020] [Accepted: 07/13/2020] [Indexed: 12/22/2022]
Abstract
The majority of individuals over an age of 60 have hypertension. Elevated blood pressure and older age are associated with very similar changes in brain structure and function. We review the parallel brain changes associated with increasing age and blood pressure. This review focuses on joint associations of aging and elevated blood pressure with neuropsychological function, regional cerebral blood flow responses to cognitive and metabolic challenges, white matter disruptions, grey matter volume, cortical thinning, and neurovascular coupling. Treatment of hypertension ameliorates many of these changes but fails to reverse them. Treatment of hypertension itself appears more successful with better initial brain function. We show evidence that sympathetic and renal influences known to increase blood pressure also impact brain integrity. Possible central mechanisms contributing to the course of hypertension and aging are then suggested. An emphasis is placed on psychologically relevant factors: stress, cardiovascular reactions to stress, and diet/obesity. The contribution of some of these factors to biological aging remains unclear and may provide a starting point for defining the independent and interacting effects of aging and increasing blood pressure on the brain.
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Affiliation(s)
- J Richard Jennings
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Matthew F Muldoon
- Department of Medicine, Heart and Vascular Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ben Allen
- Department of Psychology, University of Tennessee, Knoxville, TN, USA
| | - Annie T Ginty
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA
| | - Peter J Gianaros
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
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29
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Litwin M. It Is Time for Microcirculation. Hypertension 2020; 76:327-329. [PMID: 32639891 DOI: 10.1161/hypertensionaha.120.15471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mieczysław Litwin
- From the Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland
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30
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Retinal arteriolar wall-to-lumen ratios at 16–17 years in the Copenhagen Child Cohort 2000 Study. J Hypertens 2020; 38:731-736. [DOI: 10.1097/hjh.0000000000002329] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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31
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Dai G, He W, Xu L, Pazo EE, Lin T, Liu S, Zhang C. Exploring the effect of hypertension on retinal microvasculature using deep learning on East Asian population. PLoS One 2020; 15:e0230111. [PMID: 32134976 PMCID: PMC7058325 DOI: 10.1371/journal.pone.0230111] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 02/23/2020] [Indexed: 11/18/2022] Open
Abstract
Hypertension is the leading risk factor of cardiovascular disease and has profound effects on both the structure and function of the microvasculature. Abnormalities of the retinal vasculature may reflect the degree of microvascular damage due to hypertension, and these changes can be detected with fundus photographs. This study aimed to use deep learning technique that can detect subclinical features appearing below the threshold of a human observer to explore the effect of hypertension on morphological features of retinal microvasculature. We collected 2012 retinal photographs which included 1007 from patients with a diagnosis of hypertension and 1005 from normotensive control. By method of vessel segmentation, we removed interference information other than retinal vasculature and contained only morphological information about blood vessels. Using these segmented images, we trained a small convolutional neural networks (CNN) classification model and used a deep learning technique called Gradient-weighted Class Activation Mapping (Grad-CAM) to generate heat maps for the class “hypertension”. Our model achieved an accuracy of 60.94%, a specificity of 51.54%, a precision of 59.27%, and a recall of 70.48%. The AUC was 0.6506. In the heat maps for the class “hypertension”, red patchy areas were mainly distributed on or around arterial/venous bifurcations. This indicated that the model has identified these regions as being the most important for predicting hypertension. Our study suggested that the effect of hypertension on retinal microvascular morphology mainly occurred at branching of vessels. The change of the branching pattern of retinal vessels was probably the most significant in response to elevated blood pressure.
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Affiliation(s)
- Guangzheng Dai
- The Second Clinical College, Dalian Medical University, Dalian, Liaoning, China
- Clinical Research Center, He Eye Specialists Hospitals, Shenyang, Liaoning, China
| | - Wei He
- The Second Clinical College, Dalian Medical University, Dalian, Liaoning, China
- Clinical Research Center, He Eye Specialists Hospitals, Shenyang, Liaoning, China
- Clinical College, He University, Shenyang, Liaoning, China
- * E-mail:
| | - Ling Xu
- Clinical Research Center, He Eye Specialists Hospitals, Shenyang, Liaoning, China
- Clinical College, He University, Shenyang, Liaoning, China
| | - Eric E. Pazo
- Clinical Research Center, He Eye Specialists Hospitals, Shenyang, Liaoning, China
- Clinical College, He University, Shenyang, Liaoning, China
| | - Tiezhu Lin
- Clinical Research Center, He Eye Specialists Hospitals, Shenyang, Liaoning, China
- Clinical College, He University, Shenyang, Liaoning, China
| | - Shasha Liu
- Clinical Research Center, He Eye Specialists Hospitals, Shenyang, Liaoning, China
| | - Chenguang Zhang
- The Second Clinical College, Dalian Medical University, Dalian, Liaoning, China
- Clinical Research Center, He Eye Specialists Hospitals, Shenyang, Liaoning, China
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Robertson G, Fleming A, Williams MC, Trucco E, Quinn N, Hogg R, McKay GJ, Kee F, Young I, Pellegrini E, Newby DE, van Beek EJR, Peto T, Dhillon B, van Hemert J, MacGillivray TJ. Association between hypertension and retinal vascular features in ultra-widefield fundus imaging. Open Heart 2020; 7:e001124. [PMID: 32076560 PMCID: PMC6999694 DOI: 10.1136/openhrt-2019-001124] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 11/27/2019] [Accepted: 12/17/2019] [Indexed: 01/14/2023] Open
Abstract
Objective Changes to the retinal vasculature are known to be associated with hypertension independently of traditional risk factors. We investigated whether measurements of retinal vascular calibre from ultra-widefield fundus imaging were associated with hypertensive status. Methods We retrospectively collected and semiautomatically measured ultra-widefield retinal fundus images from a subset of participants enrolled in an ongoing population study of ageing, categorised as normotensive or hypertensive according to thresholds on systolic/diastolic blood pressure (140/90 mm Hg) measured in a clinical setting. Vascular calibre in the peripheral retina was measured to calculate the nasal–annular arteriole:venule ratio (NA-AVR), a novel combined parameter. Results Left and right eyes were analysed from 440 participants (aged 50–59 years, mean age of 54.6±2.9 years, 247, 56.1% women), including 151 (34.3%) categorised as hypertensive. Arterioles were thinner and the NA-AVR was smaller in people with hypertension. The area under the receiver operating characteristic curve of NA-AVR for hypertensive status was 0.73 (95% CI 0.68 to 0.78) using measurements from left eyes, while for right eyes, it was 0.64 (95% CI 0.59 to 0.70), representing evidence of a statistically significant difference between the eyes (p=0.020). Conclusions Semiautomated measurements of NA-AVR in ultra-widefield fundus imaging were associated with hypertension. With further development, this may help screen people attending routine eye health check-ups for high blood pressure. These individuals may then follow a care pathway for suspected hypertension. Our results showed differences between left and right eyes, highlighting the importance of investigating both eyes of a patient.
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Affiliation(s)
| | | | | | - Emanuele Trucco
- The VAMPIRE Project, Computer Vision and Image Processing Group, School of Science and Engineering, University of Dundee, Dundee, Dundee, UK
| | - Nicola Quinn
- Centre for Public Health, Queen's University Belfast, Belfast, Belfast, UK
| | - Ruth Hogg
- Centre for Public Health, Queen's University Belfast, Belfast, Belfast, UK
| | - Gareth J McKay
- Centre for Public Health, Queen's University Belfast, Belfast, Belfast, UK
| | - Frank Kee
- Centre for Public Health, Queen's University Belfast, Belfast, Belfast, UK
| | - Ian Young
- Centre for Public Health, Queen's University Belfast, Belfast, Belfast, UK
| | | | - David E Newby
- Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, Lothian, UK
| | - Edwin J R van Beek
- Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, Lothian, UK.,Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, UK
| | - Tunde Peto
- Centre for Public Health, Queen's University Belfast, Belfast, Belfast, UK
| | - Baljean Dhillon
- The VAMPIRE Project, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Thomas J MacGillivray
- Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, UK.,The VAMPIRE Project, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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Abstract
White-coat and masked hypertension are important hypertension phenotypes. Out-of-office blood pressure measurement is essential for the accurate diagnosis and monitoring of these conditions. This review summarizes literature related to the detection and diagnosis, prevalence, epidemiology, prognosis, and treatment of white-coat and masked hypertension. Cardiovascular risk in white-coat hypertension appears to be dependent on the presence of coexisting risk factors, whereas patients with masked hypertension are at increased risk of target organ damage and cardiovascular events. There is an unmet need for robust data to support recommendations around the use of antihypertensive treatment for the management of white-coat and masked hypertension.
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Affiliation(s)
- Kazuomi Kario
- From the Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K.)
| | - Lutgarde Thijs
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.T., J.A.S.)
| | - Jan A Staessen
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.T., J.A.S.).,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, The Netherlands (J.A.S.)
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34
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Novel biomarker of sphericity and cylindricity indices in volume-rendering optical coherence tomography angiography in normal and diabetic eyes: a preliminary study. Graefes Arch Clin Exp Ophthalmol 2020; 258:711-723. [PMID: 31907642 DOI: 10.1007/s00417-019-04582-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 12/05/2019] [Accepted: 12/19/2019] [Indexed: 12/16/2022] Open
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Kario K, Kanegae H, Oikawa T, Suzuki K. Hypertension Is Predicted by Both Large and Small Artery Disease. Hypertension 2019; 73:75-83. [PMID: 30571549 DOI: 10.1161/hypertensionaha.118.11800] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Both small and large artery disease might precede the development of hypertension. However, no prospective trial has yet determined the role of small and large artery disease on the rate of new-onset hypertension in a normotensive general population. This study investigated associations between both arterial stiffness and small artery retinopathy and the development of hypertension in adults from Japan. Normotensive individuals who underwent a baseline health checkup from 2005 to 2015 and at least 1 annual follow-up were eligible. The cardio-ankle vascular index (CAVI) was measured, and retinal fundus photography was performed at baseline. Follow-up visits included measurement of clinic blood pressure. The primary end point was new-onset hypertension (blood pressure ≥140/90 mm Hg or initiation of antihypertensive medication with self-reported hypertension). The analysis included 34 649 subjects (mean age, 44.2 years; 46.4% male). Mean follow-up duration was 3.18±2.50 years. The cumulative incidence of new-onset hypertension during the 10-year follow-up period was 40% of patients overall, with rates increasing in parallel with baseline CAVI (quartile [Q]1, 23%; Q2, 33%; Q3, 42%; Q4, 58%; P<0.001), and as the severity of retinopathy increased ( P<0.001). CAVI showed good discriminative ability for detecting new-onset hypertension. In multivariate analysis, both CAVI and small artery retinopathy were independent predictors of hypertension development. There was no interaction between CAVI and small artery retinopathy with respect to incident hypertension. In conclusion, we showed that both large and small artery disease predict future hypertension independently of each other and confounding risk factors in a general normotensive population.
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Affiliation(s)
- Kazuomi Kario
- From the Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K., H.K.)
| | - Hiroshi Kanegae
- From the Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K., H.K.).,Genki Plaza Medical Center for Health Care, Tokyo, Japan (H.K., T.O.)
| | - Takamitsu Oikawa
- Genki Plaza Medical Center for Health Care, Tokyo, Japan (H.K., T.O.)
| | - Kenji Suzuki
- Japan Health Promotion Foundation, Tokyo, Japan (K.S.)
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36
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Park SK, Jung JY, Kang JG, Chung PW, Oh CM. Left ventricular geometry and risk of incident hypertension. Heart 2019; 105:1402-1407. [PMID: 30995990 DOI: 10.1136/heartjnl-2018-314657] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/18/2019] [Accepted: 03/24/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Left ventricular (LV) geometry change is an independent predictor for cardiovascular disease. However, data are equivocal on the association of echocardiographic parameters of LV geometry with incident hypertension. Thus, we were to investigate the risk of hypertension according to the baseline echocardiographic parameters of LV geometry. METHODS Study participants were 12 562 Koreans without hypertension who received echocardiography as an item of health check-up. They were divided into normotensive or prehypertensive group according to baseline blood pressure. In each group, study subjects were classified by quintiles of baseline echocardiographic parameters including left ventricular mass index (LVMI), relative wall thickness (RWT), interventricular septal thickness (IVST), posterior wall thickness (PWT) and IVST plus PWT and followed up for 5 years. Cox proportional hazards model was used in calculating adjusted HRs and their 95% CI for hypertension according to each quintile group. Area under the curve (AUC) analysis (AUC [95% CI]) was performed to compare the predictability of LVMI, RWT, IVST, PWT, IVST plus PWT for hypertension. RESULTS Prehypertensive group had the worse clinical and echocardiographic parameters in baseline analysis than normotensive group. The risk of hypertension significantly increased proportionally to baseline LVMI, RWT, IVST, PWI and IVST plus PWT above specific quintile levels, which was identified in both normotensive and prehypertensive group. In AUC analysis, IVST, PWT and IVST plus PWT showed a significantly increased AUC, compared with LVMI. CONCLUSION LV geometry change was significantly associated with the increased risk for hypertension in non-hypertensive individuals.
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Affiliation(s)
- Sung Keun Park
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ju Young Jung
- Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeong Gyu Kang
- Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Pil-Wook Chung
- Department of Neurology, College of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chang-Mo Oh
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Dongdaemun-gu, Republic of Korea
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37
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Swart R, Schutte AE, van Rooyen JM, Smith W, Mels CMC. The Association of Measures of the Micro- and Macro-Vasculature with Selenium and GPx Activity in a Young Bi-Ethnic Population: The African-PREDICT Study. J Am Coll Nutr 2019; 38:614-622. [PMID: 30822227 DOI: 10.1080/07315724.2019.1570479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Rijané Swart
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - Aletta E. Schutte
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
- Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Johannes M. van Rooyen
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
- Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Wayne Smith
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
- Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Catharina M. C. Mels
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
- Medical Research Council: Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
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38
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Chyou AC, Klein BEK, Klein R, Barr RG, Cotch MF, Praestgaard A, Wong TY, Lima J, Bluemke DA, Kawut S. Retinal vascular changes and right ventricular structure and function: the MESA-Right Ventricle and MESA-Eye studies. Pulm Circ 2018; 9:2045894018819781. [PMID: 30622700 PMCID: PMC6304712 DOI: 10.1177/2045894018819781] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 11/21/2018] [Indexed: 11/16/2022] Open
Abstract
Retinal vessel diameters have been associated with left ventricular morphology
and function but their relationship with the right ventricle (RV) has not been
studied. We hypothesized that wider retinal venules and narrower retinal
arterioles are associated with RV morphology and function. RV end-diastolic mass
(RVEDM), end-diastolic volume (RVEDV), end-systolic volume (RVESV), stroke
volume (RVSV), and ejection fraction (RVEF) were assessed using cardiac magnetic
resonance imaging (MRI) scans of 4204 participants without clinical
cardiovascular disease at the baseline examination; retinal photography was
obtained at the second examination. Mean diameters of retinal arterioles and
venules were measured and summarized as central retinal vein and artery
equivalents (“veins” and “arteries,” respectively). After adjusting for
covariates, wider veins were associated with greater RVEDM and RVEDV in women
(P = 0.04 and P = 0.02, respectively),
whereas there was an inverse association with RVEDV in men
(P = 0.02). In both sexes, narrower arteries were associated
with lower RVEDM (P < 0.001 in women and
P = 0.002 in men) and smaller RVEDV
(P < 0.001 in women and P = 0.04 in men) in
adjusted models. Narrower arteries were also associated with lower RVEF in men
but this was of borderline significance after adjusting for the LVEF
(P = 0.08). Wider retinal venular diameter was associated
with sex-specific changes in RVEDM and RVEDV in adults without clinical
cardiovascular disease. Narrower retinal arteriolar diameter was associated with
significantly lower RVEDM and smaller RVEDV in both sexes.
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Affiliation(s)
- Anthony C Chyou
- Division of Cardiology and the Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, New York City, NY, USA
| | - Barbara E K Klein
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Ronald Klein
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - R Graham Barr
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York City, NY, USA
| | - Mary Frances Cotch
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Amy Praestgaard
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Tien Y Wong
- Singapore Eye Research Institute, National University of Singapore, Singapore, Republic of Singapore
| | - Joao Lima
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David A Bluemke
- National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD, USA
| | - Steven Kawut
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Wei FF, Huang QF, Zhang ZY, Van Keer K, Thijs L, Trenson S, Yang WY, Cauwenberghs N, Mujaj B, Kuznetsova T, Allegaert K, Struijker-Boudier HAJ, Verhamme P, Vermeer C, Staessen JA. Inactive matrix Gla protein is a novel circulating biomarker predicting retinal arteriolar narrowing in humans. Sci Rep 2018; 8:15088. [PMID: 30305657 PMCID: PMC6180139 DOI: 10.1038/s41598-018-33257-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 09/17/2018] [Indexed: 12/15/2022] Open
Abstract
Active matrix Gla protein (MGP), a potent inhibitor of calcification in large arteries, protects against macrovascular complications. Recent studies suggested that active MGP helps maintaining the integrity of the renal and myocardial microcirculation, but its role in preserving the retinal microcirculation remains unknown. In 935 randomly recruited Flemish participants (mean age, 40.9 years; 50.3% women), we measured plasma desphospho-uncarboxylated MGP (dp-ucMGP), a marker of poor vitamin K status using an ELISA-based assay at baseline (1996-2010) and retinal microvascular diameters using IVAN software (Vasculomatic ala Nicola, version 1.1) including the central retinal arteriolar (CRAE) and venular (CRVE) equivalent and the arteriole-to-venule ratio (AVR) at follow-up (2008-2015). CRAE (P = 0.005) and AVR (P = 0.080) at follow-up decreased across tertiles of the dp-ucMGP distribution. In unadjusted models, for a doubling of dp-ucMGP at baseline, CRAE and AVR at follow-up respectively decreased by 1.40 µm (95% confidence interval [CI], 0.32 to 2.48; P = 0.011) and 0.006 (CI, 0.001 to 0.011; P = 0.016). In multivariable-adjusted models accounting for sex, baseline characteristics and follow-up duration, these estimates were -1.03 µm (CI, -1.96 to -0.11; P = 0.028) and -0.007 (CI, -0.011 to -0.002; P = 0.007). Additional adjustment for changes from baseline to follow-up in major baseline characteristics yielded as estimates -0.91 µm (CI, -1.82 to -0.01; P = 0.048) and -0.006 (95% CI, -0.011 to -0.001; P = 0.014), respectively. Circulating inactive dp-ucMGP is a long-term predictor of smaller retinal arteriolar diameter in the general population. Our observations highlight the possibility that vitamin K supplementation might promote retinal health.
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Affiliation(s)
- Fang-Fei Wei
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Qi-Fang Huang
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Zhen-Yu Zhang
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Karel Van Keer
- Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium
| | - Lutgarde Thijs
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Sander Trenson
- Division of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Wen-Yi Yang
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Nicholas Cauwenberghs
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Blerim Mujaj
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Tatiana Kuznetsova
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Karel Allegaert
- Research Unit Organ Systems, Department of Development and Regeneration, University of Leuven, Leuven, Belgium
- Department of Pediatric Surgery and Intensive Care and Neonatology, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands
| | | | - Peter Verhamme
- Centre for Molecular and Vascular Biology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Cees Vermeer
- R&D Group VitaK, Maastricht University, Maastricht, The Netherlands
| | - Jan A Staessen
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.
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40
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Siegrist M, Hanssen H, Lammel C, Haller B, Koch AM, Stemp P, Dandl E, Liestak R, Parhofer KG, Vogeser M, Halle M. Effects of a cluster-randomized school-based prevention program on physical activity and microvascular function (JuvenTUM 3). Atherosclerosis 2018; 278:73-81. [PMID: 30261471 DOI: 10.1016/j.atherosclerosis.2018.09.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 07/30/2018] [Accepted: 09/07/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS It is unknown whether a school-based prevention program has the potential to improve microvascular health in children. This study investigates the impact of the school-based lifestyle intervention program JuvenTUM 3 on physical activity, physical fitness, serum biomarkers and microvascular function. METHODS We studied 434 children (10-11 years) in a cluster-randomized setting (8 intervention schools, IG; 7 control schools, CG) over 18 months. The school-based prevention program included weekly lifestyle lessons for children with the aim to increase physical activity in and outside of school, physical fitness as well as health behavior. Anthropometric measurements and blood sampling were conducted using standard protocols, physical activity by use of a questionnaire and physical fitness by a 6-item-test battery. Central retinal arteriolar (CRAE) and venular (CRVE) vessel diameters as early marker of vascular dysfunction, as well as the arteriolar-to-venular diameter ratio (AVR), were investigated with a non-mydriatic vessel analyser. RESULTS School-based physical activity increased in 41% of children in IG (19% in CG, p = 0.038). Improvements in vascular parameters were observed for AVR (increase in 83% of children in IG versus 50% in CG; p < 0.001) and for CRVE (43% of children with retinal venular widening in IG versus 58% in CG, p = 0.019). These vascular improvements were also seen in overweight children for CRAE (p = 0.021) and AVR (p < 0.001). CONCLUSIONS The school-based prevention program JuvenTUM 3 increased physical activity at school inducing favourable effects on retinal microvasculature function. These findings underline the importance of early lifestyle interventions in children for primary prevention of cardiovascular disease.
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Affiliation(s)
- Monika Siegrist
- Department of Prevention, Rehabilitation and Sports Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany.
| | - Henner Hanssen
- Department of Sport, Exercise and Health, Division of Sports and Exercise Medicine, University of Basel, Switzerland
| | - Christoph Lammel
- Department of Prevention, Rehabilitation and Sports Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany
| | - Bernhard Haller
- Institute of Medical Informatics, Statistics and Epidemiology, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany
| | - Anna-Maria Koch
- Department of Prevention, Rehabilitation and Sports Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany
| | - Pia Stemp
- Department of Prevention, Rehabilitation and Sports Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany
| | - Elke Dandl
- Department of Prevention, Rehabilitation and Sports Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany
| | - Roberta Liestak
- Department of Prevention, Rehabilitation and Sports Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany
| | - Klaus G Parhofer
- Department of Internal Medicine II, University of Munich, Großhadern Campus, Munich, Germany
| | - Michael Vogeser
- Institute of Laboratory Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Martin Halle
- Department of Prevention, Rehabilitation and Sports Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner site Munich Heart Alliance, Munich, Germany
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41
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Dumitrescu AG, Voinea L, Badarau IA, Paun VA, Schowe M, Ciuluvica R. Update on retinal vascular caliber. Rom J Ophthalmol 2018; 61:171-180. [PMID: 29450394 PMCID: PMC5710034 DOI: 10.22336/rjo.2017.32] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Retinal vessels are the only blood vessels that can be viewed directly, in vivo, repetitively and non-invasively. Retinal vessel caliber is influenced by physiological (age, sex, race, blood pressure, blood glucose, body mass index) and pathological (atherosclerosis, dyslipidemia, smoking) determinants. There are studies on large population groups that demonstrate the associations between retinal vasculature and subclinical or clinical changes in systemic diseases (hypertension, diabetes, stroke, renal or cardiac diseases). The assessment of retinal vessels can provide information about the pathophysiology of many diseases, but it also has a direct applicability in clinic, being used as a screening method that predicts the risk of their occurrence.
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Affiliation(s)
- Alina Gabriela Dumitrescu
- Coltea Clinical Hospital, Bucharest, Romania.,Physiology Department I, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Liliana Voinea
- Ophthalmology Department, University Emergency Hospital; "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Ioana Anca Badarau
- Physiology Department I, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Vanessa Andrada Paun
- Ophthalmology Department, University Emergency Hospital; "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Radu Ciuluvica
- Anatomy Department, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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42
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Huang QF, Wei FF, Zhang ZY, Raaijmakers A, Asayama K, Thijs L, Yang WY, Mujaj B, Allegaert K, Verhamme P, Struijker-Boudier HAJ, Li Y, Staessen JA. Reproducibility of Retinal Microvascular Traits Decoded by the Singapore I Vessel Assessment Software Across the Human Age Range. Am J Hypertens 2018; 31:438-449. [PMID: 29186314 PMCID: PMC5861549 DOI: 10.1093/ajh/hpx202] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 11/23/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Retinal microvascular traits predict adverse health outcomes. The Singapore I Vessel Assessment (SIVA) software improved automated postprocessing of retinal photographs. In addition to microvessel caliber, it generates measures of arteriolar and venular geometry. Few studies addressed the reproducibility of SIVA measurements across a wide age range. METHODS In the current study, 2 blinded graders read images obtained by nonmydriatic retinal photography twice in 20 11-year-old children, born prematurely (n = 10) or at term (n = 10) and in 60 adults (age range, 18.9–86.1 years). RESULTS Former preterm compared with term children had lower microvessel diameter and disorganized vessel geometry with no differences in intraobserver and interobserver variability. Among adults, microvessel caliber decreased with age and blood pressure and arteriolar geometry was inversely correlated with female sex and age. Intraobserver differences estimated by the Bland–Altman method did not reach significance for any measurement. Across measurements, median reproducibility (RM) expressed as percent of the average trait value was 8.8% in children (median intraclass correlation coefficient [ICC], 0.94) and 8.0% (0.97) in adults. Likewise, interobserver differences did not reach significance with RM (ICC) of 10.6% (0.85) in children and 10.4% (0.93) in adults. Reproducibility was best for microvessel caliber (intraobserver/interobserver RM, 4.7%/6.0%; ICC, 0.98/0.96), worst for venular geometry (17.0%/18.8%; 0.93/0.84), and intermediate for arteriolar geometry (10.9%/14.9%; 0.95/0.86). CONCLUSIONS SIVA produces repeatable measures of the retinal microvasculature in former preterm and term children and in adults, thereby proving its usability from childhood to old age.
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Affiliation(s)
- Qi-Fang Huang
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium
- Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Fang-Fei Wei
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium
| | - Zhen-Yu Zhang
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium
| | - Anke Raaijmakers
- Department of Development and Regeneration, University of Leuven, Belgium
| | - Kei Asayama
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
- Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan
| | - Lutgarde Thijs
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium
| | - Wen-Yi Yang
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium
| | - Blerim Mujaj
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium
| | - Karel Allegaert
- Department of Development and Regeneration, University of Leuven, Belgium
- Department of Pediatric Surgery and Intensive Care, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Peter Verhamme
- Centre for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium
| | | | - Yan Li
- Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jan A Staessen
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
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Abstract
Supplemental Digital Content is available in the text Objectives: To examine factors influencing retinal vasculature in two environmentally contrasted, cross-sectional studies of adult participants of European descent and to estimate the extent and specificity of genetic contributions to each retinal vasculature feature. Methods: Retinal images from 1088 participants in the Orkney Complex Disease Study and 387 in the CROATIA-Korčula study, taken using the same nonmydriatic camera system and graded by the same person, were evaluated. Using general linear models, we estimated the influence of an extensive range of systemic risk factors, calculated retinal traits heritabilities and genetic correlations. Main results: Systemic covariates explained little (<4%) of the variation in vessel tortuosity, substantially more (>10%, up to 31.7%) of the variation in vessel width and monofractal dimension. Suggestive not well trodden associations of biological interest included that of urate, tissue plasminogen activator and cardiac PR interval with arteriolar narrowing, that of carotid intima–media thickness with less-tortuous arterioles and of cardiac QT interval with more tortuous venules. The genetic underpinning of tortuosity is largely distinct from that of the other retinal vascular features, whereas that of fractal dimension and vessel width greatly overlaps. The previously recognized influence of ocular axial length on vessel widths was high and can be expected to lead to artefactual genetic associations [genetic correlation with central retinal arteriolar equivalent: −0.53 (standard error 0.11)]. The significant genetic correlation between SBP and central retinal arteriolar equivalent, −0.53 (standard error 0.22) (after adjusting for age, sex and axial length of the eye), augurs more favourably for the discovery of genetic variants relevant to vascular physiology.
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Retinal vessel metrics: normative data and their use in systemic hypertension: results from the Gutenberg Health Study. J Hypertens 2018; 35:1635-1645. [PMID: 28505063 DOI: 10.1097/hjh.0000000000001380] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW In-vivo measurement of retinal vascular calibers may be used as a tool to study the pathophysiology and clinical status of the microvasculature of the retina. The aim of this study was to generate normative data for retinal vessel parameters, and to evaluate the clinical relevance in systemic hypertension. METHODS Fundus photographs from 4309 participants of the Gutenberg Health Study were assessed using the 'retinal vessel analyzer' software (IMEDOS). We generated age and sex-specific nomograms in a disease-free subpopulation of 890 participants for determining the central retinal arteriolar equivalent (CRAE), the central retinal venular equivalent, and the arteriovenous ratio (AVR). RESULTS Women had higher values of CRAE, central retinal venular equivalent, and AVR than men, and the decrease in measures with increasing age was less steep in women than in men. Systemic hypertension was associated with lower values [odds ratio (OR), 95% confidence interval (CI) referring to area below the 5% percentile] of AVR (men: OR 2.41, 95% CI 1.669-3.490, P < 0.001; women: OR 3.01, 95% CI 2.126-4.268, P < 0.001) and CRAE (men: OR 2.60, 95% CI 1.563-4.326, P < 0.001, women: OR 3.00, 95% CI 2.004-4.487, P < 0.001). Both median CRAE and AVR were lower in participants with uncontrolled hypertension (172.28, range 83.05-251.04; and 0.81, range 0.56-1.04) versus those with screening-detected hypertension (175.72, range 101.23-222.09, P < 0.001; and 0.82, range 0.64-1.05, P = 0.001), and versus those with controlled (179.10, range 108.19-221.92, P < 0.001; and 0.84, range 0.60-1.08, P < 0.001) hypertension. CONCLUSION The study provides sex and age-specific normative data for retinal vasculature. Persons with untreated or insufficiently treated hypertension are more likely to have retinal vessel equivalents outside the reference range.
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Chua J, Chia AR, Chee ML, Man REK, Tan GSW, Lamoureux EL, Wong TY, Chong MFF, Schmetterer L. The relationship of dietary fish intake to diabetic retinopathy and retinal vascular caliber in patients with type 2 diabetes. Sci Rep 2018; 8:730. [PMID: 29335432 PMCID: PMC5768794 DOI: 10.1038/s41598-017-18930-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 12/18/2017] [Indexed: 12/29/2022] Open
Abstract
In this cross-sectional study, we evaluated the association of dietary fish intake with varying severity of diabetic retinopathy (DR) and retinal vascular caliber in Asians with type 2 diabetes mellitus. 357 Asians (median age: 58 years; 31% women; 78% Chinese) were recruited from a tertiary eye care institution in Singapore. Fish consumption was evaluated using a validated food frequency questionnaire. Digital retinal photographs assessed for DR severity and retinal vascular caliber. Ordered logistic and linear regression models were used to investigate the association of fish intake with DR severity and vascular caliber. Increasing frequency of fish consumption was significantly associated with lower odds of having severe DR (odds ratio [OR] = 0.91, 95% CI: 0.84–0.99 per 1-unit increase of fish intake; P = 0.038). Among those with no retinopathy, persons in quartile 4 fish intake had a wider retinal vascular caliber for arteriolar (β = 22.27 µm, 95% CI: 12.64–31.90; P-trend < 0.001) and venular (β = 32.00 µm, 95% CI: 17.56–46.43; P-trend < 0.001), than those in quartile 1 fish intake. Persons with higher fish intake had a decreased likelihood of having severe DR. In diabetics without retinopathy, higher fish intake was associated with wider retinal vascular caliber. Future research is needed to reinforce the direction of the casualty.
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Affiliation(s)
- Jacqueline Chua
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Ai-Ru Chia
- Department of Obstetrics & Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Miao Li Chee
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Ryan Eyn Kidd Man
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Gavin Siew Wei Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Ecosse L Lamoureux
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Mary Foong-Fong Chong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.,Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore.,Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, A*STAR, Singapore, Singapore
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore. .,Duke-NUS Medical School, Singapore, Singapore. .,Department of Ophthalmology, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore. .,Department of Clinical Pharmacology, Medical University of Vienna, Wien, Austria. .,Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Wien, Austria.
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46
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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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47
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Association Between Blood Pressure and Retinal Vessel Diameters Among Police Officers in the US Northeast. J Occup Environ Med 2017; 60:234-240. [PMID: 29227361 DOI: 10.1097/jom.0000000000001246] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to examine relationships of blood pressure with central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent (CRVE) among 242 police officers. METHODS Computerized retinal images of each eye were taken. Mean values of CRAE and CRVE were compared across hypertension status categories using analysis of variance and analysis of covariance. Associations of mean arterial blood pressure (MABP) with CRAE and CRVE were obtained using regression models. RESULTS CRAE was significantly narrower in officers with uncontrolled hypertension (142.8 ± 2.7 μm), compared with those with controlled hypertension (153.6 ± 2.7 μm, P = 0.0013) and those with no hypertension (156.4 ± 1.0 μm, P ≤ 0.0001) after covariate adjustment. CRAE decreased by 3.43 μm for each 5 mm Hg increase in MABP (P ≤ 0.0001). CONCLUSION Uncontrolled hypertension was significantly associated with narrower retinal arterioles. No association was observed with retinal venules.
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Mehta R, Hodakowski A, Cai X, Lee KE, Kestenbaum BR, de Boer IH, Fawzi A, Wong TY, Ix J, Klein B, Klein R, Isakova T. Serum Phosphate and Retinal Microvascular Changes: The Multi-Ethnic Study of Atherosclerosis and the Beaver Dam Eye Study. Ophthalmic Epidemiol 2017; 24:371-380. [PMID: 28402694 PMCID: PMC5844221 DOI: 10.1080/09286586.2017.1304562] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 03/04/2017] [Indexed: 12/22/2022]
Abstract
PURPOSE Higher levels of serum phosphate are strongly linked to increased risk of cardiovascular disease and therapies aimed to lower serum phosphate are employed in the management of patients with chronic kidney disease (CKD). Data are limited, however, on serum phosphate as a risk factor for microvascular disease in community-based populations. It is important to determine the impact of novel risk factors, such as phosphate, on the microvasculature. METHODS We conducted a prospective study of 3919 individuals in the Multi-Ethnic Study of Atherosclerosis (MESA) and 3544 individuals in the Beaver Dam Eye Study (BDES) to test the associations of serum phosphate with retinopathy and retinal vessel caliber, and change in retinopathy severity and change in retinal vessel caliber. RESULTS Mean (standard deviation) serum phosphate was 3.66 (0.52) mg/dl in the MESA and 3.77 (0.55) mg/dl in the BDES. In multivariable adjusted models, phosphate was significantly associated with prevalent retinopathy in the MESA (Odds Ratio [OR] per 1 mg/dl increase in phosphate, 1.22; Confidence Interval [CI] 1.02-1.47) and the BDES (OR 1.06; CI 1.01-1.11). In stratified analyses, these relationships were even stronger and only seen in individuals with diabetes in both the MESA (OR 1.81; CI 1.30-2.53) and the BDES (OR 1.16; CI 1.05-1.29). Phosphate was not associated with incident or change in retinopathy severity, nor any retinal caliber outcome. CONCLUSIONS Among community-living individuals with low prevalence of CKD, higher serum phosphate was associated with prevalent retinopathy in individuals with diabetes. Further longitudinal assessments in patients with diabetes necessitate further investigation.
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Affiliation(s)
- Rupal Mehta
- Division of Nephrology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Translational Metabolism and Health, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Jesse Brown Veterans Administration Medical Center, Division of Nephrology, Chicago, IL, USA
| | - Alexander Hodakowski
- Center for Translational Metabolism and Health, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Xuan Cai
- Center for Translational Metabolism and Health, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kris E. Lee
- Ocular Epidemiology Research Group, University of Wisconsin–Madison, Madison, WI, USA
| | | | - Ian H. de Boer
- Division of Nephrology, University of Washington, Seattle, WA, USA
| | - Amani Fawzi
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Tien Yin Wong
- Vitreo-Retinal Department, Singapore National Eye Centre, Singapore, Singapore
| | - Joachim Ix
- Division of Nephrology, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Barbara Klein
- Ocular Epidemiology Research Group, University of Wisconsin–Madison, Madison, WI, USA
| | - Ronald Klein
- Ocular Epidemiology Research Group, University of Wisconsin–Madison, Madison, WI, USA
| | - Tamara Isakova
- Division of Nephrology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Translational Metabolism and Health, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Velayutham V, Benitez-Aguirre PZ, Craig ME, Liew G, Wong TY, Jenkins AJ, Donaghue KC. Innovative technology shows impact of glycaemic control on peripheral retinal vessels in adolescents with type 1 diabetes. Diabetologia 2017; 60:2103-2110. [PMID: 28711971 DOI: 10.1007/s00125-017-4375-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 06/01/2017] [Indexed: 12/21/2022]
Abstract
AIMS/HYPOTHESIS Retinal imaging enables non-invasive microvasculature assessment; however, only central retinal vessels have been studied in type 1 diabetes. Peripheral smaller vessels have a major haemodynamic role and may differ from central vessels in their response to the diabetic milieu. We hypothesise that diabetes has a greater impact on peripheral retinal vessels vs central vessels. METHODS Retinal photographs from adolescents (n = 736; age 12-20 years) with type 1 diabetes were graded (Singapore I Vessel Assessment) with vessel calibres measured in the 'central zone' as central retinal arteriolar and venular equivalents (CRAE and CRVE, respectively) and the 'extended zone' as mean width of arterioles and venules (MWa and MWv, respectively). Multivariable linear regression was used to explore associations between vessel calibres and HbA1c, diabetes duration, sex and BP. RESULTS Mean ± SD age was 14.1 ± 1.5 years, HbA1c was 8.5 ± 1.3% (69.4 ± 14.1 mmol/mol) and median diabetes duration was 4.9 years (interquartile range 3.1-7.6 years). Wider MWa was associated with HbA1c (β 0.01 [95% CI 0.004, 0.03]), longer diabetes duration (0.07 [0.02, 0.13]) and higher systolic BP (0.04 [0.02, 0.05]). MWv was associated with HbA1c (0.02 [0.009, 0.03]) and higher systolic BP (0.04 [0.03, 0.06]). CRAE was associated with longer diabetes duration (0.93 [0.58, 1.28]) and higher systolic BP (-0.28 [-0.37, -0.19]). CRVE was associated with longer diabetes duration (0.91 [0.42, 1.41]) and higher systolic BP (-0.20 [-0.33, -0.07]). Girls had wider vessels (for all four calibre measurements). CONCLUSIONS/INTERPRETATION In adolescents with type 1 diabetes, higher HbA1c is associated with adverse changes to peripheral smaller retinal vessels but not central vessels. The predictive value of retinal vascular imaging should be evaluated using longitudinal data.
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Affiliation(s)
- Valli Velayutham
- The Children's Hospital at Westmead, 212 Hawkesbury Road, Westmead, NSW, 2145, Australia
| | - Paul Z Benitez-Aguirre
- The Children's Hospital at Westmead, 212 Hawkesbury Road, Westmead, NSW, 2145, Australia
- Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Maria E Craig
- The Children's Hospital at Westmead, 212 Hawkesbury Road, Westmead, NSW, 2145, Australia
- Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
- School of Paediatrics, University of New South Wales, Sydney, NSW, Australia
| | - Gerald Liew
- The Children's Hospital at Westmead, 212 Hawkesbury Road, Westmead, NSW, 2145, Australia
- Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Tien Y Wong
- Department of Ophthalmology, University of Melbourne and Centre for Eye Research, East Melbourne, VIC, Australia
- Singapore Eye Research Institute, Singapore, Republic of Singapore
| | - Alicia J Jenkins
- Singapore Eye Research Institute, Singapore, Republic of Singapore
| | - Kim C Donaghue
- The Children's Hospital at Westmead, 212 Hawkesbury Road, Westmead, NSW, 2145, Australia.
- Singapore Eye Research Institute, Singapore, Republic of Singapore.
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50
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Benschop L, Schalekamp-Timmermans S, Roeters van Lennep JE, Jaddoe VWV, Wong TY, Cheung CY, Steegers EAP, Ikram MK. Gestational hypertensive disorders and retinal microvasculature: the Generation R Study. BMC Med 2017; 15:153. [PMID: 28803548 PMCID: PMC5554975 DOI: 10.1186/s12916-017-0917-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 07/18/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Changes in the microvasculature associated with pre-eclampsia and gestational hypertension have been proposed as a potential pathway in the development of cardiovascular disease. We examined whether gestational hypertensive disorders, such as pre-eclampsia and gestational hypertension, are related to the maternal retinal microvasculature status after pregnancy. METHODS This study is part of an ongoing population-based prospective cohort study. During pregnancy and 6.2 years after the index pregnancy (90% range 5.7-7.4 years), we examined 3391 women with available information on pre-eclampsia, gestational hypertension, and retinal vascular calibers. Retinal arteriolar and venular calibers were measured in the left eye from digitized retinal photographs. RESULTS Women with pre-eclampsia had smaller retinal arteriolar calibers 6 years after pregnancy than women with a normotensive pregnancy (adjusted difference: -0.40 standard deviation score [SDS]; 95% confidence interval [CI]: -0.62, -0.19). For women with previous gestational hypertension, similar trends were observed (-0.20 SDS; 95% CI: -0.34, -0.05). With respect to retinal venular calibers, we did not observe consistent trends for women with previous pre-eclampsia. However, in women with previous gestational hypertension, we observed larger venular calibers (0.22 SDS; 95% CI: 0.07-0.36) than in women with a previous normotensive pregnancy. The association of gestational hypertensive disorders with retinal vessel calibers was mediated through mean arterial pressure at the time of retinal imaging. CONCLUSIONS Compared to women with a previous normotensive pregnancy, women with pre-eclampsia and gestational hypertension show an altered status of the microvasculature 6 years after the index pregnancy. This is reflected by smaller retinal arteriolar calibers and wider retinal venular calibers. These microvascular changes may possibly contribute to the development of cardiovascular disease in later life.
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Affiliation(s)
- Laura Benschop
- Department of Obstetrics and Gynecology, Erasmus Medical Center, Wytemaweg 80, PO Box 2040, 3000 CA, Rotterdam, the Netherlands.
| | - Sarah Schalekamp-Timmermans
- Department of Obstetrics and Gynecology, Erasmus Medical Center, Wytemaweg 80, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | | | - Vincent W V Jaddoe
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Pediatrics, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Carol Y Cheung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore.,Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Eric A P Steegers
- Department of Obstetrics and Gynecology, Erasmus Medical Center, Wytemaweg 80, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - M Kamran Ikram
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Neurology, Erasmus Medical Center, Rotterdam, the Netherlands
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