Looking into the eye of patients with chronic obstructive pulmonary disease: an opportunity for better microvascular profiling of these complex patients

Vaes, Anouk W.; Spruit, Martijn A.; Theunis, Jan; Goswami, Nandu; Vanfleteren, Lowie E.G.W.; Franssen, Frits M.E.; Wouters, Emiel F.M.; Boever, Patrick De

doi:10.1111/aos.13765

Cited by 16 publications

(12 citation statements)

References 78 publications

(207 reference statements)

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“…Due to long-term chronic hypoxia and chronic inflammation, the pulmonary blood vessels of COPD patients have undergone obvious pathophysiological changes, which are manifested by a significant reduction in the cross-sectional area of the pulmonary small blood vessels, especially as the disease worsens [34,35]. Previous studies [36][37][38] have shown that during the year of follow-up, CSA subjects receiving regular and reasonable management have significantly increased CSA, especially among smoke quitters. This suggests that in patients with COPD, if they can be early detected on their pulmonary small blood vessel and, and with active and effective management, smoking ban, correction of hypoxia, acidosis, inflammation and other factors may restore the small blood vessels to their original shape to a certain extent [39].…”

Section: Discussionmentioning

confidence: 99%

The CT pulmonary vascular parameters and disease severity in COPD patients on acute exacerbation: a correlation analysis

Yang

Chen

2021

BMC Pulm Med

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Background It is necessary to analyze the CT pulmonary vascular parameters and disease severity in chronic obstructive pulmonary disease (COPD) patients to provide evidence support for the management of COPD. Methods COPD patients on acute exacerbation admitted to our hospital from COPD patients from January 2019 to March 2020 was selected. The characteristics and ratio of the cross-sectional area (CSA) of small pulmonary vessels to the total area of the lung field, and the ratio of pulmonary artery and aorta (PA/A) cross-sectional diameter in patients with COPD were analyzed. Results A total of 128 COPD patients were included. There were significant differences in the duration of COPD, smoking history, the PaO2, PaCO2, pH, and FEV1, FVC and FEV1/FVC among COPD patients with different severity (all p < 0.05). The duration of COPD, smoking, PaO2, PaCO2, CSA and PA/A were correlated with the COPD severity (all p < 0.05). Both CSA, PA/A were correlated with post BD FEV1 (all p < 0.05). The cutoff value of CSA and PA/A for the diagnosis of severe COPD was 0.61 and 0.87 respectively, and the AUC of CSA and PA/A for the diagnosis of severe COPD was 0.724 and 0.782 respectively. Conclusions Patients with CSA ≤ 0.61 and PA/A ≥ 0.87 may have higher risks for severe COPD, and more studies are needed in the future to further elucidate the management of COPD.

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Section: Discussionmentioning

confidence: 99%

The CT pulmonary vascular parameters and disease severity in COPD patients on acute exacerbation: a correlation analysis

Yang

Chen

2021

BMC Pulm Med

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“…The correlation of microvascular abnormalities in COPD patients has been recently reviewed by Vaes and colleagues in 2018 [31]. Peripapillary choroidal thickness in COPD patients has been examined in three studies [32][33][34].…”

Section: Discussionmentioning

confidence: 99%

Simple non-mydriatic retinal photography is feasible and demonstrates retinal microvascular dilation in Chronic Obstructive Pulmonary Disease (COPD)

McKay¹,

McCarter²,

Hogg³

et al. 2020

PLoS ONE

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Background Chronic Obstructive Pulmonary Disease (COPD) is associated with an increased risk of myocardial infarction and stroke but it remains unclear how to identify microvascular changes in this population. Objectives We hypothesized that simple non-mydriatic retinal photography is feasible and can be used to assess microvascular damage in COPD. Methods Novel Vascular Manifestations of COPD was a prospective study comparing smokers with and without COPD, matched for age. Non-mydriatic, retinal fundus photographs were assessed using semi-automated software. Results Retinal images from 24 COPD and 22 control participants were compared. Cases were of similar age to controls (65.2 vs. 63.1 years, p = 0.38), had significantly lower Forced Expiratory Volume in one second (FEV 1) (53.4 vs 100.1% predicted; p < 0.001) and smoked more than controls (41.7 vs. 29.6 pack years; p = 0.04). COPD participants had wider mean arteriolar (155.6 ±15 uM vs. controls [142.2 ± 12 uM]; p = 0.002) and venular diameters (216.8 ±20.7 uM vs. [201.3± 19.1 uM]; p = 0.012). Differences in retinal vessel caliber were independent of confounders, odds ratios (OR) = 1.

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“…It has been suggested that hypoxia may be involved in the etiology of some retinal abnormalities in COPD 43,44 . Indeed, a constant oxygen supply is crucial for adequate organ function 44 ., andeven small changes in oxygen supply to the retina can result in tissue hypoxia and retinal changes 44 .…”

Section: Discussionmentioning

confidence: 99%

“…In addition, exposure to corticosteroids may contribute to an increased risk of glaucoma and cataract, though results in patients with COPD are contradictory [45][46][47] . An earlier review demonstrated that structural and functional changes in the retinal microvasculature are more common and severe in patients with COPD compared to non-COPD controls, including increased retinal vessel diameter, lower retinal arterial oxygen saturation, impaired haemodynamics and increased resistive index of the orbital vessels 43 . Chew et al also demonstrated that retinal abnormalities were more frequently present in hospital patients with COPD compared to other hospital patients (80% vs. 50%) 27 .…”

Section: Discussionmentioning

confidence: 99%

Structural analysis of retinal blood vessels in patients with COPD during a pulmonary rehabilitation program

Vaes

Spruit

Keer

et al. 2020

Sci Rep

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cardiovascular diseases are frequently present in chronic obstructive pulmonary disease (copD). population-based studies found associations between retinal vessel diameters and cardiovascular health, but it is unknown whether this also applies to COPD patients. Therefore, we measured retinal vessel diameters in copD patients and aimed to determine the association with cardiovascular risk factors, lung function, and functional outcomes. In addition, we investigated whether an exercisebased pulmonary rehabilitation (PR) program would change retinal vessel diameters, as a proxy for improved microvascular health. Demographics and clinical characteristics, including pulmonary function, exercise capacity, blood pressure, blood measurements and level of systemic inflammation were obtained from 246 patients during routine assessment before and after PR. Retinal vessel diameters were measured from digital retinal images. older age and higher systolic blood pressure were associated with narrower retinal arterioles (β: −0.224; p = 0.042 and β: −0.136; p < 0.001, respectively). Older age, higher systolic blood pressure and lower level of systemic inflammation were associated with narrower retinal venules (β: −0.654; −0.229; and −13.767, respectively; p < 0.05). No associations were found between retinal vessel diameters and lung function parameters or functional outcomes. After PR, no significant changes in retinal venular or arteriolar diameter were found. To conclude, retinal vessel diameters of COPD patients were significantly associated with systolic blood pressure and systemic inflammation, whilst there was no evidence for an association with lung function parameters, functional outcomes or other cardiovascular risk factors. Furthermore, an exercise-based PR program did not affect retinal vessel diameter. Chronic obstructive pulmonary disease (COPD) is characterized by persistent respiratory symptoms and airflow limitation due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases 1. Although the diagnosis of COPD is based on spirometry, it is well recognized that COPD is associated with a range of systemic extrapulmonary effects 1. Indeed, comorbidities are frequently present and contribute to the severity of disease 2-4. Cardiovascular disease (including hypertension, coronary artery disease, congestive heart failure, stroke and peripheral arterial disease) is a common comorbidity in COPD 2,5. Smoking is the most important risk factor for the development of COPD, but it is also a major risk factor for the development of cardiovascular disease 6,7. Indeed, cigarette smoke not only affects the airway epithelium, but also causes vascular endothelial damage and loss of microvascular integrity in several organs, including the heart, brain, and kidney 8,9. In addition, systemic inflammatory processes, oxidative stress, and hypoxia may contribute

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Looking into the eye of patients with chronic obstructive pulmonary disease: an opportunity for better microvascular profiling of these complex patients

Cited by 16 publications

References 78 publications

The CT pulmonary vascular parameters and disease severity in COPD patients on acute exacerbation: a correlation analysis

The CT pulmonary vascular parameters and disease severity in COPD patients on acute exacerbation: a correlation analysis

Simple non-mydriatic retinal photography is feasible and demonstrates retinal microvascular dilation in Chronic Obstructive Pulmonary Disease (COPD)

Structural analysis of retinal blood vessels in patients with COPD during a pulmonary rehabilitation program

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