Central Retinal Artery Occlusion Is Related to Vascular Endothelial Injury and Left Ventricular Diastolic Dysfunction

Abstract

Central retinal artery occlusion (CRAO) is an emergency state characterized by sudden, painless vision impairment. Patients with CRAO have an increased risk of cardiovascular events, including stroke, likely related to vascular endothelial damage. Therefore, we investigated flow-mediated dilatation (FMD) of the brachial artery as a marker of endothelial dysfunction, intima-media complex thickness (IMT) of the common carotid artery, pointing to the arterial wall atherosclerotic alteration, and transthoracic echocardiographic parameters in 126 consecutive CRAO patients (66 men [52.4%], median age 55 years) and 107 control participants (56 men [52.3%], matched by age, sex, and body mass index). Most CRAO patients (n = 104, 82.5%) had at least one internal medicine comorbidity, mainly hypercholesterolemia and hypertension, which coexisted in one-fourth of them. Furthermore, they had a 38.2% lower relative increase of FMD (FMD%) and a 23.1% thicker IMT compared to the controls (p < 0.001, both, also after adjustment for potential confounders). On echocardiography, the CRAO group was characterized by increased dimensions of the left atrium and thicker left ventricular walls, together with impaired left ventricular diastolic function. CRAO is related to vascular endothelial damage, atherosclerosis, and left ventricular diastolic cardiac dysfunction. Thus, non-invasive ultrasound assessments, such as FMD%, IMT, and echocardiography, may be helpful in screening patients with increased CRAO risk, particularly those with other comorbidities.

Endothelial dysfunction, oxidative stress and low-grade endotoxemia in COVID-19 patients hospitalised in medical wards

“…It's important to underline that despite a low number of enrolled patients, all groups were comparable according to the most relevant parameters, and indeed they were similar in demographic and clinical characteristics. In our study we have searched but not found, although it was not the primary aim, a correlation between FMD with BMI, age and sex, but despite this we cannot exclude that there could be an association as demonstrated by previous studies ( Ergul et al, 2022 ; Dropiński et al, 2022 ). It's possible that also this could be related to the size of the population.…”

Relationship between Preoperative Echocardiographic Parameters and the Incidence of Postoperative Complications in Patients Undergoing Clipping of Unruptured Intracranial Aneurysms: A Retrospective Cohort Study

“…Although this correlation is partially explained by worsening atrial function and blood stasis due to elevated LV filling pressures in patients with atrial fibrillation [24], the study did not establish a definite causal relationship or a clear mechanism connecting LV diastolic dysfunction and ischemic stroke, especially due to the limitations of a retrospective study. In a study reporting the association of central retinal artery occlusion with vascular endothelial injury and LV diastolic dysfunction, impaired LV diastolic function was associated with lower flow-mediated dilatation of the brachial artery and thicker intima-media complex thickness, suggesting reciprocal remodeling between cardiac structures and the arterial wall [25]. Given that the evidence points to a significant involvement of inflammation in both myocardial fibrosis and diastolic dysfunction [26], the findings of these studies may indirectly explain the mechanisms of diastolic dysfunction and neurovascular outcomes.…”

Acute central retinal artery occlusion with emboli

“…In cases of CRAO, particularly embolic, emergency systemic evaluation is indicated because such patients are prone to cerebral stroke 1 . Ultrasound vascular assessment in emergency cases can be readily performed and can provide valuable information as a marker of endothelial vascular dysfunction helping identify individuals at increased cardiovascular risk 2 …”