Differences Between Hypertensive and Atherosclerotic Lesions in Retinal Arteries Assessed By Scheie's Classification in Hypertensive Patients Following Stroke

Abstract

Scheie's classification regarding hypertensive and atherosclerotic lesions in retinal arteries is generally used to assess the severity of hypertensive retinopathy and the risks of cardiovascular events in hypertensive patients. However, the differences between these two types of retinal artery lesions have not been fully examined. Both arterial stiffness and aortic root diameter are increased in hypertensive patients. The aim of this study was to elucidate differences in the two types of lesions by comparing their relationships to arterial stiffness and aortic root diameter in hypertensive patients following stroke. Fifty-two hypertensive patients following stroke were divided into five stages according to Scheie's classification of hypertensive (H stage 0-4) and atherosclerotic (S stage 0-4) lesions by ophthalmologists. Arterial stiffness was measured as brachial-ankle pulse wave velocity (baPWV) using an automatic waveform analyzer. Aortic root diameter was measured using M-mode echocardiography. The H and S stages in retinal arteries correlated with each other (ρ = 0.443, p < 0.001). However, the S stage correlated with baPWV (ρ = 0.385, p = 0.005) and the aortic root diameter (ρ = 0.285, p = 0.043), while the H stage did not correlate with these parameters. Multiple stepwise regression analysis demonstrated that the aortic root diameter was independently associated with S stage (β = 0.373, p = 0.006), even though baPWV was independently associated with neither S stage nor H stage. In conclusion, hypertensive lesions (H stage) in retinal arteries are associated with atherosclerotic lesions (S stage) in retinal arteries. However, S stage may reflect arterial stiffening and aortic root dilatation better than H stage in hypertensive patients following stroke. This difference between H and S stages of Scheie's classification should be kept in mind when considering the association between retinal microcirculation and large vessel arteriosclerosis.

Examination of Large Artery Atherosclerosis could Reveal Small Artery Retinopathy in Untreated Middle-Aged Individuals

“…The prevalence of retinopathy was different based on the background of the enrolled individuals [36][37][38][39] . CAVI is a functional index of arterial stiffness, while carotid IMT is a morphological index of atherosclerotic vascular damage.…”

“…In the present study, we investigated subclinical atherosclerosis in large arteries using CAVI for functional assessment and carotid IMT for morphological assessment and confirmed significant associations between these examinations and the presence of small artery retinopathy. Although an association between the small artery retinopathy and aortic stiffness measured by PWV was reported previously, the previous study included a small number of hypertensive individuals [36][37][38][39] . The present study enrolled a larger number of individuals with relatively low risk and ROC curve analysis discriminating individuals with hypertensive or atherosclerotic retinopathy revealed that the cut-off levels and AUC values for CAVI and carotid IMT were 7.55 and 0.80 (95% CI 0.79-0.81, p 0.0001) and 0.55 mm and 0.75 (95% CI 0.74-0.76, p 0.0001), respectively (Fig.…”

Remission Induction of IgG4-related Membranous Nephropathy with Multitarget Therapy

“…The patient had a history of hypertension and dyslipidemia at 44 years old, type 2 diabetes with maximum HbA1c of 12.3% at 56 years old, and bronchial asthma at 66 years old. He had no history of diabetic retinopathy but had mild hypertensive changes to his fundus with a score of H1S1 as per the Scheie classification ( 3 ). He had no history of diabetic neuropathy.…”

Not Only Diabetic Retinopathy - Retinal Vascular Lesions and Signs in Diabetic Patients: Description and Associations

“…In more advanced cases, the venule appears tapered as hourglass or the column of blood in the venule vanishes on each side of the arteriole [5]. The constrictions of the veins persist even when the blood pressure falls to normal because of structural changes in the vessel walls [39]. As at the crossing site the venous blood flow is impeded the venule becomes distended for some distance peripheral to the crossing site which is called distal dilatation, banking, Gunn´s sign or Bonnet´s sign) [34].…”