Identification of Subclinical Microvascular Biomarkers in Coronary Heart Disease in Retinal Imaging

Abstract

Purpose Cardiovascular disease and foremost coronary heart disease (CHD) are the worldwide leading causes of death. The aim of this study was to use non-invasive, multimodel retinal imaging to define microvascular features in patients with and without coronary angiography (CA)-confirmed CHD. Methods In this prospective, cross-sectional pilot study we included adult patients who presented to a tertiary referral center for elective CA due to suspected CHD. All patients underwent widefield fundus photography for retinopathy grading. Optical coherence tomography angiography was used to measure vessel density (VD) of the individual capillary plexuses in 6 × 6-mm macular volume scans. Adaptive optics imaging was performed to assess the first-order arteriolar lumen diameter (LD), total diameter (TD), wall-to-lumen ratio (WLR), and wall cross-section area, as well as to qualitatively describe vessel morphology. Results Of the included 45 patients (13 females; 65 ± 10 years old), 27 were confirmed with CHD in elective CA. The most prevalent retinal vascular pathologies were arteriovenous nickings, focal arterial narrowings, and microaneurysms. VD in the superficial capillary plexus, deep capillary plexus, and choriocapillaris was lower in CHD patients, although the odds ratios were not significantly different from 1 ( P = 0.06–0.92). Median arterial LD, TD, and WLR values were 98.3 µm (interquartile range [IQR] = 13.0), 122.9 µm (IQR = 17.6), and 0.26 µm (IQR = 0.07), respectively, with a trend toward a higher WLR in CHD patients. Conclusions In a cardiovascular risk population, high-resolution quantitative and qualitative microvascular phenotyping in the retina may provide valuable subclinical indicators for coronary artery impairment, although larger clinical trials are needed. Translational Relevance Subclinical retinal microvascular changes may serve as non-invasive, cost-effective biomarkers for risk stratification of patients with CHD.

Retinal Structural and Vascular Changes in Patients with Coronary Artery Disease: A Systematic Review and Meta-Analysis

“…Individuals exhibiting lower retinal vascular density show inconsistent signs of systemic vascular disease and are more frequently associated with a medical history of peripheral artery disease, CAD, high blood pressure, and type 2 diabetes mellitus. The microvascularization of the retina is closely linked to the cardiovascular risk profile and the severity of coronary lesions [34].…”

Retinal and Choroidal Thinning—A Predictor of Coronary Artery Occlusion?

“…Aschauer J. examined coronary heart disease patients with a control group and findings were similar. They observed a trend of reduced VD in the total retina, as well as the individual retinal capillary plexuses (superficial and deep) and the choriocapillaris layer in patients with significant CHD, but neither these results nor logistic regression analysis were significant [ 37 ]. Wang et al also reported that CAD patients have significantly decreased VD [ 38 ].…”

The Eye as the Window to the Heart: Optical Coherence Tomography Angiography Biomarkers as Indicators of Cardiovascular Disease

“…Another study examined 45 patients undergoing elective coronary angiography and OCTA. Patients with coronary heart disease confirmed using elective coronary angiography had a significantly lower VD in the SCP, DCP, and choriocapillaris [34]. Additionally, an observational study by Matuleviciute et al [35] demonstrated a significantly decreased risk of three-vessel CAD with increased VD [35].…”