Relationship between media-to-lumen ratio of subcutaneous small arteries and wall-to-lumen ratio of retinal arterioles evaluated noninvasively by scanning laser Doppler flowmetry

Rizzoni, Damiano; Porteri, Enzo; Duse, Sarah; Ciuceis, Carolina De; Rosei, Claudia Agabiti; Boria, Elisa La; Semeraro, Francesco; Costagliola, Ciro; Sebastiani, Adolfo; Danzi, P.; Tiberio, Guido A M; Giulini, Stefano Maria; Docchio, Franco; Sansoni, Giovanna; Sarkar, Annamaria; Rosei, Enrico Agabiti

doi:10.1097/hjh.0b013e328352f81d

Cited by 87 publications

(58 citation statements)

References 42 publications

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“…11 In addition, it was demonstrated that WLR of retinal arterioles assessed with SLDF provides information similar to that obtained with the micromyographic measurement of media-to-lumen ratio of subcutaneous small arteries, generally considered the gold standard approach to the evaluation of microvascular structure. 12 Central BP, indicative of changes in large conduit arteries, was found to be an independent determinant of vascular remodeling in retinal arterioles, 13 supporting the concept that changes in macrovasculature and microvasculature are strongly interrelated and confirming previous results obtained with invasive assessment of small artery remodeling by micromyography. 14 Because the possible interrelationship between alterations in retinal arterioles and 24-hour BP has not been extensively evaluated and because the influence of ambulatory BP monitoring in respect to peripheral and central hemodynamics on retinal structure deserves further investigation, we considered worthwhile assessing the relationship of WLR of retinal arterioles with clinic brachial and 24-hour ambulatory BP and with central BP in normotensive subjects and in patients with primary hypertension.…”

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confidence: 80%

Relationship of Wall-to-Lumen Ratio of Retinal Arterioles With Clinic and 24-Hour Blood Pressure

et al. 2014

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S ystemic arterial hypertension is associated with vascular changes in the retina that may occur in acute stages or develop chronically.1 Retinal microcirculation represents, perhaps, the only microvascular district that may be directly observed and evaluated by a relatively simple funduscopic examination. Clinical fundoscopic assessment of retinal microcirculation is still based on a classic approach used to detect structural alterations of retinal arterioles associated with chronic blood pressure (BP) elevations, as well as long-lasting abnormalities in insulin sensitivity and blood glucose profile. However, several studies have proved a weak clinical usefulness of Keith-Wegener classification, because of poor reproducibility and association with other indices of target organ damage.2,3 Fundoscopic examination has gained new popularity, thanks to the availability of standardized procedures based on computer-assisted evaluation of digitized retinal photographs. [4][5][6] The arteriovenous ratio of retinal arterioles and venules, proposed with these techniques, was shown to predict the incidence of stroke and cardiovascular morbidity, although the methodology with digitized photographs and the need of a core reading center prohibited its widespread clinical use.7 Wall-to-lumen ratio (WLR) of retinal arterioles, measured using scanning laser Doppler flowmetry (SDLF), has been proposed as an in vivo parameter of vascular damage for large-scale evaluation. [8][9][10] This index seems to be a robust indicator of the severity of hypertension 9 and of the presence of early renal damage.10 WLR of the retinal arterioles was found to be increased in patients with cerebrovascular events 9 and related to the extent of intima-media thickness in the carotid artery.11 In addition, it was demonstrated that WLR of retinal arterioles assessed with SLDF provides information similar to that obtained with the micromyographic measurement of media-to-lumen ratio of subcutaneous small arteries, generally considered the gold standard approach to the evaluation of microvascular structure. 12Central BP, indicative of changes in large conduit arteries, was found to be an independent determinant of vascular remodeling in retinal arterioles, 13 supporting the concept that changes in macrovasculature and microvasculature are strongly interrelated and confirming previous results obtained with invasive assessment of small artery remodeling by micromyography. 14 Because the possible interrelationship between alterations in retinal arterioles and 24-hour BP has not been extensively evaluated and because the influence of ambulatory BP monitoring in respect to peripheral and central hemodynamics on retinal structure deserves further investigation, we considered worthwhile assessing the relationship of WLR of retinal arterioles with clinic brachial and 24-hour ambulatory BP and with central BP in normotensive subjects and in patients with primary hypertension.Abstract-Wall-to-lumen ratio of retinal arterioles might serve as an in vivo parameter of ...

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confidence: 80%

Relationship of Wall-to-Lumen Ratio of Retinal Arterioles With Clinic and 24-Hour Blood Pressure

et al. 2014

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“…Most recently a close relation between remodeling of small arteries assessed in vitro from biopsies was found to be related to changes to retinal arteriolar changes (ie, WLR) measured by SLDF. 13 Indeed, by using SLDF, we could show that WLR of retinal arterioles is increased in patients with hypertension and cerebrovascular events compared with treated hypertensives and normotensives. 17 Moreover, we have shown that WLR seems to be a robust indicator of the severity of hypertension, 26 the presence of early renal damage, 27 and, in contrast with arteriolar-to-venular ratio, is related to the extent of atherosclerotic damage in the carotid artery, as indicated by evaluation of the intima-media thickness.…”

Section: Discussionmentioning

confidence: 87%

“…A close correlation was observed between M/L of subcutaneous small arteries and wall-to-lumen ratio (WLR) of retinal arteries, indicating that SLDF may provide similar information about microvascular morphology compared with an invasive, accurate, and prognostically relevant micromyographic measurement of M/L of subcutaneous small arteries. 13 The relationship between the vascular remodeling of the large conduit arteries and the small resistance arteries in hypertension has not yet thoroughly been analyzed in humans, although a relationship between the macrocirculation and microcirculation is obvious. Hence, we analyzed in the current observational study the association and relationship of central pulse PP (a parameter of macrocirculation) with retinal arteriolar structure (microcirculation), mirroring cerebral circulation in subjects with a wide range of BP values.…”

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confidence: 99%

Central Pulse Pressure Is an Independent Determinant of Vascular Remodeling in the Retinal Circulation

et al. 2013

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A lthough the importance of hypertension as predictor of coronary heart disease and stroke has been known for a long time, the relative contribution of the individual components of peripheral blood pressure (BP) to the development of cardiovascular (CV) disease is still a matter of debate. [1][2][3][4][5] More striking nowadays, the importance of central hemodynamics is more and more acknowledged. Pathophysiologically, it seems consistent that the estimation of the central pressure in the aorta, which is actually the perfusion pressure to key organs, rather than the pressure in the arm, provides more relevant prognostic information. Indeed, it has been shown in a population-based study (the Strong Heart Study) 6 and in a hypertension trial (the Conduit Artery Function Evaluation [CAFÉ] study) 7 that the noninvasively measured central BP is superior to brachial BP in predicting CV outcomes. In a comprehensive review, Laurent et al 8 summarized the evidence that central pressure and pulse pressure (PP) are superior indicators of incident CV disease in a variety of prospective studies. Vascular remodeling, characterized by an increased mediato-lumen ratio (M/L) of small resistance and large arteries, has been identified as one of the early processes that occurs in response to increased BP and leads to hypertensive endorgan damage.9,10 The prognostic role of structural alterations of isolated subcutaneous small arteries and arterioles has been shown in arterial hypertension, with adverse prognosis in those patients with an increased M/L. 11,12 Moreover, in a former study it was shown that, although all known CV risk factors were considered, only PP and M/L were significantly associated with the occurrence of CV events. 11However, the evaluation of small artery and arteriolar structure of isolated subcutaneous small vessels requires an invasive procedure, namely the performance of a biopsy of subcutaneous tissue. Hence, this methodology is inadequate for routine patient management. In contrast, the analysis of the retinal vessels offers the opportunity to visualize the microvasculature of the body noninvasively, repeatedly, and safely in vivo. Hence, a new approach focuses on retinal arteriolar structural parameters by using scanning laser Doppler flowmetry (SLDF).Previously, both methodologies SLDF (in vivo) and myograph (in vitro) were assessed in patients with hypertension and normotensive controls. A close correlation was observed between M/L of subcutaneous small arteries and wall-to-lumen ratio (WLR) of retinal arteries, indicating that SLDF may provide similar information about microvascular morphology compared with an invasive, accurate, and prognostically Abstract-Pulse pressure has been recognized as a risk factor for stroke. Moreover, it was shown that central pulse pressure relates more strongly to vascular disease and outcome than (peripheral) brachial pulse pressure. Because vascular remodeling in the retinal circulation mirrors the 1 in the cerebral circulation and represents an easy, noninvasive possi...

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“…98 The validity of the wall:lumen ratio of retinal arterioles has also been assessed by examining the correlation of media:lumen ratio of subcutaneous small arteries with micromyography, providing evidence that retinal arterioles undergo remodeling similar to that seen in arterioles of the subcutaneous tissue. 99 Using such approach, an increased wall:lumen ratio of retinal arterioles was initially demonstrated in treated hypertensive patients with cerebrovascular event, 100 as well as in untreated hypertensive patients. 101 Further recent studies report that increased wall:lumen ratio of retinal arterioles is correlated with increased BP, urinary albumin excretion, and cerebrovascular damage.…”

Section: Assessment Of Retinal Vascular Flowmentioning

confidence: 99%

Retinal Microvasculature as a Model to Study the Manifestations of Hypertension

Cheung

Ikram²,

Sabanayagam³

et al. 2012

Hypertension

216

157

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The retinal vasculature allows direct noninvasive visualization of the body’s mircrovasculature. Because the retina and other end organs (brain and kidney) share similar anatomical features and physiological properties, the retinal vessels offer a unique and easily accessible window to study the health and disease of the human microcirculation. Advanced retinal vascular imaging technologies have been developed to allow a more objective and precise assessment of retinal vascular changes. The changes in the retinal vasculature associated with hypertension can be broadly divided into 3 groups: (1) classic retinal vascular changes in response to blood pressure (referred to as hypertensive retinopathy signs), (2) changes in retinal vascular caliber, and (3) changes in more global geometrical patterns of the retina. In this review, we summarize the current understanding of the relationship between retinal vascular changes and blood pressure, the evidence for the retinal vasculature as a biological model to study the manifestation and early pathogenic correlates of hypertension, the latest advances in retinal vascular imaging technologies, and the future opportunities and challenges of retinal vascular imaging. We suggest that further development of retinal vascular analyses and standardized measurement protocols, evaluation of the clinical use of retinal vascular imaging in assessing cardiovascular risk prediction, and using retinal vascular imaging to test antihypertensive treatments will allow the translation of retinal vascular imaging as a tool to improve the diagnosis, prognosis, and management of hypertension in clinical practice.

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Relationship between media-to-lumen ratio of subcutaneous small arteries and wall-to-lumen ratio of retinal arterioles evaluated noninvasively by scanning laser Doppler flowmetry

Cited by 87 publications

References 42 publications

Relationship of Wall-to-Lumen Ratio of Retinal Arterioles With Clinic and 24-Hour Blood Pressure

Relationship of Wall-to-Lumen Ratio of Retinal Arterioles With Clinic and 24-Hour Blood Pressure

Central Pulse Pressure Is an Independent Determinant of Vascular Remodeling in the Retinal Circulation

Retinal Microvasculature as a Model to Study the Manifestations of Hypertension

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