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Bruce Ira Gaynes, Justin Wanek, Nicole Camardo, Groo Vicki, Mayank Kansal, Chris Gans, Mahnaz Shahidi; Relationship between bulbar conjunctival hemorheology and metrics of cardiac function in patients with heart failure.. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):1972.
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© ARVO (1962-2015); The Authors (2016-present)
<br /> Imaging of the human bulbar conjunctival microvasculature provides a novel non-invasive means to assess in-vivo hemorheology in relation to systemic disease influences.The purpose of this study was to assess the relationship between bulbar conjunctival hemorheology and metrics of cardiac function in subjects with congestive heart failure (CHF).
The study employed a cross-sectional assessment of bulbar conjunctival hemorheology including diameter, venular axial blood velocity (Vax) and flow (Q) measured by a prototype imaging system on conescutive patients undergoing cardiac catherization for right or left sided heart failure. Following ocular imaging, cardiac catheterization and echocardiography were performed to evaluate central venous pressure, pulmonary capillary wedge pressure, cardiac output, cardiac index, ejection fraction and pulmonary artery and right ventricle pressure. A Pearson correlation coefficient was computed to assess the relationship between conjunctival hemorheology and metrics of cardiac function.
Five subjects were enrolled in the study, age range 24-61 years. Data was pooled for analysis. Conjunctival Vax directly correlated with vessel diameter (R = 0.5, p<0.001). Conjunctival Q was inversely correlated with cardiac ejection fraction (R = -0.9, p = 0.02). Central venous pressure and right systolic ventricular pressure appeared to demonstrate a non-linear relationship with conjunctival Q.Two subjects demonstrated significant segmentation of conjunctival Q characterized by anomalous rouleaux formation.
Microvascular axial blood velocity is directly proportional to vessel diameter suggesting a proportional reduction in flow resistance with increased vessel diameter. It is unclear if the relationship between Q and ejection fraction is a consequence of local microvascular abnormalities due to CHF or hemodynamic influences of cardiac function. The relationship between cardiac ejection fraction and Q, may however prove useful in prognostic serial assessment of CHF. Examination of microvascular nouleaux may be of benefit in optimizing pharmacotherapy related to erythrocyte aggregation.
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