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Felix Goldbach, Georgios Mylonas, Martin Riegelnegg, Jonas Brugger, Bianca S S. Gerendas, Ursula Schmidt-Erfurth; Association of microvascular biomarkers in fluorescein angiography with macrovascular-related mortality in clinical routine data. Invest. Ophthalmol. Vis. Sci. 2020;61(7):5317.
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© ARVO (1962-2015); The Authors (2016-present)
Cardiovascular diseases are the leading cause of mortality in Europe. The Early detection of microvascular changes may be important for the risk assessment of cardiovascular death. Therefore, the purpose of this study was to investigate imaging biomarkers in fluorescein angiography (FA) as potential predictors.
In this retrospective and matched case-control study, we included FA images from clinical routine data between 2007 and 2018 of patients who died of macrovascular events. The latter were identified with the help of the Austrian death register (group 1) and were age- and sex-matched with patients who are alive (group 2). Early phase FA images were used for the measurement of the foveal avascular zone (FAZ) and vessel diameter. The measurements were performed by two independent, experienced and certified image graders at the Vienna Reading Center. To determine whether the patient groups differed in terms of their FAZ size, a paired t-test was performed, where pairs were matched by gender and age on the respective examination day. Bland-Altman-Diagrams were created to assess the agreement of the graders.
200 eyes of 200 patients were enrolled in this study. The mean age on the examination day was 69.5 ± 8.3 years with a 1:1 female:male subject ratio. The mean FAZ area of our sample was 0.341 ± 0.13 mm2 for group 1 and 0.264 ± 0.14 mm2 for group 2 (p < 0,001), showing a larger FAZ area in patients who died of macrovascular-related diseases. The Bland Altmann Diagram suggests that Grader 1 in general estimated the FAZ to be larger in both groups than Grader 2. Aside from that, no systematic differences were found.
On average, patients whose death was caused by a macrovascular-related disease show a larger FAZ on FA examinations during lifetime than patients who are alive. Our results hint at a possible role of the FAZ as an imaging biomarker for the risk assessment of cardiovascular events. With the increasing use of OCT-A devices in clinical routine, such imaging biomarkers may be the key to early detection of microvascular changes in patients suffering from cardiovascular diseases.
This is a 2020 ARVO Annual Meeting abstract.
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