Relationships between retinal microvasculature and coronary microvascular function in women with ischemia and no obstructive coronary artery disease

Abstract

Purpose : Retinal imaging offers a non-invasive assessment of small vessels that can predict incident heart disease, stroke, and dementia in women. However, it remains unknown whether retinal imaging can predict coronary microvascular dysfunction, which is associated with adverse cardiovascular prognosis in women with ischemia and no obstructive coronary arteries (INOCA). We performed a cross-sectional study to test the hypothesis that retinal small vessel measures are related to coronary microvascular function in INOCA.

Methods : Digital retinal images via non-mydriatic color fundus photography were collected from a sample of 93 participants with INOCA enrolled in the MAE-WEST SCORE (NIA U54AG065141) including those with cardiac magnetic resonance imaging (MRI) (n=37) and/or invasive coronary flow reserve testing (n=36).

Results : The cohort was predominately female (93.7%), white (79.6%) with a mean (SD) age of 60.7 (11.8) years and typically several cardiac risk factors. We observed trends toward positive correlations between mean central retinal arteriolar equivalent (CRAE), an index of arteriolar size, and stress (handgrip) cardiac MRI myocardial perfusion reserve index (MPRI), a measure of endothelial dependent microvascular function (Figure). We did not observe significant correlations between CRAE and coronary flow reserve (r=0.05, p=0.76).

Conclusions : Our pilot results demonstrate trends toward positive relations between retinal arteriolar diameter and coronary microvascular endothelial function in an INOCA cohort, suggesting that non-invasive retinal microvascular measures may predict coronary microvascular disease.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.

 

Figure: Correlations of retinal small vessel marker CRAE with MPRI in response to isometric handgrip exercise. (CRAE: central retinal arteriolar equivalent, MPRI: myocardial perfusion reserve index, MRI: magnetic resonance imaging)