Widefield swept-source OCT angiography biomarkers associated with the development of cardiovascular disease and all-cause mortality in patients with diabetic retinopathy: A prospective study

Abstract

Purpose : To explore the association among widefield swept-source optical coherence tomography angiography (WF SS-OCTA) metrics and systemic parameters and the development of myocardial infarction (MI), congestive heart failure (CHF), and all-cause mortality in patients with diabetic retinopathy (DR).

Methods : This prospective, observational, single-institution study included 178 eyes from 119 adults with NPDR and PDR, followed for at least 3 months. All patients were imaged with WF SS-OCTA (6×6mm, Montage 15×15mm and HD-51 Line scan). Images were independently evaluated by two graders for quantitative and qualitative WF SS-OCTA metrics defined a priori. WF SS-OCTA metrics, systemic, and ocular parameters were screened using Least Absolute Shrinkage and Selection Operator (LASSO) variable selection. Multilevel mixed-effects Cox regression models were used to identify parameters associated with the occurrence of MI, CHF, and all-cause mortality, adjusting for age and sex.

Results : Over a median follow-up of 44 months (range: 3-57 months), 11 patients (9.2%) had a cardiovascular event (MI or CHF) and 7 patients died (5.9%). WF SS-OCTA neovascularization vessel density (HR=155, 95%CI:6.8-3,536, P=0.002) and vitreous hemorrhage (HR=81.7, 95%CI:9.1-736, P<0.001) were associated with the development of CHF (9 events). Regarding cardiovascular disease (CHF and MI, 16 events), vitreous hemorrhage (HR=22.5, 95%CI:6.1-82.6, P<0.001) and prior treatment with anti-VEGF injections or panretinal photocoagulation (HR=14.4, 95%CI:3.9-52.9, P<0.001) were associated with increased risk. Macular perfusion in the deep capillary plexus on WF SS-OCTA (HR=1.4, 95%CI:1.1-1.7, P=0.003) and prior treatment (anti-VEGF, PRP, focal laser, or pars plana vitrectomy) (HR=19.0, 95%CI:2.9-124.7, P=0.002) were associated with all-cause mortality.

Conclusions : Neovascularization and macular perfusion metrics on WF SS-OCTA were associated with the development of cardiovascular disease and all-cause mortality in patients with DR. Larger samples and longer follow-up are needed to verify these imaging metrics as potential predictors of cardiovascular events and mortality.

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