Abstract
Purpose :
Small vessel disease and endothelial dysfunction play a key role in the pathophysiology of heart failure (HF). OCT-A has been used to show retinal microvascular changes prior to the onset of clinical symptoms in other small vessel diseases such as Alzheimer’s Disease and Diabetic Retinopathy. Our novel investigation compared the retinal microvasculature of patients at elevated heart failure risk with healthy controls.
Methods :
Patients with a >5% chance of developing HF in the next 10 years based on PCP-HF risk equations (n=27; 50 eyes) were included. Those with evidence or history of heart failure or ocular opacities that precluded imaging were excluded. Healthy controls (n=85; 155 eyes) were collected from a departmental database.
All subjects underwent OCT-A imaging with segmentation of the full retinal slab into superficial (SCP) and deep (DCP) capillary plexus. Images were exported to FIJI software with averaging of multiple images. The foveal avascular zone (FAZ) was manually delineated on the full slab. A FIJI macro was then used to measure vessel density (VD) and vessel length density (VLD).
OCT-A variables were analyzed using linear mixed effects models with fixed effects for high-risk status, age, sex, hypertension and diabetes status, and a random effect for patient (to account for measurements from both eyes for some patients). Observations were weighted by the number of scans used to obtain the final OCT-A measurement. The coefficient of high-risk status was used to determine statistical significance, and p-values were adjusted using the Benjamini-Hochberg procedure.
Results :
Patients with a >5% risk of developing heart failure within 10 years exhibited a statistically significant reduction in DCP VLD (p=0.007) and SCP VLD (p=0.044). No other OCT-A parameters reached statistical significance.
Conclusions :
Our results indicate that VLD in both the DCP and SCP may be reduced in those at elevated risk of developing heart failure. This suggests that the smallest blood vessels may be preferentially targeted early in the disease course. This is the first study to identify retinal vascular changes in patients at elevated risk of developing heart failure and further supports the exploration of OCT-A as a potential screening tool for cardiovascular disease.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.