Cheung Ning, Bluemke David A, Klein Ronald, Sharrett A Richey, Islam F M Amirul, Cotch Mary Frances, Klein Barbara E K, Criqui Michael H, Wong Tien Yin
Centre for Eye Research Australia, University of Melbourne, Victoria, Australia.
J Am Coll Cardiol. 2007 Jul 3;50(1):48-55. doi: 10.1016/j.jacc.2007.03.029. Epub 2007 Jun 18.
This study sought to examine the relationships of retinal vascular signs with left ventricular (LV) mass, volume, and concentric remodeling.
Microvascular disease, reflected as retinopathy lesions, has been shown to predict clinical congestive heart failure. Whether these retinal vascular changes are related to early structural alterations and remodeling of the heart in asymptomatic individuals is unknown.
A cross-sectional, population-based study of 4,593 participants ages 45 to 85 years, free of clinical cardiovascular disease. Retinal vascular calibers and retinopathy were graded from retinal photographs according to standardized protocols. The LV mass and volume were measured from cardiac magnetic resonance imaging. Extent of LV concentric remodeling was determined by the ratio of LV mass to end-diastolic volume (M/V ratio).
After controlling for age, gender, race, center, past and current systolic blood pressure, body mass index, smoking, antihypertensive medications, diabetes, diabetes duration, glycosylated hemoglobin, lipid profile, and C-reactive protein, narrower retinal arteriolar caliber was associated with concentric (highest quintile of M/V ratio) remodeling (odds ratio [OR] 2.06, 95% confidence interval 1.57 to 2.70). This association was seen in men and women, and was present even in those without diabetes, without hypertension, and without significant coronary calcification. In multivariate analysis, the presence of retinopathy (OR 1.31, 95% confidence interval 1.08 to 1.61) was also associated with concentric remodeling.
Narrower retinal arteriolar caliber is associated with LV concentric remodeling independent of traditional risk factors and coronary atherosclerotic burden, supporting the hypothesis that microvascular disease may contribute to cardiac remodeling.
本研究旨在探讨视网膜血管体征与左心室（LV）质量、容积及向心性重塑之间的关系。
作为视网膜病变表现的微血管疾病已被证明可预测临床充血性心力衰竭。这些视网膜血管变化是否与无症状个体心脏的早期结构改变和重塑相关尚不清楚。
一项基于人群的横断面研究，纳入4593名年龄在45至85岁之间、无临床心血管疾病的参与者。根据标准化方案从视网膜照片中对视网膜血管管径和视网膜病变进行分级。通过心脏磁共振成像测量左心室质量和容积。左心室向心性重塑程度由左心室质量与舒张末期容积之比（M/V比）确定。
在控制了年龄、性别、种族、中心、既往和当前收缩压、体重指数、吸烟、抗高血压药物、糖尿病、糖尿病病程、糖化血红蛋白、血脂谱和C反应蛋白后，较窄的视网膜小动脉管径与向心性（M/V比最高五分位数）重塑相关（比值比[OR]2.06，95%置信区间1.57至2.70）。这种关联在男性和女性中均可见，甚至在无糖尿病、无高血压且无明显冠状动脉钙化的人群中也存在。在多变量分析中，视网膜病变的存在（OR 1.31，95%置信区间1.08至1.61）也与向心性重塑相关。
较窄的视网膜小动脉管径与左心室向心性重塑相关，独立于传统危险因素和冠状动脉粥样硬化负担，支持微血管疾病可能导致心脏重塑的假说。
