1(st) Medical Department, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
Microvasc Res. 2010 Mar;79(2):150-3. doi: 10.1016/j.mvr.2009.12.007. Epub 2010 Jan 4.
Retinal microvascular changes predict cardiovascular morbidity and mortality independent of classical risk factors. However, it is unclear which retinal changes characterize patients with established coronary artery disease (CAD), and in particular, with acute coronary syndromes (ACS). The aim of the present preliminary study was to assess retinopathy in these patients.
43 consecutive patients with ACS and 19 consecutive patients with stable CAD were investigated. Among the patient group with ACS, 20 patients presented with ST-Elevation Myocardial Infarction (STEMI) and 23 patients presented with Non-STEMI (NSTEMI). Standardized protocols were used and retinal fundus photography was taken within 48 h post-coronary angiography to assess retinopathy and general arteriolar narrowing as arterio-venous ratio (AVR). Clinical and laboratory cardiovascular risk factors were recorded.
Despite comparable age and comparable frequency of diabetes and hypertension, patients with ACS had a much higher likelihood for retinal microaneurysms and dot bleedings than patients with stable CAD (17 (40%) vs. 1 (5%) patients, OR 11.77; 95%CI 1.43-96.59; p=0.006). Performing multivariate analysis, this association remains significant (OR 20.5, 95%CI 1.6-255, p=0.019). CAD patients presented more often with focal signs of arteriovenous nicking / focal vasoconstriction (10 (53%) vs. 9 (21%) patients, OR 4.2; 95%CI 1.31-13.4; p=0.018), however after multivariate analysis this association lost significance. The AVR was comparably low in both groups.
Patients with ACS present more often with dot bleedings and microaneurysms. These findings provide preliminary evidence that retinal fundus examination may be useful to contribute to the risk profile of patients, enabling a more intensive survey and care.
视网膜微血管变化可预测心血管发病率和死亡率，独立于传统危险因素。然而，目前尚不清楚哪些视网膜变化是已确诊的冠状动脉疾病（CAD）患者，特别是急性冠状动脉综合征（ACS）患者的特征。本初步研究旨在评估这些患者的视网膜病变。
共纳入 43 例 ACS 患者和 19 例稳定型 CAD 患者。ACS 患者中，20 例为 ST 段抬高型心肌梗死（STEMI）患者，23 例为非 ST 段抬高型心肌梗死（NSTEMI）患者。使用标准方案，在冠状动脉造影后 48 小时内进行视网膜眼底照相，以评估视网膜病变和总小动脉狭窄程度（动静脉比，AVR）。记录临床和实验室心血管危险因素。
尽管年龄和糖尿病、高血压的发生率相似，但 ACS 患者的视网膜微动脉瘤和点状出血的发生率明显高于稳定型 CAD 患者（17 例（40%）比 1 例（5%），比值比 11.77；95%置信区间 1.43-96.59；p=0.006）。多变量分析显示，这种相关性仍然显著（比值比 20.5，95%置信区间 1.6-255，p=0.019）。CAD 患者更常出现局灶性动静脉吻合/局灶性血管收缩的征象（10 例（53%）比 9 例（21%），比值比 4.2；95%置信区间 1.31-13.4；p=0.018），但多变量分析后这种相关性失去意义。两组的 AVR 相似。
ACS 患者更常出现点状出血和微动脉瘤。这些发现初步表明，眼底检查可能有助于评估患者的风险状况，从而进行更密集的监测和护理。
