National Neuroscience Institute, Department of Neurology, Singapore General Hospital, Singapore.
Neurology. 2011 Aug 30;77(9):896-903. doi: 10.1212/WNL.0b013e31822c623b. Epub 2011 Aug 17.
Retinal microvasculature changes are associated with vascular events including stroke in healthy populations. It is not known whether retinal microvascular changes predict recurrent vascular events after ischemic stroke. We examined the relationship between retinal microvascular signs and subsequent vascular events in a prospective cohort of 652 acute ischemic stroke patients admitted to a tertiary hospital in Singapore from 2005 to 2007.
Retinal photographs taken within 1 week of stroke onset were assessed in a masked manner for quantitative and qualitative measures. Follow-up data over 2-4 years were obtained by standardized telephone interview and then were verified from medical records. Predictors of recurrent vascular events (cerebrovascular, coronary, vascular death, and composite vascular events) were determined using Cox regression models.
Follow-up data over a median of 29 months were obtained for 89% (652 patients) of the cohort. After adjustment for covariates including traditional risk factors and index stroke etiology, patients with severe arteriovenous nicking (AVN) were more likely to have a recurrent cerebrovascular event (hazard ratio [HR] 2.28, 95% confidence interval [CI] 1.20-4.33) compared with those without AVN. Patients with severe focal arteriolar narrowing (FAN) were more likely to have a recurrent cerebrovascular event (HR 2.75, 95% CI 1.14-6.63) or subsequent composite vascular event (HR 2.77, 95% CI 1.31-5.86) compared to those without FAN.
Retinal microvascular changes predicted subsequent vascular events after ischemic stroke, independent of traditional risk factors and stroke subtype. Thus, retinal imaging has a potential role in predicting the risk of recurrent vascular events after ischemic stroke and in understanding novel vascular risk factors.
视网膜微血管变化与血管事件有关，包括健康人群中的中风。目前尚不清楚视网膜微血管变化是否可预测缺血性中风后的复发性血管事件。我们在新加坡一家三级医院 2005 年至 2007 年收治的 652 例急性缺血性中风患者前瞻性队列中，研究了视网膜微血管病变与随后血管事件之间的关系。
以盲法方式评估中风发作后 1 周内拍摄的视网膜照片的定量和定性指标。通过标准化电话访谈获得 2-4 年的随访数据，然后从病历中核实。使用 Cox 回归模型确定复发性血管事件（脑血管、冠状动脉、血管性死亡和复合血管事件）的预测因子。
该队列中 89%（652 例患者）获得了中位随访时间为 29 个月的数据。在校正了包括传统危险因素和指数性中风病因在内的混杂因素后，与无 AVN 相比，严重动静脉吻合（AVN）患者更易发生复发性脑血管事件（风险比[HR]2.28，95%置信区间[CI]1.20-4.33）。与无 FAN 相比，严重局灶性小动脉狭窄（FAN）患者更易发生复发性脑血管事件（HR 2.75，95% CI 1.14-6.63）或随后的复合血管事件（HR 2.77，95% CI 1.31-5.86）。
视网膜微血管变化可预测缺血性中风后的后续血管事件，独立于传统危险因素和中风亚型。因此，视网膜成像有可能预测缺血性中风后复发性血管事件的风险，并有助于了解新的血管危险因素。
