Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada.
Department of Ophthalmology, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montreal, Canada.
Int J Cardiol. 2014 Jun 1;174(1):25-30. doi: 10.1016/j.ijcard.2014.03.129. Epub 2014 Mar 21.
Aortic coarctation has been associated with generalized vascular disease, yet little is known about retinal vascular patterns and their changes over time.
The aim of this study is to characterize the nature and extent of retinal vascular disease in adults with aortic coarctation, and explore age-related effects and associations with cardiovascular outcomes.
A prospective cross-sectional seroepidemiological study was conducted on 60 consecutive adults with repaired aortic coarctation, age 42.4±14.1 years, 61.7% male. In addition to detailed questionnaires, imaging studies, and laboratory testing, high-quality retinal images were acquired by 45° nonmydriatic digital funduscopy.
No patient had evidence of hypertensive retinopathy. A distinctive vascular pattern characterized by bilaterally symmetric tortuosity of retinal arteries and veins was observed. Arterial tortuosity was abnormal in 98.3% of patients and decreased with age (P=0.0005). In patients≥45 years, a 1-point increase in the arterial tortuosity score was associated with a 1.5-fold higher risk of cardiovascular complications (i.e., acute coronary syndrome, stroke, cerebral aneurysm, aortic dissection/rupture) [odds ratio 1.50, 95% CI (1.01, 2.24), P=0.0496]. Abnormal venous tortuosity was present in 75.0% of patients and non-significantly correlated with higher levels of serum inflammatory markers (C-reactive protein, fibrinogen, interleukin-6, and tumor necrosis factor-alpha). A higher venous tortuosity score was likewise associated with an increased risk of cardiovascular complications [odds ratio 1.86, 95% CI (1.03, 3.35), P=0.0392].
Adults with repaired aortic coarctation exhibit a unique retinal vascular pattern characterized by excessive arterial and venous tortuosity that regresses with age. Greater tortuosity is associated with adverse cardiovascular outcomes in patients≥45 years.
主动脉缩窄与全身性血管疾病有关，但对于视网膜血管模式及其随时间的变化知之甚少。
本研究旨在描述主动脉缩窄成人的视网膜血管病变的性质和程度，并探讨与年龄相关的影响因素及其与心血管结局的关系。
对 60 例连续的、经修复的主动脉缩窄成年患者（年龄 42.4±14.1 岁，61.7%为男性）进行前瞻性横断面血清流行病学研究。除了详细的问卷调查、影像学研究和实验室检测外，还通过 45°非散瞳数字眼底镜获得高质量的视网膜图像。
没有患者出现高血压性视网膜病变的证据。观察到一种特征性的血管模式，表现为视网膜动静脉双侧对称的迂曲。动脉迂曲在 98.3%的患者中异常，并随年龄增长而减少（P=0.0005）。在年龄≥45 岁的患者中，动脉迂曲评分增加 1 分，与心血管并发症（即急性冠状动脉综合征、中风、脑动脉瘤、主动脉夹层/破裂）的风险增加 1.5 倍相关（比值比 1.50，95%可信区间 1.01-2.24，P=0.0496）。75.0%的患者存在静脉迂曲异常，且与血清炎症标志物（C 反应蛋白、纤维蛋白原、白细胞介素-6 和肿瘤坏死因子-α）水平升高无显著相关性。较高的静脉迂曲评分也与心血管并发症的风险增加相关（比值比 1.86，95%可信区间 1.03-3.35，P=0.0392）。
经修复的主动脉缩窄成人表现出一种独特的视网膜血管模式，其特征为动脉和静脉迂曲过度，且随年龄增长而消退。在年龄≥45 岁的患者中，迂曲程度越大与不良心血管结局相关。
