Gopinath Bamini, Chiha Joseph, Plant Adam J H, Thiagalingam Aravinda, Burlutsky George, Kovoor Pramesh, Liew Gerald, Mitchell Paul
Centre for Vision Research, Department of Ophthalmology, Westmead Millennium Institute, University of Sydney, NSW, Australia.
Centre for Heart Research, Westmead Millennium Institute, University of Sydney, NSW, Australia.
Atherosclerosis. 2014 Sep;236(1):25-30. doi: 10.1016/j.atherosclerosis.2014.06.018. Epub 2014 Jun 26.
Microvascular mechanisms are increasingly recognized as being involved in a significant proportion of coronary artery disease (CAD) cases, but their exact contribution or role is unclear. We aimed to define the association between retinal microvascular signs and both CAD extent and severity.
1120 participants of the Australian Heart Eye Study were included. Retinal vessel caliber was measured from digital retinal images. Extent and severity of CAD was assessed using several approaches. First, a simple scoring classifying participants as having one-vessel, two-vessel, and three-vessel disease was used. Gensini and Extent scores were calculated using angiography findings.
After multivariable adjustment, significantly narrower retinal arteriolar caliber in women (comparing lowest versus highest quartile or reference) and wider venular caliber in men (comparing highest versus lowest quartile or reference) were associated with 2-fold and 54% higher odds of having at least one stenosis ≥50% in the epicardial coronary arteries, respectively. Women in the third versus first tertile of retinal venular caliber had 92% and ∼2-fold higher likelihood of having higher Gensini and Extent scores, respectively. Women in the lowest versus highest tertile of retinal arteriolar caliber had greater odds of having higher Extent scores, OR 2.99 (95% CI 1.45-6.16). In men, non-significant associations were observed between retinal vascular caliber and Gensini and Extent scores.
An unhealthy retinal microvascular profile, namely, narrower retinal arterioles and wider venules was associated with more diffuse and severe CAD among women.
微血管机制在相当一部分冠状动脉疾病（CAD）病例中的作用日益受到认可，但其确切贡献或作用尚不清楚。我们旨在确定视网膜微血管体征与CAD范围和严重程度之间的关联。
纳入澳大利亚心脏与眼科研究的1120名参与者。从数字化视网膜图像测量视网膜血管管径。使用多种方法评估CAD的范围和严重程度。首先，采用一种简单的评分方法，将参与者分为单支血管病变、双支血管病变和三支血管病变。根据血管造影结果计算Gensini评分和范围评分。
经过多变量调整后，女性视网膜小动脉管径显著变窄（比较最低四分位数与最高四分位数或参照组）以及男性视网膜小静脉管径变宽（比较最高四分位数与最低四分位数或参照组），分别与心外膜冠状动脉至少有一处狭窄≥50%的几率高出2倍和54%相关。视网膜小静脉管径处于第三个三分位数与第一个三分位数的女性，其Gensini评分和范围评分较高的可能性分别高出92%和约2倍。视网膜小动脉管径处于最低三分位数与最高三分位数的女性，范围评分较高的几率更大，比值比为2.99（95%置信区间1.45 - 6.16）。在男性中，未观察到视网膜血管管径与Gensini评分和范围评分之间存在显著关联。
不健康的视网膜微血管特征，即视网膜小动脉变窄和小静脉变宽，与女性中更弥漫和严重的CAD相关。
