Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland.
Department of Life, Health & Environmental Sciences, University of L'Aquila, Via Giovanni di Vincenzo 16/B, 67100 L'Aquila, Italy.
Eur Heart J. 2018 Jan 1;39(1):47-56. doi: 10.1093/eurheartj/ehx565.
Retinal vessel analysis (RVA) represents a novel, non-invasive, and reliable method to study the microcirculation in the eye. The goal of this study was to assess the extent of retinal microvascular dysfunction in patients with chronic heart failure (CHF) compared to controls and established measures of vascular function.
In this prospective, single-centre, observational study, 74 patients with compensated CHF (mean age 63.5 ± 11.2 years, 32% female, mean left-ventricular ejection fraction 37 ± 12.8%), 74 patients with cardiovascular risk factors (CVRF; 64.1 ± 12.7 years, 34% female), and 74 healthy controls (HC; 57.8 ± 14.2 years, 35% female) were included. The primary endpoint, flicker-induced dilatation of retinal arterioles (FIDart), was significantly reduced in patients with CHF compared to CVRF and HC (mean FIDart 0.9 ± 0.2 vs. 2.3 ± 0.3 and vs. 3.6 ± 0.3%, respectively, both P < 0.001 before and after propensity score-weighted analysis). Similar differences were seen for venular FID. FIDart was less impaired in patients with dilated compared to ischaemic cardiomyopathy. No significant differences were observed for arteriovenous ratio and flow-mediated dilatation. Impaired FIDven was associated with echocardiographically estimated systolic pulmonary artery pressure and left atrial volume index.
Retinal microvascular dilatation in response to flicker light is impaired in CHF. RVA may represent a new and useful method to non-invasively monitor microvascular abnormalities in heart failure in an easy and standardized way without the use of radiation.
视网膜血管分析（RVA）是一种新颖的、非侵入性的、可靠的方法，可用于研究眼部微循环。本研究旨在评估与对照组和已建立的血管功能测量值相比，慢性心力衰竭（CHF）患者的视网膜微血管功能障碍程度。
在这项前瞻性、单中心、观察性研究中，纳入了 74 例代偿性 CHF 患者（平均年龄 63.5±11.2 岁，32%为女性，平均左心室射血分数 37±12.8%）、74 例心血管危险因素（CVRF；64.1±12.7 岁，34%为女性）和 74 例健康对照者（HC；57.8±14.2 岁，35%为女性）。CHF 患者的视网膜小动脉闪烁诱导扩张（FIDart）的主要终点显著低于 CVRF 和 HC（平均 FIDart 为 0.9±0.2%，分别为 2.3±0.3%和 3.6±0.3%，在倾向评分加权分析前后均 P<0.001）。静脉 FIDart 也存在类似的差异。与缺血性心肌病相比，扩张型心肌病患者的 FIDart 受损程度较轻。动静脉比值和血流介导的扩张无显著差异。FIDven 受损与超声心动图估计的收缩期肺动脉压和左心房容积指数相关。
闪烁光刺激下视网膜微血管扩张在 CHF 中受损。RVA 可能是一种新的、有用的方法，可无创、简便且标准化地监测心力衰竭中的微血管异常，而无需使用辐射。
