Dąbrowska Edyta, Harazny Joanna M, Miszkowska-Nagórna Eliza, Stefański Adrian, Graff Beata, Kunicka Katarzyna, Świerblewska Ewa, Rojek Agnieszka, Szyndler Anna, Wolf Jacek, Gruchała Marcin, Schmieder Roland E, Narkiewicz Krzysztof
Department of Hypertension and Diabetology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland.
First Department of Cardiology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland.
Blood Press. 2019 Sep 5;29(2):70-79. doi: 10.1080/08037051.2019.1657769.
In the course of hypertension, left ventricular hypertrophy and diastolic dysfunction develop very often and may progress toward heart failure. The aim of the study was to analyze the relationship between abnormalities of retinal microcirculation and cardiac damage defined as left ventricular hypertrophy and/or diastolic dysfunction. The study comprised 88 patients with essential hypertension. The group was divided into two subgroups: hypertensives without cardiac damage ( = 55) and with cardiac damage ( = 33). Control group comprised 32 normotensive subjects. Scanning laser Doppler flowmetry was used to evaluate retinal microcirculation. Echocardiography was used to assess cardiac damage. Lumen diameter of retinal arterioles was significantly smaller in patients with cardiac damage vs. controls (77 vs. 84 µm, = 0.02). Additionally, there was an evident trend with respect to lumen diameter (LD) across all three studied subgroups; i.e.: the smallest dimeters were present in cardiac damage patients, moderate size in hypertensives' without cardiac damage, and the largest diameters in healthy controls ( < 0.01). Lumen diameter was inversely correlated with cardiac intraventricular septum diameter ( = -0.25, = 0.02), left ventricular mass ( = -0.24, = 0.02), and left atrial volume ( = -0.22, = 0.04). Wall to lumen ratio was associated with intraventricular septum diameter ( = 0.21, = 0.044) and left atrial volume ( = 0.21, = 0.045). In multivariable regression analysis, lumen diameter was independently associated with intraventricular septum diameter ( = -0.05, = 0.03), left ventricular mass ( = -1.15, = 0.04), and left atrial volume ( = -0.42, = 0.047); wall to lumen ratio was independently associated with intraventricular septum diameter ( = 3.67, = 0.02) and left atrial volume ( = 30.0, = 0.04). In conclusion, retinal arterioles lumen diameter and wall to lumen ratio were independent biomarkers of cardiac damage. Retinal examination performed by means of scanning laser Doppler flowmetry might be a valuable tool to improve cardiovascular risk stratification of hypertensive patients.
在高血压病程中，左心室肥厚和舒张功能障碍经常发生，并可能进展为心力衰竭。本研究的目的是分析视网膜微循环异常与定义为左心室肥厚和/或舒张功能障碍的心脏损害之间的关系。该研究纳入了88例原发性高血压患者。该组被分为两个亚组：无心脏损害的高血压患者（n = 55）和有心脏损害的高血压患者（n = 33）。对照组包括32名血压正常的受试者。使用扫描激光多普勒血流仪评估视网膜微循环。使用超声心动图评估心脏损害。与对照组相比，有心脏损害的患者视网膜小动脉的管腔直径显著更小（77 vs. 84 µm，P = 0.02）。此外，在所有三个研究亚组中，管腔直径（LD）存在明显趋势；即：心脏损害患者的管腔直径最小，无心脏损害的高血压患者管腔直径中等大小，健康对照组的管腔直径最大（P < 0.01）。管腔直径与心脏室间隔直径呈负相关（r = -0.25，P = 0.02）、与左心室质量呈负相关（r = -0.24，P = 0.02）以及与左心房容积呈负相关（r = -0.22，P = 0.04）。壁腔比与室间隔直径（r = 0.21，P = 0.044）和左心房容积（r = 0.21，P = 0.045）相关。在多变量回归分析中，管腔直径与室间隔直径独立相关（β = -0.05，P = 0.03）、与左心室质量独立相关（β = -1.15，P = 0.04）以及与左心房容积独立相关（β = -0.42，P = 0.047）；壁腔比与室间隔直径独立相关（β = 3.67，P = 0.02）和与左心房容积独立相关（β = 30.0，P = 0.04）。总之，视网膜小动脉管腔直径和壁腔比是心脏损害的独立生物标志物。通过扫描激光多普勒血流仪进行的视网膜检查可能是改善高血压患者心血管风险分层的有价值工具。
