Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA.
Retina Department, Institute of Ophthalmology Fundación Conde de Valenciana, Mexico, Mexico.
Eur J Ophthalmol. 2024 Nov;34(6):2038-2044. doi: 10.1177/11206721241244413. Epub 2024 Mar 28.
BACKGROUND/AIMS: Demonstrate through objective multidisciplinary imaging that subretinal drusenoid deposits (SDDs) in age-related macular degeneration (AMD) are linked to both coexistent valvular heart disease (VHD) and reduced systemic perfusion via cardiac index (CI).
Post-hoc analysis of cross-sectional study. 200 intermediate AMD (iAMD) subjects were assigned by masked readers to two groups: SDD (with or without drusen) and drusen (only) based on multimodal ophthalmic imaging. 65 transthoracic echocardiograms (TTEs) reports were available for cardiologist evaluation of VHD severity of the four cardiac valves and the presences of precursor lesions of aortic sclerosis (ASc) and mitral annular calcification (MAC). Necessary parameters to calculate CI were also obtained. Univariate testing was performed using Fisher's Exact test and t-test.
82.6% (19/23) of the iAMD subjects with at least one moderate/severe VHD had concurrent SDDs ( = 0.0040). All cases of aortic regurgitation (6/6, = 0.0370) and mitral regurgitation (13/13, = 0.0004) were found with coexisting SDDs. Stenotic VHD was not significantly associated with SDDs, however 70.7% of subjects with ASc (29/41, = 0.0108) and 76.0% of subjects with MAC (19/25, 0.0377) had coexisting SDDs. CI was available in 48 subjects and was significantly below normal levels in the SDD cohort (mean CI SDD 1.95 ± 0.60 L/min/m, non-SDD 2.71 ± 0.73 L/min/m, = 0.0004).
Several specific VHDs have been found associated with the SDD form of AMD. Decreased systemic perfusion as measured by CI was also associated with SDDs, which supports a perfusion hypothesis of SDD pathogenesis. Further research is warranted to understand the relationship between cardiovascular disease and SDDs.
背景/目的：通过客观的多学科成像证明，与年龄相关性黄斑变性（AMD）相关的视网膜下类 drusen 沉积物（SDD）与并存的瓣膜性心脏病（VHD）和通过心脏指数（CI）降低的全身灌注有关。
对横断面研究的事后分析。根据多模态眼科成像，由掩蔽读者将 200 名中度 AMD（iAMD）患者分为两组：SDD（有或无 drusen）和 drusen（仅）。共有 65 份经胸超声心动图（TTE）报告可供心脏病专家评估四个心瓣的 VHD 严重程度以及主动脉瓣硬化（ASc）和二尖瓣环钙化（MAC）的前驱病变。还获得了计算 CI 所需的必要参数。使用 Fisher 精确检验和 t 检验进行单变量检验。
至少有一个中度/重度 VHD 的 iAMD 患者中，82.6%（19/23）同时存在 SDD（=0.0040）。所有主动脉瓣反流（6/6，=0.0370）和二尖瓣反流（13/13，=0.0004）病例均伴有并存的 SDD。狭窄性 VHD 与 SDD 无显著相关性，但 70.7%的 ASc 患者（29/41，=0.0108）和 76.0%的 MAC 患者（19/25，0.0377）存在并存的 SDD。共有 48 名患者可获得 CI，SDD 组的 CI 明显低于正常水平（SDD 组平均 CI SDD 为 1.95±0.60 L/min/m，非 SDD 组为 2.71±0.73 L/min/m，=0.0004）。
已经发现几种特定的 VHD 与 AMD 的 SDD 形式有关。通过 CI 测量的全身灌注减少也与 SDD 有关，这支持了 SDD 发病机制的灌注假说。需要进一步研究以了解心血管疾病与 SDD 之间的关系。
