Yusufu Mayinuer, Friedman David S, Kang Mengtian, Padhye Ambhruni, Shang Xianwen, Zhang Lei, Shi Danli, He Mingguang
Centre for Eye Research Australia, The Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia.
Department of Surgery (Ophthalmology), The University of Melbourne, Melbourne, Victoria, Australia.
Heart. 2025 Mar 13;111(7):306-313. doi: 10.1136/heartjnl-2024-324705.
To investigate the associations between a comprehensive set of retinal vascular parameters and incident stroke to unveil new associations and explore its predictive power for stroke risk.
Retinal vascular parameters were extracted from the UK Biobank fundus images using the Retina-based Microvascular Health Assessment System. We used Cox regression analysis, adjusted for traditional risk factors, to examine the associations, with false discovery rate adjustment for multiple comparisons. Receiver operating characteristic (ROC) curves were used to assess their predictive values.
During a median follow-up of 12.5 years, 749 incident strokes occurred among 45 161 participants. The analysis identified 29 significant parameters associated with stroke risk, with a notable dominance of density parameters (over half). Each SD change in these parameters increased stroke risk by 9.8% to 19.0%. For identified calibre parameters, each SD change was associated with an increased risk (ranging from 10.1% to 14.1%). For identified complexity parameters and arterial inflection count tortuosity, each SD decrease was linked to an increased risk (ranging from 10.4% to 19.5%). The introduction of retinal vascular parameters improved the area under the ROC curve to 0.752, significantly outperforming the model using only traditional risk factors (0.739, p<0.001).
Retinal vascular analysis, a non-invasive screening approach for stroke risk assessment, performed better than traditional risk stratification models. The 29 novel retinal indicators identified offer new avenues for stroke pathophysiology research.
研究一套全面的视网膜血管参数与卒中发病之间的关联，以揭示新的关联并探索其对卒中风险的预测能力。
使用基于视网膜的微血管健康评估系统从英国生物银行眼底图像中提取视网膜血管参数。我们采用经传统危险因素调整的Cox回归分析来检验这些关联，并对多重比较进行错误发现率调整。使用受试者工作特征（ROC）曲线评估其预测价值。
在中位随访12.5年期间，45161名参与者中发生了749例卒中。分析确定了29个与卒中风险相关的显著参数，其中密度参数占主导（超过一半）。这些参数每标准差变化会使卒中风险增加9.8%至19.0%。对于确定的管径参数，每标准差变化与风险增加相关（范围为10.1%至14.1%）。对于确定的复杂性参数和动脉弯曲计数曲折度，每标准差降低与风险增加相关（范围为10.4%至19.5%）。引入视网膜血管参数后，ROC曲线下面积提高到0.752，显著优于仅使用传统危险因素的模型（0.739，p<0.001）。
视网膜血管分析作为一种用于卒中风险评估 的非侵入性筛查方法，其表现优于传统风险分层模型。所确定的29个新的视网膜指标为卒中病理生理学研究提供了新途径。
