Lishinsky-Fischer Natan, Chowers Itay, Shwartz Yahel, Levy Jaime
Ophthalmology Department, Hadassah Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.
Ophthalmol Sci. 2024 Dec 16;5(2):100677. doi: 10.1016/j.xops.2024.100677. eCollection 2025 Mar-Apr.
Valvular heart disease (VHD) contributes significantly to cardiovascular-related morbidity worldwide. Aortic valve stenosis is the third most common cardiovascular disease in the Western world, after hypertension and coronary artery disease. Recent studies have reported an association between VHD and the presence of subretinal drusenoid deposits (SDDs), a distinct manifestation of age-related macular degeneration (AMD). However, these findings were based on self-reported questionnaires and relatively modest cohort sizes. Our goal was therefore to investigate the putative associations between AMD and VHD and between the presence of SDDs and VHD.
Retrospective case-control study.
A total of 945 with AMD and 8275 control patients without AMD from a single tertiary center.
All patients with AMD underwent spectral-domain OCT (SD-OCT). The SD-OCT scans were annotated by 2 experienced graders. Among the patients with AMD, 547 had drusen and SDDs, and 398 had drusen only with no SDDs. We also extracted data from all 9220 patients' electronic medical records, including demographics and previous heart valve procedures based on International Classification of Diseases, ninth revision codes.
Heart valve-related diagnoses and procedures performed in both patient groups.
Patients with AMD had a higher prevalence of various VHDs compared with the control group, including increased rates of aortic stenosis (odds ratio [OR], 2.00; 95% confidence interval (CI), 1.40-2.86; < 0.001), aortic regurgitation (OR, 2.41; 95% CI, 1.49-3.91; < 0.001), and mitral valve regurgitation (OR, 1.51; 95% CI, 1.13-2.01; = 0.004). Heart valve procedures were also more prevalent among AMD patients including aortic valve replacement (OR, 1.70; 95% CI, 1.08-2.66; = 0.019) and tricuspid valve replacement (OR, 3.99; 95% CI, 1.03-15.46; 0.03). Moreover, a supervised machine learning model successfully detected the presence of AMD based solemnly on the patient's history of VHD. In the AMD cohort, we found no significant difference in VHD prevalence between patients with nonneovascular AMD and patients with neovascular AMD, or between patients with SDDs and patients without SDDs.
Patients with AMD have a higher prevalence of VHD and are more likely to undergo a heart valve-related procedure compared with patients without AMD, with no difference between patients with SDDs and patients without SDDs in the AMD cohort.
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
在全球范围内，心脏瓣膜病（VHD）是导致心血管相关发病的重要因素。在西方世界，主动脉瓣狭窄是继高血压和冠状动脉疾病之后第三常见的心血管疾病。最近的研究报告了VHD与视网膜下玻璃膜疣样沉积物（SDDs）之间的关联，SDDs是年龄相关性黄斑变性（AMD）的一种独特表现。然而，这些发现基于自我报告问卷且队列规模相对较小。因此，我们的目标是研究AMD与VHD之间以及SDDs的存在与VHD之间的假定关联。
回顾性病例对照研究。
来自单一三级中心的945例AMD患者和8275例无AMD的对照患者。
所有AMD患者均接受了频域光学相干断层扫描（SD-OCT）。SD-OCT扫描由2名经验丰富的分级人员进行标注。在AMD患者中，547例有玻璃膜疣和SDDs，398例仅有玻璃膜疣而无SDDs。我们还从所有9220例患者的电子病历中提取了数据，包括人口统计学信息以及基于国际疾病分类第九版编码的既往心脏瓣膜手术情况。
两组患者中与心脏瓣膜相关的诊断和手术情况。
与对照组相比，AMD患者各种VHD的患病率更高，包括主动脉瓣狭窄发生率增加（比值比[OR]，2.00；95%置信区间[CI]，1.40 - 2.86；P < 0.001）、主动脉瓣反流（OR，2.41；95% CI，1.49 - 3.91；P < 0.001）以及二尖瓣反流（OR，1.51；95% CI，1.13 - 2.01；P = 0.004）。心脏瓣膜手术在AMD患者中也更常见，包括主动脉瓣置换（OR，1.70；95% CI，1.08 - 2.66；P = 0.019）和三尖瓣置换（OR，3.99；95% CI，1.03 - 15.46；P = 0.03）。此外，一个监督机器学习模型仅根据患者的VHD病史就能成功检测出AMD的存在。在AMD队列中，我们发现非新生血管性AMD患者与新生血管性AMD患者之间，以及有SDDs的患者与无SDDs的患者之间，VHD患病率无显著差异。
与无AMD的患者相比，AMD患者VHD的患病率更高，且更有可能接受与心脏瓣膜相关的手术，在AMD队列中有SDDs的患者与无SDDs的患者之间无差异。
在本文末尾的脚注和披露中可能会发现专有或商业披露信息。
