212 Retinal fundus: An open window to the coronary microcirculation

Abstract

The non-invasive investigational methods of the CHD address macro-vascular manifestation while micro-vascular anomalies may be present long-term. Our hypothesis is that the retinal vascular abnormalities are the reflection of coronary micro-vascularisation ,these retinal vascular signs may add to the prediction of CHD over traditional CHD risk factors and this represents a unique “window” on a “difficultly” accessible world. We recruited patients who have at least one risk factor of CHD and have recently had (< 3 months) a coronary angiogram at the Montréal Heart Institute. 71 patients aged 60 ± 5 were recruited in the protocol. A Fundus examination was done on patients using a non-medriatic digital camera Canon CRG. Ratio arteriole/veinules caliber (A/V) was measured and retinal vascular abnormalities were scored from 0 to 4 reflecting the changes of microvascular arteriosclerosis. Risk factor included age, sex, body mass index (BMI), systolic and diastolic pressure, fasting blood glucose, lipids profil, hsCRP levels and clearance level were measured. The CAD extent was evaluated by Gensini score, and coronary angiograms were analyzed by 1 expert blinded of the patient retinal vessels status. Standard univariate and multivariate analyses were performed. Increased level of SBP (HR1.1per 1 unit increase [95% CI, 1.01, 1.2; P = 0.02]) and decreased level HDL (HR 0.09 per 1 mmol decrease [95% CI, 0.011, 0.7; P = 0.002]) correlate significantly with severe sclerotic change in retinal fundus. This association remained significant in both men and women and in persons with and without diabetes or hypertension in the multi-variate analysis. Sclerotic changes of the micro-vasculature of the retina were found to be associated with factors known to predispose to endothelial dysfunction. The observed changes were independent from the Framingham risk and macro-vascular CAD (Gensini score). These results suggest that the ophthalmic fundus may be a representation of the cardiac micro-vascular disease and therefore can open a way to evaluate a vascular bed that is otherwise very difficult to access.