Abstract
BackgroundThe inter-relationships of atrial fibrillation (AF) to retinal vascular occlusions (whether retinal artery occlusion (RAO) or retinal venous occlusion (RVO)) remain unclear. It is unknown if a presentation of retinal artery or venous occlusions may indicate a new onset cardiac arrhythmia. To shed light on this association, we investigated the risk of new onset AF in patients with known RAO and RVO.MethodsPatients with retinal occlusions from 1997 to 2011 were identified through Danish nationwide registries and matched 1:5 according to sex and age. Cumulative incidence and unadjusted rates of AF according to retinal vascular occlusions (i.e. RAO or RVO) were determined. Hazard ratios (HR) of AF according to retinal vascular occlusion were adjusted for hypertension, diabetes, vascular disease and prior stroke/systemic thromboembolism/transient ischemic attack.ResultsOne thousand three hundred sixty-eight cases with retinal vascular occlusions were identified (median age 71.4 (inter quartile range (IQR); 61.2–79.8), 47.3% male). RAO constituted 706 cases (51.6%) and RVO 529 (38.7%). The rate of incident AF amongst all cases with retinal vascular occlusion was 1.74 per 100 person-years (95% confidence interval (CI), 1.47–2.06) compared to 1.22 (95% CI, 1.12–1.33) in the matched control group. The rate of AF in RAO was 2.01 (95% CI, 1.6–2.52) and 1.52 (1.15–2.01) in RVO. HRs of incident AF adjusted for cardiovascular comorbidities were 1.26 (95% CI; 1.04–1.53, p = 0.019) for any retinal vascular occlusion, 1.45 (95% CI; 1.10–1.89, p = 0.015) for RAO, and 1.02 (95% CI; 0.74–1.39, p = 0.920) for RVO.ConclusionsA new diagnosis of retinal vascular occlusion in patients without prior AF was associated with increased risk of incident AF, particularly amongst patients with RAO. Awareness of AF in patients with retinal vascular occlusions is advised.
Highlights
The inter-relationships of atrial fibrillation (AF) to retinal vascular occlusions (whether retinal artery occlusion (RAO) or retinal venous occlusion (RVO)) remain unclear
Christiansen et al BMC Cardiovascular Disorders (2018) 18:91 include a careful evaluation of cardiovascular risk factors. [6, 18, 19] While it has been argued that embolisms arising in the atria are too large to cause RAO, [20] valvular heart disease, as well as AF, may be risk factors for RAO. [11, 21,22,23] As AF is often asymptomatic, subclinical AF could represent the underlying cause in RAO patients without known AF, Guidelines recommend treatment with anticoagulation to decrease the risk of ischemic stroke in patients with AF according to the CHA2DS2-VASc. [24,25,26]
The unadjusted hazard ratio (HR) of AF according to any retinal vascular occlusion was 1.44, and the Hazard ratios (HR) adjusted for heart failure, hypertension, diabetes, ischemic stroke/systemic thromboembolism/transitory ischemic attack and vascular disease the HR was 1.26
Summary
The inter-relationships of atrial fibrillation (AF) to retinal vascular occlusions (whether retinal artery occlusion (RAO) or retinal venous occlusion (RVO)) remain unclear. Retinal artery and vein occlusions (RAO and RVO) are common causes of retinal vascular disease. [17] This definition of ischemic stroke applies to current guidelines, and implies that the work-up of patients with retinal vascular occlusions (i.e. RAO or RVO) should. We hypothesized that in patients without previously known AF, retinal vascular occlusions (i.e. RAO or RVO) overall would be associated with increased risk of incident AF. To explore these associations, we identified all new cases of retinal vascular occlusion in patients without prior AF in Denmark between 1997 and 2011 in a nationwide cohort study. Independent subgroup analyses were performed for RAO and RVO
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