TY - JOUR
T1 - The association of retinal vessel calibres with heart failure and long-term alterations in cardiac structure and function
T2 - the Atherosclerosis Risk in Communities (ARIC) Study
AU - Chandra, Alvin
AU - Seidelmann, Sara B.
AU - Claggett, Brian L.
AU - Klein, Barbara E.
AU - Klein, Ronald
AU - Shah, Amil M.
AU - Solomon, Scott D.
N1 - Funding Information:
The Atherosclerosis Risk in Communities (ARIC) Study is a collaborative work supported by National Heart, Lung, and Blood Institute contracts (HHSN268201100005C, HHSN268201100006C, HHSN268201100007C, HHSN2682011 00008C, HHSN268201100009C, HHSN268201100010C, HHSN268201100011C, and HHSN268201100012C). The authors thank ARIC participants and staff for their important contributions. Drs. Chandra and Seidelmann were supported by National Institutes of Health grant 5T32HL094301–08. Dr Shah was supported by NIH/NHLBI grants K08HL116792, R01HL135008, and R01HL143224, and a Watkins Discovery Award from the Brigham and Women's Heart and Vascular Center.
Publisher Copyright:
© 2019 The Authors. European Journal of Heart Failure © 2019 European Society of Cardiology
PY - 2019/10/1
Y1 - 2019/10/1
N2 - Aims: Narrower retinal arterioles and wider retinal venules have been associated with macrovascular forms of cardiovascular disease (CVD). However, whether they are predictive of the development of heart failure (HF) independent of atherosclerotic CVD is unclear. We aimed to describe long-term associations of retinal vessel calibres with incident HF, in those with and without prevalent macrovascular disease, and how they relate to cardiac structure and function. Methods and results: This analysis included Atherosclerosis Risk in Communities Study participants who underwent retinal photography between 1993 and 1995. HF outcomes were followed in these participants until the end of 2013. Returning participants underwent echocardiography between 2011 and 2013. Participants with retinal vessel measurements who were free of CVD at baseline (n = 10 692) were followed for a mean of 16 years (baseline mean age 60 ± 6 years). Wider central retinal venular equivalent (CRVE) and narrower central retinal arteriolar equivalent (CRAE), adjusted for age, gender, and race, were significantly linearly associated with incident HF; however, a non-linear association was detected with CRVE and incident HF (P-value for overall trend < 0.001; P-value for non-linearity = 0.002). After adjustment with clinical risk factors, CRVE association with incident HF remained significant (P-value for overall trend = 0.025). Adjusted for age, gender, and race, CRVE widening and CRAE narrowing were associated with larger left ventricular size, higher prevalence of left ventricular hypertrophy, and worse measures of diastolic and systolic function. Conclusion: Retinal vessel calibre imaging, which characterizes retinal microvasculature, is a simple, non-invasive test that predicts incident HF and adverse cardiac structure/function 18 years in the future, thereby providing insight into systemic cardiovascular health.
AB - Aims: Narrower retinal arterioles and wider retinal venules have been associated with macrovascular forms of cardiovascular disease (CVD). However, whether they are predictive of the development of heart failure (HF) independent of atherosclerotic CVD is unclear. We aimed to describe long-term associations of retinal vessel calibres with incident HF, in those with and without prevalent macrovascular disease, and how they relate to cardiac structure and function. Methods and results: This analysis included Atherosclerosis Risk in Communities Study participants who underwent retinal photography between 1993 and 1995. HF outcomes were followed in these participants until the end of 2013. Returning participants underwent echocardiography between 2011 and 2013. Participants with retinal vessel measurements who were free of CVD at baseline (n = 10 692) were followed for a mean of 16 years (baseline mean age 60 ± 6 years). Wider central retinal venular equivalent (CRVE) and narrower central retinal arteriolar equivalent (CRAE), adjusted for age, gender, and race, were significantly linearly associated with incident HF; however, a non-linear association was detected with CRVE and incident HF (P-value for overall trend < 0.001; P-value for non-linearity = 0.002). After adjustment with clinical risk factors, CRVE association with incident HF remained significant (P-value for overall trend = 0.025). Adjusted for age, gender, and race, CRVE widening and CRAE narrowing were associated with larger left ventricular size, higher prevalence of left ventricular hypertrophy, and worse measures of diastolic and systolic function. Conclusion: Retinal vessel calibre imaging, which characterizes retinal microvasculature, is a simple, non-invasive test that predicts incident HF and adverse cardiac structure/function 18 years in the future, thereby providing insight into systemic cardiovascular health.
KW - Cardiac structure and function
KW - Heart failure
KW - Microcirculation
KW - Microvascular dysfunction
KW - Non-invasive testing
KW - Retinal vessel analysis
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U2 - 10.1002/ejhf.1564
DO - 10.1002/ejhf.1564
M3 - Article
C2 - 31373139
AN - SCOPUS:85070109447
SN - 1388-9842
VL - 21
SP - 1207
EP - 1215
JO - European Journal of Heart Failure
JF - European Journal of Heart Failure
IS - 10
ER -