A multimodal approach to cardiovascular risk stratification in patients with type 2 diabetes incorporating retinal, genomic and clinical features

Fetit, Ahmed E.; Doney, Alex S.F.; Hogg, Stephen; Wang, Ruixuan; MacGillivray, Tom; Doubal, Fergus; McKay, Gareth J.; McKenna, Stephen J.; Trucco, Emanuele

doi:10.1038/s41598-019-40403-1

Cited by 27 publications

(27 citation statements)

References 27 publications

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“…6,23 Comparing our results with previous studies, our definition of postoperative recurrence of CSDH and postoperative AIH are in accordance with medical norms and logic.CSDHs are usually unilateral, but do present as bilateral in ~ 9.2-34.9% of cases.5,28−30 However, not all patients with bilateral CSDH warrant evacuation of both sides at initial presentation. The major In our study, 155 patients (34%) had bilateral CSDH.…”

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confidence: 88%

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Predictors of acute intracranial hemorrhage and recurrence of chronic subdural hematoma following burr hole drainage

Chen

Wang

et al. 2019

Preprint

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Objective To investigate predictors of postoperative acute intracranial hemorrhage (AIH) and recurrence of chronic subdural hematoma (CSDH) after burr hole drainage.MethodsA multicenter retrospective study of patients who underwent burr hole drainage for CSDH between January 2013 and March 2019. Univariate and multiple logistic regression analyses were performed to determine the relationship between CSDH recurrence and postoperative AIH and clinical, radiological, and surgical variables. Results A total of 456 CSDH patients (361 males, 95 females) were enrolled in the study. The median (IQR) age was 68 (61–77) years (range: 8–98 years). CSDH recurrence occurred in 63 patients (56 males, seven females), with a recurrence rate of 13.8%. The median time interval between initial burr hole drainage and recurrence was 37 (27–46) days (range: 12–180 days). Postoperative AIH developed in 23 patients (15 males, eight females), with an incidence of 5.0%. The median time interval between initial burr hole drainage and postoperative AIH was 4 (2–6) days (range: 1–10 days). Bilateral hematoma, hyperdense hematoma and anticoagulant drug use were independent predictors of recurrence in the multiple logistic regression analyses. Preoperative headache was an independent risk factor of postoperative AIH in the multiple logistic regression analyses, however, intraoperative irrigation reduced the incidence of postoperative AIH. Conclusions This study found that bilateral hematoma, hyperdense hematoma and anticoagulant drug use were independently associated with CSDH recurrence. Clinical presentation of headache was the strongest predictor of postoperative AIH, and intraoperative irrigation decreased the incidence of postoperative AIH.

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confidence: 88%

“…9,10,20−22 Previous reports have shown a CSDH mortality rate of 1.8-32%. 6,23 Surgical complications, such as irritability, wound infection and acute intracranial hemorrhage (AIH), occur at a rate of 0-38%. 24−26 AIH, in particular, can cause severe neurological dysfunction, leading to a poor prognosis.…”

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confidence: 99%

Predictors of acute intracranial hemorrhage and recurrence of chronic subdural hematoma following burr hole drainage

Chen

Wang

et al. 2019

Preprint

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“…RMPs included central retinal arteriolar equivalent (CRAE), central retinal venular equivalents (CRVE), arteriole to venular ratio (AVR), fractal dimension and tortuosity quantified from optic disc centred fundus images using the semi-automated software Vessel Assessment and Measurement Platform for Images of the Retina (VAMPIRE; VAMPIRE group, University of Dundee, Dundee, Scotland, Version 3.1, Fig. 1 ), by a trained grader that was blinded to participant data [ 37 , 38 ]. Analysis was performed mostly on left eye retinal images except when unavailable or of insufficient quality, in which case right eye images was used.…”

Section: Methodsmentioning

confidence: 99%

Retinal microvascular parameters are not significantly associated with mild cognitive impairment in the Northern Ireland Cohort for the Longitudinal Study of Ageing

O'Neill¹,

Maxwell²,

Paterson³

et al. 2021

BMC Neurol

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Background The retinal and cerebral microvasculature share similar embryological origins and physiological characteristics. Improved imaging technologies provide opportunistic non-invasive assessment of retinal microvascular parameters (RMPs) against cognitive outcomes. We evaluated baseline measures for associations between RMPs and mild cognitive impairment (MCI) from participants of the Northern Ireland Cohort for the Longitudinal Study of Ageing (NICOLA). Methods RMPs (central retinal arteriolar / venular equivalents, arteriole to venular ratio, fractal dimension and tortuosity) were measured from optic disc centred fundus images and analysed using semi-automated software. Associations between RMPs and MCI were assessed by multivariable logistic regression with adjustment for potential confounders including age, sex, alcohol consumption, smoking status, educational attainment, physical activity, cardiovascular disease (CVD), hypertension, mean arterial blood pressure, triglycerides, diabetes, body mass index, and high density lipoprotein levels. P < 0.05 was considered statistically significant. Results Data were available for 1431 participants, of which 156 (10.9%) were classified with MCI defined by a Montreal Cognitive Assessment (MoCA) score ≤ 26, with subjective cognitive decline, in the absence of depression or problems with activities of daily living. Participants had a mean age of 62.4 ± 8.5 yrs. and 52% were female. As expected, individuals with MCI had a lower MoCA score than those without (23.5 ± 2.6 versus 26.3 ± 2.7, respectively), were more likely to be female, have a lower level of educational attainment, be less physically active, more likely to have CVD, have higher levels of triglycerides and lower levels of high density lipoprotein. No significant associations between RMPs and MCI were detected in unadjusted, minimally adjusted or fully adjusted regression models or subsequent sensitivity analyses. Conclusion Previous studies have reported both increased retinal venular calibre and reduced fractal dimension in association with mild cognitive impairment. Our study failed to detect any associations between RMPs and those individuals at an early stage of cognitive loss in an older community-based cohort.

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“…RMPs (central retinal arteriolar/ venular equivalents [CRAE/CRVE], arteriolar to venular ratio [AVR], fractal dimension and tortuosity) were measured from optic disc centred fundus images, collected at participant health assessment and analysed using the semi-automated software Vessel Assessment and Measurement Platform for Images of the Retina (VAMPIRE; VAMPIRE group, University of Dundee, Dundee, Scotland, Version 3.1; Fig. 2 ), by a qualified grader blinded to participant data [ 25 , 26 ]. Images were taken from the left eye except when unavailable or of poor quality, in which case the right eye image was used.…”

Section: Methodsmentioning

confidence: 99%

Association of retinal venular tortuosity with impaired renal function in the Northern Ireland Cohort for the Longitudinal Study of Ageing

et al. 2020

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Background: Previous studies have identified retinal microvascular features associated with renal dysfunction. Biopsies are necessary to confirm kidney microvascular damage and retinal imaging may enable evaluation of microangiopathic characteristics reflecting renal changes associated with chronic kidney disease (CKD). We evaluated retinal microvascular parameters (RMPs) for associations with renal function in a cross-sectional analysis of the Northern Ireland Cohort for the Longitudinal Study of Ageing. Methods: RMPs (central retinal arteriolar/ venular equivalents [CRAE/CRVE], arteriolar to venular ratio [AVR], fractal dimension and tortuosity) were measured from optic disc centred fundus images using semi-automated software. Associations were assessed with multivariable regression analyses between RMPs and estimated glomerular filtration rate (eGFR) defined by serum creatinine (eGFRscr) and cystatin C (eGFRcys) and also CKD status characterised by eGFR < 60 mL/min/1.73m 2. Regression models were adjusted for potential confounders including age, sex, diabetes, smoking status, educational attainment, cardiovascular disease, body mass index, antihypertensive medication, systolic blood pressure, triglycerides, high-and low-density lipoprotein levels. Results: Data were included for 1860 participants that had measures of renal function and retinal fundus images of sufficient quality for analysis. Participants had a mean age of 62.0 ± 8.5 yrs. and 53% were female. The mean eGFR for scr and cys were 82.2 ± 14.9 mL/min/1.73m 2 and 70.7 ± 18.6 mL/min/1.73m 2 respectively. eGFRcys provided lower estimates than eGFRscr resulting in a greater proportion of participants categorised as having CKD stages 3-5 (eGFRcys 26.8%; eGFRscr 7.9%). Multivariable regression analyses showed that increased venular tortuosity (OR = 1.30; 95%CI: 1.10, 1.54; P < 0.01) was associated with CKD stages 3-5 characterised by eGFRscr < 60 mL/min/1.73 m 2. No additional associations between CKD status characterised by eGFRscr or with eGFRcys, were detected (P > 0.05). Multivariable regression failed to detect associations between CRAE, CRVE, AVR, fractal dimension or tortuosity and eGFRscr or eGFRcys (P > 0.05). Conclusion: Increased retinal venular tortuosity was associated with CKD stages 3-5 defined by eGFRscr < 60 mL/ min/1.73 m 2 , in an older population independent of potential confounding factors. These retinal measures may provide non-invasive microvascular assessment of associations with CKD.

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A multimodal approach to cardiovascular risk stratification in patients with type 2 diabetes incorporating retinal, genomic and clinical features

Cited by 27 publications

References 27 publications

Predictors of acute intracranial hemorrhage and recurrence of chronic subdural hematoma following burr hole drainage

Predictors of acute intracranial hemorrhage and recurrence of chronic subdural hematoma following burr hole drainage

Retinal microvascular parameters are not significantly associated with mild cognitive impairment in the Northern Ireland Cohort for the Longitudinal Study of Ageing

Association of retinal venular tortuosity with impaired renal function in the Northern Ireland Cohort for the Longitudinal Study of Ageing

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