Correlation Between Coronary and Retinal Microangiopathy in Patients With STEMI

Abstract

Purpose To investigate the morphological and functional correlation between microvascular retinal changes in optical coherence tomography angiography (OCTA) and the microvascular coronary circulation in patients with ST elevation myocardial infarction (STEMI) coronary heart disease (CHD). Methods A total of 330 eyes from 165 participants (88 cases and 77 controls) were enrolled and imaged. Superficial capillary plexus (SCP) and deep capillary plexus (DCP) vascular density was measured in the central (1 mm) and perifoveal (1–3 mm) areas and in the superficial foveal avascular zone (FAZ) and choriocapillaris (3 mm). These parameters were then correlated to the left ventricular ejection fraction (LVEF), and the number of affected coronary arteries. Results Decreased vessel densities in the SCP and DCP and choriocapillaris were positively correlated to the LVEF values ( P = 0.006, P = 0.026, and P = 0.002, respectively). No statistically significant correlation between the SCP and DCP central area or FAZ area was found. Regarding the number of affected vessels, significant negative correlations were revealed for the SCP and DCP central vessel densities ( P < 0.001 and P < 0.001, respectively) and the SCP perifoveal vascular density ( P = 0.009). Conclusions OCTA vascular indices are significantly correlated with morphological and functional parameters in patients with STEMI CHD. SCP vascular density especially seems to be a promising biomarker for the extent of both macrovascular damage (number of affected coronary arteries) and microvascular damage, as mirrored in the decreased LVEF at admission. Translational Relevance OCTA vascular indices offer a valuable insight into the microvascular status of coronary circulation.

Optical Coherence Tomography Angiography Changes in Patients Diagnosed With Acute Coronary Syndrome: A Systematic Review and Meta-Analysis

“…In two studies, OCTA measurements were conducted using the Cirrus HD-OCT, Model 5000 (Carl Zeiss AG, Oberkochen, Baden-Wurttemberg, Germany) with Cirrus AngioPlex software, version 10, software [ 16 , 25 ], while two studies used the AngioVue Avanti with RTVue-XR, version 2017.1.0.155, software (Optovue Inc., Fremont, California, United States) [ 24 , 26 ], and three studies used the DRI Optical Coherence Tomography (OCT) Triton (Topcon Corporation, Tokyo, Japan) [ 11 , 22 , 23 ] with Topcon's IMAGEnet 6, version 1.14, [ 11 ], Fiji, version 1.53f51, IMAGEnet 6, version 1.28.17646, software [ 22 ]. The time at which OCTA was performed was vastly different among studies and varied from 48 hours within admission to seven days post coronary angiography.…”

“…More specifically, in three studies, OCTA was performed on both eyes, but only one eye was selected for the analysis [ 11 , 7 , 25 ]: the functional eye for single-eye patients [ 16 , 25 ], the right eye for an even-numbered year of birth of the participants, the left eye for an odd-numbered year of birth, and the exclusion of the eye with uninterpretable scan [ 16 , 26 ] or worse quality of acquisition [ 25 ]. In another study, unremarkable media opacity was a prerequisite, and the eye with the best-corrected visual acuity (BCVA) was preferred [ 22 ], whereas one study assessed both eyes in case of adequate scan quality and in the absence of artifacts [ 11 ]. Two studies did not report whether one or both eyes were included in the analysis [ 23 , 24 ].…”

“…One study set OCT signal strength index < 45 and OCTA image quality < 60 [ 22 ], while another one defined signal strength index ≥ 60 and scan quality index ≥ 8 [ 24 ]. One study set scan quality > 40 [ 11 ]. Two studies did not report a signal strength threshold [ 23 , 24 ].…”

“…The majority of the studies were characterized as having medium risk of bias [ 16 , 22 , 25 , 26 ]. One study was awarded six stars and considered to have a high risk of bias [ 26 ], while one study was marked with the maximum, i.e., 10 stars [ 11 ]. Two studies were not given stars for comparability [ 24 , 25 ], while only two studies justified the size of the sample [ 11 , 23 ].…”

“…One study was awarded six stars and considered to have a high risk of bias [ 26 ], while one study was marked with the maximum, i.e., 10 stars [ 11 ]. Two studies were not given stars for comparability [ 24 , 25 ], while only two studies justified the size of the sample [ 11 , 23 ]. The risk of bias in the included studies is presented in Table 4 .…”