Relationship between heart failure and central serous chorioretinopathy: A cohort study in Taiwan

Huang, Ke-Hao; Chen, Yi-Hao; Lee, Lung-Chi; Tai, Ming‐Cheng; Chung, Chi‐Hsiang; Chen, Jiann‐Torng; Liang, Chang-Min; Chien, Wu-Chien; Chen, Ching‐Long

doi:10.1097/jcma.0000000000000207

Cited by 4 publications

(4 citation statements)

References 24 publications

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“…Increased risk of CSC among the patients with heart failure could be attributed to the activation of RAAS, which has been hypothesized based on an animal model study that exhibited aldosterone-mediated upregulation of the endothelial vasodilatory potassium channel (KCa2.3). [ 89 90 ]…”

Section: Cardiovascular Diseases and Central Serous Chorioretinopathymentioning

confidence: 99%

Central serous chorioretinopathy

Jain¹,

Mohan

Dijk

2022

Taiwan Journal of Ophthalmology

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Central serous chorioretinopathy (CSC) has remained an enigmatic disease since its initial description by Von Graefe. Over the years, multiple risk factors have been recognized: these include psychological stress, behavioral traits, and corticosteroids. The basic pathophysiology of CSC involves choroidal thickening, vascular congestion, altered choroidal blood flow (ChBF), and choroidal hyperpermeability, leading to retinal pigment epithelium decompensation and subsequent neurosensory detachment. Multiple organ systems, mainly the nervous, cardiovascular, endocrinal, and renal systems participate in the control of the vascular tone and the ChBF via hypothalamus–pituitary–adrenal axis and renin–angiotensin–aldosterone system, while others such as the hepatic system regulate the enzymatic degradation of corticosteroids. Many vasoactive and psychotropic drugs also modulate the ocular perfusion. In addition, there are anatomical and genetic predispositions that determine its progression to the chronic or recurrent form, through cellular response and angiogenesis. We herein review the basic pathophysiology and immunogenetics in CSC along with the role of multiple organ systems. With this background, we propose an etiological classification that should provide a framework for customized therapeutic interventions.

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Section: Cardiovascular Diseases and Central Serous Chorioretinopathymentioning

confidence: 99%

Central serous chorioretinopathy

Jain¹,

Mohan

Dijk

2022

Taiwan Journal of Ophthalmology

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“… 4 Furthermore, patients with heart failure have an increased risk of CSC. 5 Therefore, it seems likely that the abnormal mineralocorticoid pathway plays a role in the development of CSC. However, abnormal parasympathetic activity is not easily measured.…”

Section: Introductionmentioning

confidence: 99%

Heart-Rate Variability Correlates to Choroidal Thickness in Central Serous Chorioretinopathy

Nordsten,

Molbech,

Mehlsen

et al. 2023

OPTH

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Purpose Patients with central serous chorioretinopathy (CSC) have previously been shown to have a lower heart rate variability (HRV), implying a lower vagal tone. Vagal tone alters mineralocorticoids, which in turn affect the thickness of the choroid. Since increased choroidal thickness is characteristic of CSC, we wanted to investigate its correlation with HRV. Patients and Methods In this case–control study, 21 acute CSC patients and 31 healthy controls were included. Diagnosis was confirmed by optical coherence tomography (OCT) and retinal examination. HRV was evaluated following accepted standards. Outcome measures were chosen beforehand as follows: Standard deviation of N–N intervals (SDNN), root mean square of successive differences (RMSDD), low frequency/high frequency ratio (LF/HF ratio), and standard deviation ratio from commonly used Poincare plot (SD2/SD1 ratio). Choroidal thickness was measured using OCT directly under the foveola. Results Patients and healthy controls did not differ in health and medical characteristics in addition to CSC disease. Choroidal thickness was greatest in patients with CSC (mean±SD: 342±80 μm) compared to controls (235±60 μm, p<0.0001). A correlation was observed between LF/HF ratio and choroidal thickness in patients with CSC (Pearson correlation 0.63, p=0.02), where the CSC group had a lower LF/HF ratio (Median 2.39 ms 2 , IQR: 1.2–4.34 ms 2 ) compared to controls (Median 1.2 ms 2 , IQR: 0.9–2.4 ms 2 , p=0.06) and SD2/SD1 ratio (CSC 0.59±0.2 vs controls 0.74±0.3, p=0.06). Conclusion We found a correlation between the thickness of the choroid and the HRV-measured LF/HF ratio in patients with CSC and showed a borderline significant reduction in HRV measurements in patients with CSC. The data imply that vagal alterations exist in patients with CSC. Due to the low n, this should be considered as a pilot study. Further studies are warranted to elucidate mechanisms and validate findings.

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“…2,3 There are several risk factors strongly associated with CSCR; they include hypertension (HTN), coronary artery disease (CAD), heart failure, pregnancy, Helicobacter pylori (H pylori) infection, alcohol, tobacco use, exogenous corticosteroids and endogenous cortisol, autonomic dysfunction, type-A personality, and genetic susceptibility loci. [4][5][6][7][8][9][10][11][12] Cirrhosis, a degenerative chronic liver disease characterized by fibrosis of normal liver tissue, is mostly caused by viral infection and alcoholic and nonalcoholic steatohepatitis. In Taiwan, the prevalence of liver cirrhosis is high and cirrhosis complications and hepatocellular carcinoma (HCC) are among the top 10 causes of death.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evaluation of the relationship between central serous chorioretinopathy and liver cirrhosis: A nationwide, population-based study

Hsu

Chen

Huang

et al. 2021

Journal of the Chinese Medical Association

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Background: Central serous chorioretinopathy (CSCR) and liver cirrhosis share numerous risk factors and may have possible connections. We aimed to investigate whether patients with liver cirrhosis and the severity of cirrhosis have an increased incidence of CSCR. Methods: This population-based retrospective cohort study was conducted by collecting data from the Taiwan National Health Insurance Research Database from January 1, 2000, to December 31, 2015. We included patients who were newly diagnosed with cirrhosis and selected an equal number of sex- and age-matched control subjects. The effect of cirrhosis on the risk of CSCR was examined via a Cox proportional hazard regression analysis. The cumulative incidence of CSCR was assessed with the Kaplan-Meier method and the log-rank test. Results: Both groups in this study comprised a total of 25 925 individuals. The cirrhotic patients had a significantly higher cumulative risk of developing CSCR in following years than patients without cirrhosis (log-rank test < 0.001). Furthermore, compared with noncirrhotic patients, the risk of CSCR was increased 3.59-fold (95% confidence interval [CI], 2.31-5.28) in cirrhotic patients with complications, and 2.34-fold (95% CI, 1.27-3.24) in cirrhotic patients without complications. Additionally, male sex, springtime, diabetes mellitus, hepatitis B virus, and hepatitis C virus statistical significantly increased the incidence of CSCR. Conclusion: Cirrhosis is an independent indicator of CSCR. Among the cirrhotic population, patients with ascites and other complications have a higher incidence of CSCR than those with uncomplicated cirrhosis. Physicians should be observant when managing cirrhotic patients with visual disturbances.

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Relationship between heart failure and central serous chorioretinopathy: A cohort study in Taiwan

Cited by 4 publications

References 24 publications

Central serous chorioretinopathy

Central serous chorioretinopathy

Heart-Rate Variability Correlates to Choroidal Thickness in Central Serous Chorioretinopathy

Evaluation of the relationship between central serous chorioretinopathy and liver cirrhosis: A nationwide, population-based study

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