Retinal Endothelial Function, Physical Fitness and Cardiovascular Risk: A Diagnostic Challenge

Streese, Lukas; Kotliar, Konstantin; Deiseroth, Arne; Infanger, Denis; Vilser, Walthard; Hanssen, Henner

doi:10.3389/fphys.2019.00831

Cited by 11 publications

(13 citation statements)

References 49 publications

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“…We speculated that exercise-induced pre-dilatation of arterioles in the retinal microcirculation may lead to a reduced dilatation capacity, resulting in a blunted retinal FID. Our hypothesis was supported by our previous findings of higher arteriolar baseline diameters in HA compared to SR ( Streese et al, 2019 ). A previous study under hypoxic conditions has also shown blunted aFID in predilated arteriolar vessels ( Neumann et al, 2016 ).…”

Section: Introductionsupporting

confidence: 90%

“…Two DVA measurements were performed. The first DVA followed the standard method described in detail elsewhere ( Streese et al, 2018 , 2019 ). Briefly, the diameters of one arteriolar and one venular segment were marked and continuously measured over time.…”

Section: Methodsmentioning

confidence: 99%

“…Despite the available evidence that SVA and DVA are both promising techniques to reliably diagnose microvascular end-organ damage, we discussed the diagnostic challenge of using FID in specific populations in a previous study. In the EXAMIN AGE study, we reported that healthy and physically active individuals (HA) showed a blunted aFID comparable to sedentary CV risk patients (SR) ( Streese et al, 2019 ). FID of both groups were comparable to previous studies investigating FID in CV risk patients ( Seshadri et al, 2016 ; Nagele et al, 2018b ).…”

Section: Introductionmentioning

confidence: 99%

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Quantification of Retinal Vessel Myogenic Constriction in Response to Blood Pressure Peaks: Implications for Flicker Light-Induced Dilatation

et al. 2021

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Background/AimsFlicker-light induced retinal vessel dilatation (FID), a marker of microvascular endothelial function, has been shown to be blunted in sedentary cardiovascular risk patients (SR) as well as healthy physically active individuals (HA). This study aimed to quantify the retinal myogenic response to blood pressure (BP) peaks and its effects on consecutive FID for differentiation of microvascular health.MethodsTen HA and eleven SR with a previously established restriction of arteriolar FID (aFID) (<2.2%) were invited in order to assess BP-induced myogenic constriction following a standardized handgrip task and a consecutive FID. BP was measured beat-to-beat.ResultsThe complete dataset of nine HA (3 female, mean age 65 years) and nine SR (5 female, mean age 61 years) individuals was analyzed. The central retinal arteriolar diameter equivalent (CRAE) was 183 ± 11 μm for HA and 176 ± 20 μm for SR. Initial baseline aFID was 1.6 ± 0.4% in HA and 1.6 ± 0.7% in SR. Systolic (p = 0.334) and diastolic (p = 0.245) BP increase following the handgrip task was in the range of 20–30% and comparable in both groups. BP increase was followed by a significantly higher arteriolar (−2.9 ± 1.3% vs. −1.3 ± 0.6%, p < 0.01) myogenic constriction in HA compared to SR. Moreover, in the consecutive assessment of FID directly after the BP-induced vessel constriction, aFID (4.1 ± 2.0% vs. 1.6 ± 0.9%, p < 0.01) was higher in HA compared to SR.ConclusionInitial baseline aFID was blunted in HA and SR. Retinal myogenic constriction was impaired in SR compared to HA. The consecutive aFID after BP-induced myogenic constriction recovered in HA but remained blunted in SR. Additional assessment of retinal myogenic constriction needs to be considered to improve CV risk stratification and reduce false-positive findings of endothelial dysfunction in otherwise healthy active individuals.Clinical Trial RegistrationClinicalTrials.gov: NCT03986892 (https://clinicaltrials.gov/ct2/show/NCT03986892).

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Section: Introductionsupporting

confidence: 90%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Quantification of Retinal Vessel Myogenic Constriction in Response to Blood Pressure Peaks: Implications for Flicker Light-Induced Dilatation

et al. 2021

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“…40 Accordingly, the non-dippers in our study population had a narrower retinal artery equivalent, which itself is associated with increased risk of hypertension 14 and cardiovascular mortality. 42 Still, the questions regarding the physiological mechanisms promoting early cardiovascular risk independent of blood pressure in these individuals remain. 42 Still, the questions regarding the physiological mechanisms promoting early cardiovascular risk independent of blood pressure in these individuals remain.…”

Section: Discussionmentioning

confidence: 99%

“…41 The smaller CRAE in non-dippers may reflect the functional narrowing of arterioles due to a myogenic response to increased nighttime blood pressure (Bayliss effect). 42 Still, the questions regarding the physiological mechanisms promoting early cardiovascular risk independent of blood pressure in these individuals remain. One possibility is that increased salt sensitivity, 2,3 a recognized cardiovascular risk factor, 5 may increase the cardiovascular risk of non-dippers.…”

Section: Discussionmentioning

confidence: 99%

Microvascular function in non‐dippers: Potential involvement of the salt sensitivity biomarker, marinobufagenin—The African‐PREDICT study

Strauss‐Kruger

Smith

Wei

et al. 2019

J of Clinical Hypertension

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Suppressed nighttime blood pressure dipping is associated with salt sensitivity and may increase the hemodynamic load on the microvasculature. The mechanism remains unknown whereby salt sensitivity may increase the cardiovascular risk of non-dippers. Marinobufagenin, a novel steroidal biomarker, is associated with salt sensitivity and other cardiovascular risk factors independent of blood pressure. The authors investigated whether microvascular function in non-dippers is associated with marinobufagenin. The authors included 220 dippers and 154 non-dippers (aged 20-30 years) from the African-PREDICT study, with complete 24-hour urinary marinobufagenin and sodium data. The authors determined dipping status using 24-hour blood pressure monitoring and defined nighttime non-dipping <10%. The authors measured microvascular reactivity as retinal artery dilation in response to light flicker provocation. Young healthy non-dippers and dippers presented with similar peak retinal artery dilation, urinary sodium, and MBG excretion (P > .05). However, only in non-dippers did peak retinal artery dilation relate negatively to marinobufagenin excretion after single (r = −0.20; P = .012), partial (r = −0.23; P = .004), and multivariate-adjusted regression analyses (Adj. R 2 = 0.34; β = −0.26; P < .001). The authors also noted a relationship between peak artery dilation and estimated salt intake (Adj. R 2 = 0.30; β = −0.14; P = .051), but it was lost upon inclusion of marinobufagenin (Adj. R 2 = 0.33; β = −0.015; P = .86). No relationship between microvascular reactivity and marinobufagenin was evident in dippers (P = .77). Marinobufagenin, representing salt sensitivity, may be involved in early microvascular functional changes in young nondippers and thus contributes to the development of hypertension and cardiovascular disease later in life. | 87STRAUSS-KRUGER ET Al.

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Physical activity and exercise improve retinal microvascular health as a biomarker of cardiovascular risk: A systematic review

et al. 2020

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Background and aims: Physical activity (PA) and fitness are important modulators of vascular ageing and may therefore help expand individual health span. We aimed to systematically review the association of PA and fitness, as well as the effects of exercise interventions on the new microvascular biomarkers retinal arteriolar (CRAE) and venular (CRVE) diameters and the retinal flicker light-induced dilatation (FID) in children and adults. Methods: PubMed, Ovid, The Cochrane, EMBASE and Web of Science were searched. 805 studies were found, and 25 full-text articles analysed. Twenty-one articles were included in this systematic review. Results: Higher PA levels were associated with narrower CRVE in children and adults. Physical inactivity was associated with wider CRVE in both age groups. Combined aerobic and motor skill training in school settings lead to wider CRAE in children. Aerobic exercise interventions in adults with or without CV risk factors induced wider CRAE and narrower CRVE. Studies on the effect of exercise on FID are scarce. In a twelve-week randomized controlled trial, high-intensity interval training significantly improved FID in older patients with CV risk factors. Conclusions: Higher PA and fitness levels were associated with improved retinal microvascular health in children and adults. Short-term exercise interventions in healthy children and adults, as well as CV risk patients, improved retinal microvascular structure and function. Exercise has the potential to counteract microvascular remodelling and development of small vessel disease during lifespan. Retinal vessel analysis can differentiate the beneficial effects of exercise on target microvascular organ damage.

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Retinal Endothelial Function, Physical Fitness and Cardiovascular Risk: A Diagnostic Challenge

Cited by 11 publications

References 49 publications

Quantification of Retinal Vessel Myogenic Constriction in Response to Blood Pressure Peaks: Implications for Flicker Light-Induced Dilatation

Quantification of Retinal Vessel Myogenic Constriction in Response to Blood Pressure Peaks: Implications for Flicker Light-Induced Dilatation

Microvascular function in non‐dippers: Potential involvement of the salt sensitivity biomarker, marinobufagenin—The African‐PREDICT study

Physical activity and exercise improve retinal microvascular health as a biomarker of cardiovascular risk: A systematic review

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