Retinal fluorescein angiography: A sensitive and specific tool to predict coronary slow flow

Abstract

BackgroundObstructive coronary artery disease (OCAD) and coronary slow flow (CSF) are frequent angiographic findings for patients that have chest pain and require frequent hospital admission. The retina provides a window for detecting changes in microvasculature relating to the development of cardiovascular diseases such as arterial hypertension or coronary heart disease.ObjectivesTo assess the coronary and ocular circulations in patients with CSF and those with obstructive coronary artery disease.MethodsA prospective study was conducted over 3.5 years, included a total of 105 subjects classified to 4 groups: Group I (OCAD): Included 30 patients with obstructive coronary artery disease, group II (CSF): Included 30 patients with coronary slow-flow, group III (Control 1): Included 30 healthy control persons and group IV (Control 2): Included 15 patients indicated for coronary angiography that proved normal. All participants were subjected to coronary angiography (except control group 1), ophthalmic artery Doppler for measuring Pulsatility index (PI) and resistivity index (RI) and Fluorescence angiography of retinal vessels.ResultsPatients with CSF showed slow flow retinal circulation (microcirculation) evidenced by prolonged fluorescein angiography (Arm-retina time [ART] & Arterio-venous Transit time [AVTT]). Ophthalmic artery Doppler measurements (RI & PI) were significantly delayed in OCAD and CSF patients. There was significant positive correlation between TIMI frame count in all subjects and ART, AVTT, PI, RI and Body Mass Index. Using ART cutoff value of >16 s predicted CSF with sensitivity and specificity of 100%, meanwhile AVTT of >2 s predicted CSF with a sensitivity 96.7% and specificity of 93.3.ConclusionBoth delayed arm-retina time and retinal arterio-venous transit times can accurately predict coronary slow-flow.

Association of Speckle-Based Blood Flow Measurements and Fluorescein Angiography in Infants with Retinopathy of Prematurity

“…Although IVFA is an essential qualitative tool in ROP management, quantitative IVFA metrics are not well established in the setting of ROP. 10 , 11 , 12 , 13 , 14 , 15 , 16 One previous study reported extreme variation of artFT, ranging from 4 to 53 seconds with a mean of 12 seconds, 6 whereas another study found that delayed retinal perfusion time was a significant predictor for disease progression. 27 Early research on the application of LSCI in ROP management has suggested potential clinical utility.…”

“…Arterial-venous transit time (AVTT) has demonstrated utility in diabetic retinopathy, glaucoma, hypoperfusion retinopathy, central retinal artery occlusion, central retinal vein occlusion, retinitis pigmentosa, Rubinstein-Taybi syndrome, and coronary slow flow. 10 , 11 , 12 , 13 , 14 , 15 , 16 …”

Arm-to-retina time predicts visual outcome of anti-vascular endothelial growth factor treatment for macular edema due to central retinal vein occlusion

“…Here we focus on arm-to-retina (AR) time, measured from the administration of fluorescein into the antecubital vein until it becomes visible in the retinal arteries during fluorescein angiography (FA) recording 13 . The AR time is related to arteriosclerosis 14 , coronary slow-flow 15 , as well as carotid artery occlusion 16 , and systemic hemodynamics. Thus, to analyze the impact of AR time in CRVO in which hypertension and blood hyperviscosity are the risk factors 5 , would be of value.…”