EURETINA 2024: Cardio-ocular syndrome and retinal microvasculature changes in acute heart failure

The study could support the use of OCTA in the assessment of patients with acute heart failure. Image credit: ©Sergey Nivens – stock.adobe.com

Alaa Din Abdin, MD, and colleagues reported that a “remarkable” reversible change occurred in the retinal microvessels after patients experienced acute decompensated heart failure (ADHF). He is a consultant ophthalmologist, vitreoretinal surgeon, from Saarland University Medical Center, Homburg, Germany. The investigators reported their findings at the 24th Euretina Congress in Barcelona.

The research team used spectral-domain optical coherence tomography (SD-OCT) and OCT angiography (OCTA) imaging to study the changes in the retinal microvasculature in patients admitted to a university medical center during ADHF and then after recompensation. The findings were compared to those of age-matched controls who had no known cardiac or retinal disease.

The patients included in the study, who were all adults, had been hospitalised with the ADHF diagnosis, regardless of the left ventricular ejection fraction (LVEF); all had been treated with a minimal dose of 40 mg of intravenous furosemide or equivalent. All patients underwent transthoracic echocardiography, and ocular examinations that included measurement of the best-corrected visual acuity (VA), dilated funduscopy, SD-OCT and OCTA during the first 24 hours in the hospital and after recompensation before discharge. The control group was comprised of 40 participants without documented cardiac or retinal diseases.

Retinal effects of ADHF

The study ran a 1-year course from August 2022 to August 2023. Forty patients with ADHF (mean age, 78.9 ± 8.76 years; 32% female) were included. The mean LVEF was 43 ± 12.8%. All patients were treated with intravenous diuretics (median, 4.3± 2.8 days). The N-terminal pro-B-type natriuretic peptide level, a factor used to diagnose heart failure, decreased significantly between baseline and discharge from 10,396 pg/ml (interquartile range [IQR], 6,410 pg/ml) and 6,380 pg/ml (IQR, 3,933 pg/ml, respectively (p<0.001), as did the diameters of the inferior vena cava from 2.13± 0.4 cm to 1.63 ± 0.3 cm, respectively (p=0.003).

The investigators found that the patients had impaired VA at admission compared with the control group (0.15±0.1 vs. 0.35± 0.1, respectively (p<0.001), reduced macular vessel density (18.0 ± 1.9 mm/mm2 vs. 14.3± 3.6 mm/mm2, respectively (p <0.001) and perfusion density (42.6± 3.2% vs. 35.2± 9.7%, respectively) (p <0.001).

In contrast, after recompensation, the mean overall vessel density and mean overall perfusion density increased markedly at the time of discharge (14.3± 3.6 vs. 19.7± 2.6, p=0.001; and 35.2± 9.7 vs. 39.2± 6.5, respectively (p=0.005). The mean diameter of the superior temporal retinal vein at admission was significantly larger compared to the control group (136 ± 19 μm vs. 124 ± 22 μm, respectively (p=0.008) and decreased significantly to 122 ± 15 μm at discharge (p<0.001).

The authors concluded, “This analysis revealed a remarkable reversible change in retinal microvessels after ADHF. This may provide valuable evidence for the use of OCTA in the assessment of overall microperfusion and hemodynamic status in patients with acute heart failure."

Reference

Abdin AD, Amr Abdin A, Aljundi W, et al. Cardio-ocular syndrome: Retinal microvasculature changes in acute heart failure. Presented at the 24th Euretina Congress, September 19-22, Barcelona, Spain. Session: Speaker’s Corner: Diabetes & Vascular Diseases, September 19, 2024.