The eye as window to the heart: association of retinal microvascular function and left ventricular ejection fraction in heart failure patients
F Piciacchia, P Sommer, K Bitos, N Laptseva, V Rossi, M P Naegele, F Ruschitzka, I Sudano, A J FlammerAbstract
Background
Vascular dysfunction is a key factor for the development, progression and prognosis of heart failure (HF) and a target of different therapeutic strategies. In the current guidelines diagnostic and therapeutical strategies for HF are different according to left ventricular ejection fraction (LVEF). Retinal vascular function partly mirrors the vasculature in the heart. The association of retinal vascular dysfunction and LVEF is currently unknown.
Methods
In this observational, single center, cohort study, HF patients of different aetiologies were prospectively enrolled and divided according to HF with preserved (HFpEF, LVEF >50%), mildly reduced (HFmrEF, LVEF 40-50%) and reduced ejection fraction (HFrEF, LVEF <40%). Retinal vascular function was quantified using a retinal vessel analyzer, measuring flicker-light induced retinal arterial vasodilation (FIDart). Additionally other vascular parameters, such as flow mediated dilatation (FMD) and pulse wave velocity (PWV) were assessed.
Results
270 HF patients were included. Of this study population, 75 patients were categorised HFpEF (mean age 63.6 ± 14.1 years, 29.3% female), 37 HFmrEF (66.3 ± 11.4 years, 21.8% female) and 158 HFrEF (61.5 ± 11.8 years, 22.2% female). Retinal vascular function in patients with HFrEF and HFmrEF was significantly more impaired compared to patients with HFpEF (mean FIDart HFpEF 2.2 ± 2.2% vs. HFmrEF 1.3 ± 1.4%, p=0.04; HFpEF 2.2 ± 2.2% vs. HFrEF 1.0 ± 1.5% p<0.001, see Figure). Overall, retinal arterioles were more constricted in HFpEF compared to HFrEF (mean central retinal arteriolar equivalent [CRAE] 181.34 ± 20.3 μm vs. 190.0 ± 18.3 μm, p=0.003, respectively). There was no difference in FMD and other vascular parameters.
Conclusion
A gradual decrease in retinal vascular function was observed according to reduction of EF. HFpEF patients are characterised by a vasoconstrictive retinal arterial pattern at baseline. This may reflect different pathophysiological mechanisms underlying retinal vascular function in HFpEF and HFrEF.