Lumen narrowing and increased wall to lumen ratio of retinal microcirculation are valuable biomarkers of hypertension-mediated cardiac damage

Edyta Dąbrowska; Joanna M Harazny; Eliza Miszkowska-Nagórna; Adrian Stefański; Beata Graff; Katarzyna Kunicka; Ewa Świerblewska; Agnieszka Rojek; Anna Szyndler; Jacek Wolf; Marcin Gruchała; Roland E Schmieder; Krzysztof Narkiewicz

doi:10.1080/08037051.2019.1657769

Lumen narrowing and increased wall to lumen ratio of retinal microcirculation are valuable biomarkers of hypertension-mediated cardiac damage

Blood Press. 2019 Sep 5:1-10. doi: 10.1080/08037051.2019.1657769. Online ahead of print.

Authors

Affiliations

¹ Department of Hypertension and Diabetology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland.
² First Department of Cardiology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland.
³ Department of Pathophysiology, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland.
⁴ Department of Nephrology and Hypertension, Clinical Research Centre, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.

PMID: 32228237
DOI: 10.1080/08037051.2019.1657769

Abstract

Purpose: In the course of hypertension, left ventricular hypertrophy and diastolic dysfunction develop very often and may progress toward heart failure. The aim of the study was to analyze the relationship between abnormalities of retinal microcirculation and cardiac damage defined as left ventricular hypertrophy and/or diastolic dysfunction.Materials and methods: The study comprised 88 patients with essential hypertension. The group was divided into two subgroups: hypertensives without cardiac damage (n = 55) and with cardiac damage (n = 33). Control group comprised 32 normotensive subjects. Scanning laser Doppler flowmetry was used to evaluate retinal microcirculation. Echocardiography was used to assess cardiac damage.Results: Lumen diameter of retinal arterioles was significantly smaller in patients with cardiac damage vs. controls (77 vs. 84 µm, p = 0.02). Additionally, there was an evident trend with respect to lumen diameter (LD) across all three studied subgroups; i.e.: the smallest dimeters were present in cardiac damage patients, moderate size in hypertensives' without cardiac damage, and the largest diameters in healthy controls (p_{for trend} < 0.01). Lumen diameter was inversely correlated with cardiac intraventricular septum diameter (R = -0.25, p = 0.02), left ventricular mass (R = -0.24, p = 0.02), and left atrial volume (R = -0.22, p = 0.04). Wall to lumen ratio was associated with intraventricular septum diameter (R = 0.21, p = 0.044) and left atrial volume (R = 0.21, p = 0.045). In multivariable regression analysis, lumen diameter was independently associated with intraventricular septum diameter (β = -0.05, p = 0.03), left ventricular mass (β = -1.15, p = 0.04), and left atrial volume (β = -0.42, p = 0.047); wall to lumen ratio was independently associated with intraventricular septum diameter (β = 3.67, p = 0.02) and left atrial volume (β = 30.0, p = 0.04).Conclusions: In conclusion, retinal arterioles lumen diameter and wall to lumen ratio were independent biomarkers of cardiac damage. Retinal examination performed by means of scanning laser Doppler flowmetry might be a valuable tool to improve cardiovascular risk stratification of hypertensive patients.

Keywords: Microcirculation; cardiac damage; diastolic dysfunction; left ventricular hypertrophy.