Vol 24, No 2 (2020)
REVIEW
Published online: 2020-05-29
The eye — a window to cardiovascular diseases
Arterial Hypertension 2020;24(2):56-60.
Abstract
Microvascular alterations can parallel and even precede development of cardiovascular disease. Ocular bulb, due to transparent anatomical elements provides a unique opportunity to examine microcirculation non-invasively and in vivo by means of scanning laser Doppler flowmetry. This device enables to obtain both structural and functional parameters of retinal microvasculature. Alterations observed in retinal arterioles, i.e. lumen narrowing, increased wall-to-lumen ratio, rarefaction or reduced retinal capillary flow, have been independently associated with cardiometabolic diseases: hypertension, heart failure, coronary artery disease, stroke, chronic kidney disease and diabetes.
Therefore, examination of easily accessible retinal microcirculation may provide novel insights into the mechanisms underlying various diseases, serve as a marker of target organ damage and add valuable information to cardiovascular
risk stratification.
Keywords: microcirculationretinal arteriolesremodeling
References
- Mc Namara K, Alzubaidi H, Jackson JK. Cardiovascular disease as a leading cause of death: how are pharmacists getting involved? Integr Pharm Res Pract. 2019; 8: 1–11.
- Dzau VJ. Markers of malign across the cardiovascular continuum: interpretation and application. Circulation. 2004; 109(25 Suppl 1): IV1–IV2.
- Struijker Boudier H. From Macrocirculation to Microcirculation: Benefits of Preterax. Am J Hypertens. 2007; 20(7): S15–S18.
- Lee ML, Rosner BA, Weiss ST. Relationship of blood pressure to cardiovascular death: the effects of pulse pressure in the elderly. Ann Epidemiol. 1999; 9(2): 101–107.
- Nilsson PM, Olsen MH, Laurent S. Early Vascular Aging (EVA): New Directions in Cardiovascular Protection. Academic Press 2015.
- Mulvany MJ, Baumbach GL, Aalkjaer C, et al. Vascular remodeling. Hypertension. 1996; 28: 505–506.
- O'Rourke M. Arterial stiffness, systolic blood pressure, and logical treatment of arterial hypertension. Hypertension. 1990; 15(4): 339–347.
- Briet M, Boutouyrie P, Laurent S, et al. Arterial stiffness and pulse pressure in CKD and ESRD. Kidney Int. 2012; 82(4): 388–400.
- Mitchell GF. Effects of central arterial aging on the structure and function of the peripheral vasculature: implications for end-organ damage. J Appl Physiol (1985). 2008; 105(5): 1652–1660.
- Laurent S, Boutouyrie P. The structural factor of hypertension: large and small artery alterations. Circ Res. 2015; 116(6): 1007–1021.
- Chatterjee K. Neurohormonal activation in congestive heart failure and the role of vasopressin. Am J Cardiol. 2005; 95(9A): 8B–813B.
- Harvey A, Montezano AC, Touyz RM. Vascular biology of ageing-Implications in hypertension. J Mol Cell Cardiol. 2015; 83: 112–121.
- Dąbrowska E, Harazny J, Miszkowska-Nagórna E, et al. Lumen narrowing and increased wall to lumen ratio of retinal microcirculation are valuable biomarkers of hypertension-mediated cardiac damage. Blood Press. 2019; 29(2): 70–79.
- Harazny JM, Ritt M, Baleanu D, et al. Increased wall:lumen ratio of retinal arterioles in male patients with a history of a cerebrovascular event. Hypertension. 2007; 50(4): 623–629.
- Wong TY, Rosamond W, Chang PP, et al. Retinopathy and risk of congestive heart failure. JAMA. 2005; 293(1): 63–69.
- Guyton AC, Hall JE. Textbook of medical physiology. Elsevier Inc, Philadelphia 2006.
- Harazny JM, Raff U, Welzenbach J, et al. New software analyses increase the reliability of measurements of retinal arterioles morphology by scanning laser Doppler flowmetry in humans. J Hypertens. 2011; 29(4): 777–782.
- Michelson G, Schmauss B, Langhans MJ, et al. Principle, validity, and reliability of scanning laser Doppler flowmetry. J Glaucoma. 1996; 5(2): 99–105.
- Smith W, Wang JJ, Wong TY, et al. Retinal arteriolar narrowing is associated with 5-year incident severe hypertension: the Blue Mountains Eye Study. Hypertension. 2004; 44(4): 442–447.
- Gallo A, Mattina A, Rosenbaum D, et al. Retinal arteriolar remodeling evaluated with adaptive optics camera: Relationship with blood pressure levels. Ann Cardiol Angeiol (Paris). 2016; 65(3): 203–207.
- Ritt M, Harazny JM, Ott C, et al. Impaired increase of retinal capillary blood flow to flicker light exposure in arterial hypertension. Hypertension. 2012; 60(3): 871–876.
- Dąbrowska E, Harazny JM, Miszkowska-Nagórna E, et al. Aortic stiffness is not only associated with structural but also functional parameters of retinal microcirculation. Microvasc Res. 2020; 129: 103974.
- Wang Lu, Wong TY, Sharrett AR, et al. Relationship between retinal arteriolar narrowing and myocardial perfusion: multi-ethnic study of atherosclerosis. Hypertension. 2008; 51(1): 119–126.
- Lindley RI, Wang JJ, Wong MC, et al. Multi-Centre Retina and Stroke Study (MCRS) Collaborative Group. Retinal microvasculature in acute lacunar stroke: a cross-sectional study. Lancet Neurol. 2009; 8(7): 628–634.
- Bosch A, Scheppach JB, Harazny JM, et al. Retinal capillary and arteriolar changes in patients with chronic kidney disease. Microvasc Res. 2018; 118: 121–127.
- Ritt M, Harazny JM, Ott C, et al. Wall-to-lumen ratio of retinal arterioles is related with urinary albumin excretion and altered vascular reactivity to infusion of the nitric oxide synthase inhibitor N-monomethyl-L-arginine. J Hypertens. 2009; 27(11): 2201–2208.
- Sabanayagam C, Shankar A, Koh D, et al. Retinal microvascular caliber and chronic kidney disease in an Asian population. Am J Epidemiol. 2009; 169(5): 625–632.
- Nguyen TT, Wang JJ, Islam FM, et al. Retinal arteriolar narrowing predicts incidence of diabetes: the Australian Diabetes, Obesity and Lifestyle (AusDiab) Study. Diabetes. 2008; 57(3): 536–539.
- Jumar A, Ott C, Kistner I, et al. Early Signs of End-Organ Damage in Retinal Arterioles in Patients with Type 2 Diabetes Compared to Hypertensive Patients. Microcirculation. 2016; 23(6): 447–455.