Elsevier

JACC: Heart Failure

Volume 10, Issue 11, November 2022, Pages 785-791
JACC: Heart Failure

Review Topic of the Month
Retinal Microvasculature: A Potential Window Into Heart Failure Prevention

https://doi.org/10.1016/j.jchf.2022.07.004Get rights and content
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Highlights

  • Microvascular disease plays an important role in the pathogenesis of HF.

  • Retinal imaging provides a unique, noninvasive assessment of microcirculation.

  • Current evidence supports the use of retinal imaging in predicting risk of incident development of HF, and ongoing clinical trials have leveraged retinal measurements as surrogate endpoints.

  • Deep learning–integrated image analysis of retina vascular features may expand on potential bedside applications.

Abstract

Endothelial dysfunction and microvascular disease have been shown to play an important role in the development and progression of heart failure (HF). Retinal imaging provides a unique opportunity to noninvasively assess vascular structure and function, vessel features, and microcirculation within the retina. Accumulating evidence suggests that retinal vessel caliber, microvascular features, and vascular characteristics extracted from various imaging modalities are associated with alterations in left ventricular structure and function in stage B HF, as well as incident development of symptomatic HF in the general population. Moreover, dynamic retinal vessel analysis has been shown to differentiate HF patients based on their phenotypes. Given the increasing availability of rapid image acquisition devices (eg, nonmydriatic widefield systems and smartphone-based retinal cameras) and the integration of artificial intelligence–based interrogation/assessment techniques, retinal imaging is a promising noninvasive tool, in conjunction with cardiac imaging and biomarkers, to prevent HF and risk stratify those at risk of developing HF. This review focuses on the current evidence on retinal microvasculature changes, and potential clinical relevance and promising utility of retinal imaging in HF.

Key Words

endothelial dysfunction
heart failure
microcirculation
retinal imaging

Abbreviations and Acronyms

CAD
coronary artery disease
CRAE
central retinal arteriolar equivalents
CRVE
central retinal venular equivalents
CVD
cardiovascular diseases
DM
diabetes mellitus
FIDart
flicker-induced dilatation of retinal arterioles
FIDven
flicker-induced dilatation of retinal venules
HF
heart failure
HFpEF
heart failure with preserved ejection fraction
HFrEF
heart failure with reserved ejection fraction
LV
left ventricular
OCT
optical coherence tomography
RVA
retinal vessel analysis

Cited by (0)

Dr Chaikijurajai is currently affiliated with the Department of Medicine, University of Minnesota Medical Center, Minneapolis, Minnesota, USA.

The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the Author Center.