Abstract
Background
Ageing, hypertension and diabetes have an intricate effect on microvascular structure. In the retina, the respective contribution of remodeling and hypertrophy in such process is still unclear. We aimed at disentangling age, blood pressure and glycaemia effects on retinal microcirculation using the non-invasive adaptive optics ophthalmoscopy (AOO).
Methods
We included 429 subjects, distributed into 4 groups according to normal (nBP) or high blood pressure (hBP) and/or normal (nGly) or high fasting glycaemia (hGly). The nBP/nGly group was stratified in age tertiles to isolate the effect of ageing. AOO was used to measure arteriolar wall thickness (WT, µm), arteriolar (aID, µm) and venular internal diameter (vID, µm) and calculate arteriolar wall-to-lumen ratio (WLR), wall cross-sectional area (WCSA, µm2). One-way ANOVA for parametric variables and Kruskal–Wallis test for non-parametric variables were used for comparison among groups. A multivariate regression analysis including age, gender, BP, hGly and antihypertensive treatment was performed to calculate independent predictors of retinal remodeling.
Results
WT was increased with ageing (tertile1: 22.5 ± 3.2, tertile2: 24.2 ± 3.5, tertile 3: 25.2 ± 3.8, p = 0.001) and BP (hBP: 25.2 ± 4.1 vs nBP: 23.9 ± 3.7, p = 0.003). aID decreased with BP (hBP: 90.2 ± 13.4 vs nBP: 93.6 ± 11.6, p = 0.013) and increased with glycaemia (hGly: 97.7 ± 12.5 vs nGly: 93.6 ± 11.6, p = 0.002). A multivariate analysis showed independent association of hBP with WLR; hGly with WCSA; ageing with WLR and WCSA.
Conclusions
AOO non-invasively identifies retinal structural changes in human confirming that microvascular remodeling is exclusively related to hypertension, whereas vascular growth is related to ageing and hyperglycaemia.
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Availability of data and material (data transparency)
The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.
Code availability (software application or custom code)
Not applicable.
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Acknowledgements
The authors want to thank Dr Alessandro Mattina and Mrs Caroline Kanagasabapathy for their help in the image acquisition; Dr David Rosenbaum for his scientific support; We gratefully acknowledge the expert technical assistance of Mr Nicolas Chateau, Mr Laurent Vabre and Ms Martine Durand.
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AG conceived and designed the research, acquired the data, performed statistical analysis and wrote the first draft of the manuscript. TD performed statistical analysis and contributed to the first draft and critical revision of the manuscript. AGi contributed to data analysis and made critical revision of the manuscript. MP and NK made critical revision of the manuscript for key intellectual content. XG conceived and designed the research, acquired the data, handled funding and supervision and made critical revision of the manuscript for key intellectual content. All authors read and approved the final manuscript.
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AG declares having received honoraria from Akcea, AMGEN, Mylan, Novartis, Sanofi and Regeneron, Unilever (none of them related to this work); XG declares having received honoraria from Sanofi, Novartis and Recordati. The remaining authors declare that they have no competing interests.
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Approval of the Ethics Committee of the Saint-Antoine hospital (Paris, France) was obtained. This research was supported by the French Institute of Health and Medical Research (Institut National de la Santé et de la Recherche Médicale, INSERM; No. C10-03 No. IDRCB 2010-A00492-37).
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All study participants consented to participating in this study, and having their results published as part of this study.
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Gallo, A., Dietenbeck, T., Giron, A. et al. Non-invasive evaluation of retinal vascular remodeling and hypertrophy in humans: intricate effect of ageing, blood pressure and glycaemia. Clin Res Cardiol 110, 959–970 (2021). https://doi.org/10.1007/s00392-020-01680-3
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DOI: https://doi.org/10.1007/s00392-020-01680-3