Aortic coarctation and the retinal microvasculature

作者：Le Gloan Laurianne; Chakor Hadi; Mercier Lise Andree; Harasymowycz Paul; Dore Annie; Lachapelle Pierre; Pressacco Josephine; Thibault Bernard; Marcotte Francois; Proietti Anna; Leduc Hugues; Mondesert Blandine; Mongeon Francois Pierre; Tardif Jean Claude; Khairy Paul^*

来源：International Journal of Cardiology, 2014, 174(1): 25-30.

DOI：10.1016/j.ijcard.2014.03.129

• Aortic coarctation
• Hypertension
• Retinal vessels
• Cardiovascular risk factors

Background: Aortic coarctation has been associated with generalized vascular disease, yet little is known about retinal vascular patterns and their changes over time.
Objectives: The aim of this study is to characterize the nature and extent of retinal vascular disease in adults with aortic coarctation, and explore age-related effects and associations with cardiovascular outcomes.
Methods: A prospective cross-sectional seroepidemiological study was conducted on 60 consecutive adults with repaired aortic coarctation, age 42.4 +/- 14.1 years, 61.7% male. In addition to detailed questionnaires, imaging studies, and laboratory testing, high-quality retinal imageswere acquired by 45 degrees nonmydriatic digital funduscopy.
Results: No patient had evidence of hypertensive retinopathy. A distinctive vascular pattern characterized by bilaterally symmetric tortuosity of retinal arteries and veins was observed. Arterial tortuosity was abnormal in 98.3% of patients and decreased with age (P = 0.0005). In patients >= 45 years, a 1-point increase in the arterial tortuosity score was associated with a 1.5-fold higher risk of cardiovascular complications (i.e., acute coronary syndrome, stroke, cerebral aneurysm, aortic dissection/rupture) [odds ratio 1.50, 95% CI (1.01, 2.24), P = 0.0496]. Abnormal venous tortuosity was present in 75.0% of patients and non- significantly correlated with higher levels of serum inflammatory markers (C-reactive protein, fibrinogen, interleukin-6, and tumor necrosis factor-alpha). A higher venous tortuosity score was likewise associated with an increased risk of cardiovascular complications [odds ratio 1.86, 95% CI (1.03, 3.35), P - 0.0392].
Conclusions: Adults with repaired aortic coarctation exhibit a unique retinal vascular pattern characterized by excessive arterial and venous tortuosity that regresses with age. Greater tortuosity is associated with adverse cardiovascular outcomes in patients >= 45 years.

• 出版日期2014-6-1
• 单位McGill