Retinal arteriolar narrowing and left ventricular remodeling: the multi-ethnic study of atherosclerosis.
OBJECTIVE
This study sought to examine the relationships of retinal vascular signs with left ventricular (LV) mass, volume, and concentric remodeling.


BACKGROUND
Microvascular disease, reflected as retinopathy lesions, has been shown to predict clinical congestive heart failure. Whether these retinal vascular changes are related to early structural alterations and remodeling of the heart in asymptomatic individuals is unknown.


METHODS
A cross-sectional, population-based study of 4,593 participants ages 45 to 85 years, free of clinical cardiovascular disease. Retinal vascular calibers and retinopathy were graded from retinal photographs according to standardized protocols. The LV mass and volume were measured from cardiac magnetic resonance imaging. Extent of LV concentric remodeling was determined by the ratio of LV mass to end-diastolic volume (M/V ratio).


RESULTS
After controlling for age, gender, race, center, past and current systolic blood pressure, body mass index, smoking, antihypertensive medications, diabetes, diabetes duration, glycosylated hemoglobin, lipid profile, and C-reactive protein, narrower retinal arteriolar caliber was associated with concentric (highest quintile of M/V ratio) remodeling (odds ratio [OR] 2.06, 95% confidence interval 1.57 to 2.70). This association was seen in men and women, and was present even in those without diabetes, without hypertension, and without significant coronary calcification. In multivariate analysis, the presence of retinopathy (OR 1.31, 95% confidence interval 1.08 to 1.61) was also associated with concentric remodeling.


CONCLUSIONS
Narrower retinal arteriolar caliber is associated with LV concentric remodeling independent of traditional risk factors and coronary atherosclerotic burden, supporting the hypothesis that microvascular disease may contribute to cardiac remodeling.
Cheung
Ning
N
Centre for Eye Research Australia, University of Melbourne, Victoria, Australia.
Bluemke
David A
DA
Klein
Ronald
R
Sharrett
A Richey
AR
Islam
F M Amirul
FM
Cotch
Mary Frances
MF
Klein
Barbara E K
BE
Criqui
Michael H
MH
Wong
Tien Yin
TY
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000175:diagnosis / Q000208:ethnology; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000208:ethnology* / Q000401:mortality; D003430:Cross-Sectional Studies; D005260:Female; D006333:Heart Failure / Q000208:ethnology / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D016017:Odds Ratio; D011159:Population Surveillance; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D012161:Retinal Artery; D012164:Retinal Diseases / Q000175:diagnosis* / Q000208:ethnology* / Q000401:mortality; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D015996:Survival Rate; D020257:Ventricular Remodeling / Q000502:physiology*