Aortic coarctation and the retinal microvasculature.
BACKGROUND
Aortic coarctation has been associated with generalized vascular disease, yet little is known about retinal vascular patterns and their changes over time.


OBJECTIVE
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 images were acquired by 45° 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.
Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada.
Laurianne
L
Le Gloan
Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada.
Hadi
H
Chakor
Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada.
Lise-Andrée
LA
Mercier
Department of Ophthalmology, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montreal, Canada.
Paul
P
Harasymowycz
Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada.
Annie
A
Dore
Department of Ophthalmology, Montreal Children's Hospital Research Institute, McGill University, Montreal, Canada.
Pierre
P
Lachapelle
Department of Radiology, Montreal Heart Institute, Université de Montréal, Montreal, Canada.
Josephine
J
Pressacco
Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada.
Bernard
B
Thibault
Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada.
François
F
Marcotte
Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada.
Anna
A
Proietti
Montreal Health Innovations Coordinating Center (MHICC), Université de Montréal, Montreal, Canada.
Hugues
H
Leduc
Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada.
Blandine
B
Mondésert
Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada.
François-Pierre
FP
Mongeon
Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada; Montreal Health Innovations Coordinating Center (MHICC), Université de Montréal, Montreal, Canada.
Jean-Claude
JC
Tardif
Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada; Montreal Health Innovations Coordinating Center (MHICC), Université de Montréal, Montreal, Canada. Electronic address: paul.khairy@umontreal.ca.
Paul
P
Khairy
D000328:Adult; D001017:Aortic Coarctation / Q000150:complications*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D055806:Microvessels; D008875:Middle Aged; D011446:Prospective Studies; D012164:Retinal Diseases / Q000209:etiology*; D012171:Retinal Vessels
Aortic coarctation; Cardiovascular risk factors; Hypertension; Retinal vessels