Abstract and Introduction
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.
Introduction
Endothelial dysfunction and impaired systemic microcirculation play a significant role in the pathogenesis of heart failure (HF);[1,2] assessment of subclinical alterations in microvascular structure and function combined with the use of cardiac imaging and biomarkers may potentially improve HF risk stratification and prevention.
Retinal diseases have long been associated with hypertension and diabetes mellitus (DM). Retinal imaging is a unique tool to directly and noninvasively assess and monitor retinal microvasculature, which may provide a window into systemic microcirculation and reflect certain organs, including the heart.[3] Alterations in structure and function of retinal vessels, as well as presence of retinopathy, may result from systemic inflammation, endothelial dysfunction, and even associated cardiovascular comorbidities.[3] Accumulating evidence suggests that retinal imaging could be a promising tool to evaluate structural and functional abnormalities in microcirculation associated with left ventricular (LV) remodeling and HF.[4–7] This review summarizes current evidence on retinal microvascular evaluation in HF, as well as potential applications and opportunities of retinal imaging in clinical practice of HF. We focus on retinal imaging with artificial intelligence integration, which has been shown to significantly enhance analysis performance.[8,9]
JACC Heart Fail. 2022;10(11):785-791. © 2022 American College of Cardiology Foundation