Patients with Age-related Macular Degeneration Have Increased Susceptibility to Valvular Heart Disease

IF 3.2 Q1 OPHTHALMOLOGY

Ophthalmology science Pub Date : 2024-12-16 DOI:10.1016/j.xops.2024.100677

Natan Lishinsky-Fischer, Itay Chowers MD, PhD, Yahel Shwartz MSc, Jaime Levy MD

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Abstract

Purpose

Valvular heart disease (VHD) contributes significantly to cardiovascular-related morbidity worldwide. Aortic valve stenosis is the third most common cardiovascular disease in the Western world, after hypertension and coronary artery disease. Recent studies have reported an association between VHD and the presence of subretinal drusenoid deposits (SDDs), a distinct manifestation of age-related macular degeneration (AMD). However, these findings were based on self-reported questionnaires and relatively modest cohort sizes. Our goal was therefore to investigate the putative associations between AMD and VHD and between the presence of SDDs and VHD.

Design

Retrospective case-control study.

Subjects

A total of 945 with AMD and 8275 control patients without AMD from a single tertiary center.

Methods

All patients with AMD underwent spectral-domain OCT (SD-OCT). The SD-OCT scans were annotated by 2 experienced graders. Among the patients with AMD, 547 had drusen and SDDs, and 398 had drusen only with no SDDs. We also extracted data from all 9220 patients’ electronic medical records, including demographics and previous heart valve procedures based on International Classification of Diseases, ninth revision codes.

Main Outcome Measures

Heart valve-related diagnoses and procedures performed in both patient groups.

Results

Patients with AMD had a higher prevalence of various VHDs compared with the control group, including increased rates of aortic stenosis (odds ratio [OR], 2.00; 95% confidence interval (CI), 1.40–2.86; P < 0.001), aortic regurgitation (OR, 2.41; 95% CI, 1.49–3.91; P < 0.001), and mitral valve regurgitation (OR, 1.51; 95% CI, 1.13–2.01; P = 0.004). Heart valve procedures were also more prevalent among AMD patients including aortic valve replacement (OR, 1.70; 95% CI, 1.08–2.66; P = 0.019) and tricuspid valve replacement (OR, 3.99; 95% CI, 1.03–15.46; P = 0.03). Moreover, a supervised machine learning model successfully detected the presence of AMD based solemnly on the patient’s history of VHD. In the AMD cohort, we found no significant difference in VHD prevalence between patients with nonneovascular AMD and patients with neovascular AMD, or between patients with SDDs and patients without SDDs.

Conclusions

Patients with AMD have a higher prevalence of VHD and are more likely to undergo a heart valve-related procedure compared with patients without AMD, with no difference between patients with SDDs and patients without SDDs in the AMD cohort.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

查看原文本刊更多论文

年龄相关性黄斑变性患者对心脏瓣膜病的易感性增加。

目的：瓣膜性心脏病（VHD）是全球心血管相关发病率的重要组成部分。主动脉瓣狭窄是西方世界第三大常见心血管疾病，仅次于高血压和冠状动脉疾病。最近的研究报道了VHD与视网膜下类德鲁桑沉积物（SDDs）的存在之间的联系，这是年龄相关性黄斑变性（AMD）的一种明显表现。然而，这些发现是基于自我报告的问卷和相对适度的队列规模。因此，我们的目标是调查AMD和VHD之间以及sdd和VHD之间的推定关联。设计：回顾性病例对照研究。对象：来自单一三级中心的945例AMD患者和8275例对照无AMD患者。方法：所有AMD患者行光谱域OCT （SD-OCT）检查。SD-OCT扫描由2名经验丰富的评分员进行注释。在AMD患者中，547例患者同时有dren和sdd， 398例患者仅有dren而无sdd。我们还从所有9220名患者的电子医疗记录中提取数据，包括基于国际疾病分类第九次修订代码的人口统计数据和以前的心脏瓣膜手术。主要结局指标：两组患者的心脏瓣膜相关诊断和手术。结果：与对照组相比，AMD患者的各种vhd患病率更高，包括主动脉瓣狭窄的发生率增加(优势比[OR]， 2.00；95%置信区间（CI）， 1.40-2.86；P < 0.001)，二尖瓣返流(OR, 1.51；95% ci, 1.13-2.01；P = 0.004)。心脏瓣膜手术在AMD患者中也更为普遍，包括主动脉瓣置换术(OR, 1.70；95% ci, 1.08-2.66；P = 0.019)和三尖瓣置换术(OR, 3.99；95% ci, 1.03-15.46；P = 0.03)。此外，一个有监督的机器学习模型成功地根据患者的VHD病史检测出AMD的存在。在AMD队列中，我们发现VHD患病率在非新生血管性AMD患者和新生血管性AMD患者之间，以及sdd患者和非sdd患者之间没有显著差异。结论：与没有AMD的患者相比，AMD患者有更高的VHD患病率，更有可能接受心脏瓣膜相关手术，而在AMD队列中，有sdd的患者和没有sdd的患者之间没有差异。财务披露：专有或商业披露可在本文末尾的脚注和披露中找到。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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