Coronary artery and retinal vascularization by optical coherence tomography angiography: are eyes the window to the heart?

Abstract

Purpose: Coronary artery disease (CAD) is the leading cause of death in the United States and its assessment still relies on invasive diagnostic procedures requiring contrast, such as coronary angiography (CAG) or computed tomography angiography (CCTA). The retinal vasculature is the only microvascular site in the human body that can be assessed non-invasively, and it has been described as a promising method for predicting cardiovascular risk since the classification of hypertensive retinopathy in the 19th century. Unfortunately, most classifications still rely on qualitative findings, which exhibit high rates of interobserver and intraobserver variability. With advances in ophthalmology exams, particularly the advent of optical coherence tomography angiography (OCTA), the capability of quantitatively assessing retinal vasculature can enable a more reliable non-invasive exam that could aid in estimating cardiovascular risk and assessing coronary lesions. This review aims to provide an extensive overview of the available evidence establishing the correlation of retinal and choroidal microvascular damage observed in OCTA and parameters such as coronary stenosis grade, number of affected vessels and scores like Gensini and SYNTAX evaluated via CAG or CCTA.

Methods: Review of the literature published until December 2024 on PubMed/MEDLINE, SCOPUS and EMBASE by searching "optical coherence tomography angiography" or "OCTA" AND "Coronary artery disease" or "Coronary heart disease".

Results: Findings from sixteen studies suggest a potential correlation between vascular parameters in OCTA and results from coronary exams. Reductions in vessel density analysis of the retinal plexus, especially the superficial capillary plexus (SCP), could improve patient selection and diagnostic yield for more invasive diagnostic procedures, such as CAG and CCTA.

Conclusion: OCTA is a non-invasive technology that can provide visualization and quantification of retinal microvascular disfunction that may correlate with macrovascular disease, particularly in the coronary circulation. Longitudinal assessment of quantitative OCTA parameters may provide biomarkers for monitoring CAD patients over time.