视网膜微血管重塑与持续流左心室辅助装置支持患者的不良事件有关。

IF 6.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Sambavan Jeyakumar, Helen Nguyen, Desiree Robson, Nick Olsen, Bruno Schnegg, Peter Macdonald, Clare L Fraser, Gerald Liew, Jacky Jiang, Christopher Hayward, Kavitha Muthiah
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引用次数: 0

摘要

背景:使用连续流左心室辅助装置(cfLVAD)可有效支持终末期心力衰竭(ESHF)患者。cfLVAD 支持的患者全身循环中的血流搏动性降低可能会导致微循环发生变化。目前尚未研究过微血管的时间变化与 cfLVAD 支持患者不良事件的关系。我们旨在分析视网膜微血管的变化及其与不良事件的关系:方法:使用拓普康 TRC-NW8 非眼底照相机对支持 cfLVAD 的患者和 ESHF 对照组患者进行视网膜摄影。使用经过验证的半自动程序评估视网膜测量结果,包括动静脉口径、分形维度、分支角和血管迂曲度。记录了人口统计学和不良事件数据:共记录了 48 名患者(n=29 cfLVAD,n=19 ESHF,平均年龄(54.2 ± 11.9))的 172 张图像。在线性混合模型回归中,视网膜动静脉口径(B = -0.53 µm,95% CI:-0.96 -0.10,p = 0.016)和视网膜分形维度参数(B = 0.014,95% CI:0.001 - 0.002,p = 0.016)呈显着趋势。在 cfLVAD 患者中,胃肠道出血的发生率与视网膜动脉-静脉口径比值的逐步增加之间存在显著关联(HR:3.03,95% CI:2.06 - 4.45,p = 0.005),动脉-静脉口径比值是衡量动脉狭窄程度的指标:我们首次观察到,cfLVAD 支持的患者视网膜微血管的改变可能与消化道出血有关。虽然了解这些时间变化可以预测 cfLVAD 支持患者未来的不良事件,但还需要进一步的多中心研究来证实所观察到的关联。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Retinal microvascular remodeling associates with adverse events in continuous-flow left ventricular assist device-supported patients.

Background: Continuous-flow left ventricular assist device (cfLVAD) use is effective in supporting patients with end-stage heart failure (ESHF). Reduced flow pulsatility within the systemic circulation in cfLVAD-supported patients may lead to alterations within the microcirculation. Temporal changes in microvasculature in relation to adverse events in cfLVAD-supported patients have not been studied. We aimed to profile changes within retinal microvasculature and its association with adverse events.

Methods: Retinal photography was performed using Topcon TRC-NW8 nonmydriatic fundus camera in cfLVAD-supported patients and ESHF control patients. Specific retinal measurements were evaluated using a validated semiautomated program. Demographic and adverse event data were documented.

Results: Forty-eight patients were studied (n = 29 cfLVAD, n = 19 ESHF). There were significant trends in retinal arteriolar caliber (B = -0.53 µm, 95% confidence interval [CI]: -0.96 to -0.10, p = 0.016) and retinal fractal dimension parameters (B = 0.014, 95% CI: 0.001-0.002, p = 0.016) in linear mixed model regressions. Among cfLVAD patients, there was a significant association between the incidence of gastrointestinal bleeding and stepwise increases in retinal arteriolar-venular caliber ratio (hazard ratio: 3.03, 95% CI: 2.06-4.45, p = 0.005), a measure of arteriolar narrowing.

Conclusions: We have observed for the first time that alterations in retinal microvasculature in cfLVAD-supported patients may be associated with gastrointestinal bleeding. While understanding these temporal changes may predict future adverse events in cfLVAD-supported patients, further multicenter studies are required to confirm the associations observed.

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来源期刊
CiteScore
10.10
自引率
6.70%
发文量
1667
审稿时长
69 days
期刊介绍: The Journal of Heart and Lung Transplantation, the official publication of the International Society for Heart and Lung Transplantation, brings readers essential scholarly and timely information in the field of cardio-pulmonary transplantation, mechanical and biological support of the failing heart, advanced lung disease (including pulmonary vascular disease) and cell replacement therapy. Importantly, the journal also serves as a medium of communication of pre-clinical sciences in all these rapidly expanding areas.
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