Biomarkers of microvascular retinal perfusion in OCTA indicative of coronary heart disease.

Objective: To assess changes in retinal perfusion and microvascular architecture associated with coronary artery stenosis (CAS) due to coronary heart disease (CHD) and establish optical coherence tomography angiography (OCTA) as a noninvasive screening tool for CHD.

Methods: In this cross-sectional exploratory study, 982 eyes of 512 patients that underwent coronary angiography due to suspected CHD were included. All patients underwent OCTA to quantify perfusion density (PD) and fractal dimension (FD) within the superficial and deep vascular plexus in 1 mm, 3 mm, and 6 mm rings placed over the macula and optic nerve head (ONH).

Results: The study investigated the association between maximal stenosis and retinal microvascular parameters in 512 patients. In the superficial retinal plexus, significant negative associations were found between cardiac stenosis and retinal perfusion density (PD) (p = 0.0091) and fractal dimension (FD) (p = 0.0014) in the inner ring. Similar associations were observed in the deep plexus (PD: p = 0.047; FD: p = 0.013). In the outer ring, mean PD and FD were lower in the left compared to the right eye (PD, superficial: p < 0.0001, deep: p < 0.0001; FD, superficial: p < 0.0001, deep: p = 0.0012). However, no significant associations were found in the optic nerve head. Overall, the study suggests that retinal microvascular parameters may serve as indicators of stenosis presence, especially in specific retinal regions and layers, providing insights into potential noninvasive methods for cardiovascular risk assessment.

Conclusions: Retinal microvasculature parameters, such as PD and FD, may serve as indicators of CAS. Retinal imaging with OCTA might offer a noninvasive screening modality for cardiovascular risk assessment.