https://doi.org/10.1007/s00392-024-02526-y
1Universitätsklinikum des Saarlandes Innere Medizin III - Kardiologie, Angiologie und internistische Intensivmedizin Homburg/Saar, Deutschland; 2Uniklinik Saarland Augenheilkunde Homburg, Deutschland; 3Universitätsspital Basel Abt. für Kardiologie Basel, Schweiz; 4Universitätsmedizin der Johannes Gutenberg-Universität Mainz Mainz, Deutschland
Aims
To investigate the changes in retinal microvasculature by contemporary imaging techniques during episodes of acute decompensated heart failure (ADHF) and following recompensation compared to age-matched controls without known cardiac or retinal disease.
Methods and results
Adult patients hospitalized with a primary diagnosis of ADHF, regardless of left ventricular ejection fraction (LVEF) and treated with a minimum dose of 40 mg of intravenous furosemide or equivalent were included. Transthoracic echocardiography was conducted in all patients. Eye examinations carried out within the initial 24 hours after admission and after recompensation before discharge. All eyes underwent a general examination, including a best corrected visual acuity test, dilated fundoscopy, spectral-domain optical coherence tomography (SD-OCT) as well as OCT-angiography. In addition, 40 participants without documented cardiac or retinal diseases served as controls. Forty patients with ADHF (mean age 78.9 ± 8.8 years; 32% female) with a mean LVEF of 43 ± 12.8% were included. All patients were treated with i.v diuretics for a median of 4.3± 2.8 days. There was a significant reduction in the NT-proBNP (pg/ml) from baseline up to discharge (10396 (IQR 6410) vs. 6380 (IQR 3933), p=<0.001) and IVC diameters (cm) (2.13± 0.4 vs. 1.63± 0.3, p=0.003). Compared to the control group, patients with ADHF showed on admission impaired visual acuity (0.15±0.1 vs. 0.35±0.1 logMAR, <0.001), reduced macular vessel density (18.0± 1.9 vs. 14.3± 3.6 mm/mm2, p <0.001) and perfusion density (42.6±3.2 vs. 35.2± 9.7 %, p <0.001). After recompensation, the mean overall vessel density and mean overall perfusion density were markedly increased at discharge (14.3± 3.6 vs. 19.7± 2.6 mm/mm2, p 0.001) and (35.2± 9.7 vs. 39.2± 6.5 %, p=0.005) respectively. The mean diameter of the superior temporal retinal vein at admission was significantly larger compared to control group (136±19 vs. 124±22 μm, p=0.008) and decreased significantly to 122±15 μm at discharge (p<0.001).
Conclusion
Subsequent to ADHF a notable alteration in retinal microvasculature was detected. Additional investigations to examine the congestion on the eye, including possible long-term consequences are warranted.