Assessment of indices of conjunctival microvascular function in patients with and without obstructive coronary artery disease

Jonathan Mailey, Julie Moore, Paul Brennan, Min Jing, Agnes Awuah, Emanuele Trucco, James McLaughlin, M. Andrew Nesbit, Tara C. B. Moore, Mark S. Spence

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Abstract

Background: Atherosclerotic heart disease often remains asymptomatic until presentation with a major adverse cardiovascular event. Primary preventive therapies improve outcomes, but conventional screening often misattributes risk. Vascular imaging can be utilised to detect atherosclerosis, but often involves ionising radiation. The conjunctiva is a readily accessible vascular network allowing non-invasive hemodynamic evaluation. Aim: To compare conjunctival microcirculatory function in patients with and without obstructive coronary artery disease. Methods: We compared the conjunctival microcirculation of myocardial infarction patients (MI-cohort) to controls with no obstructive coronary artery disease (NO-CAD cohort). Conjunctival imaging was performed using a smartphone and slit-lamp biomicroscope combination. Microvascular indices of axial (V a) and cross-sectional (V cs) velocity; blood flow rate (Q); and wall shear rate (WSR) were compared in all conjunctival vessels between 5 and 45 μm in diameter. Results: A total of 127 patients were recruited (66 MI vs 61 NO-CAD) and 3602 conjunctival vessels analysed (2414 MI vs 1188 NO-CAD). Mean V a, V cs and Q were significantly lower in the MI vs NO-CAD cohort (V a 0.50 ± 0.17 mm/s vs 0.55 ± 0.15 mm/s, p < 0.001; V cs 0.35 ± 0.12 mm/s vs 0.38 ± 0.10 mm/s, p < 0.001; Q 154 ± 116 pl/s vs 198 ± 130 pl/s, p < 0.001). To correct for differences in mean vessel diameter, WSR was compared in 10–36 μm vessels (3268/3602 vessels) and was lower in the MI-cohort (134 ± 64 s −1 vs 140 ± 63 s −1, p = 0.002). Conclusions: Conjunctival microcirculatory alterations can be observed in patients with obstructive coronary artery disease. The conjunctival microvasculature merits further evaluation in cardiovascular risk screening.

Original languageEnglish
Pages (from-to)26-33
Number of pages8
JournalCardiovascular Revascularization Medicine
Volume50
Early online date13 Jan 2023
DOIs
Publication statusPublished online - 13 Jan 2023

Bibliographical note

Funding Information:
This project was funded by the Heart Trust Fund, Royal Victoria Hospital, Belfast; the Regional Medical Cardiology Centre (RMCC), Royal Victoria Hospital, Belfast; Northern Ireland Chest Heart and Stroke (NICHS) and the Ulster University all of which are located in Northern Ireland, United Kingdom. The work, in part, for image processing and microcirculatory parameters estimation was funded by Interreg SEUPB funding associated with Eastern Corridor for Medical Engineering (ECME).The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Jonathan Mailey reports financial support was provided by Belfast Health and Social Care Trust.

Funding Information:
This project was funded by the Heart Trust Fund, Royal Victoria Hospital , Belfast; the Regional Medical Cardiology Centre (RMCC), Royal Victoria Hospital , Belfast; Northern Ireland Chest Heart and Stroke (NICHS) and the Ulster University all of which are located in Northern Ireland, United Kingdom. The work, in part, for image processing and microcirculatory parameters estimation was funded by Interreg SEUPB funding associated with Eastern Corridor for Medical Engineering (ECME).

Publisher Copyright:
© 2023 Elsevier Inc.

Keywords

  • Prevention
  • Conjunctiva
  • Microvascular dysfunction
  • Cardiovascular screening
  • Coronary artery disease
  • cardiovascular disease
  • Cardiovascular disease

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